Journal of Behavioral Medicine

, Volume 15, Issue 4, pp 365–377 | Cite as

Adherence to exercise interventions in the treatment of hypercholesterolemia

  • Denis J. Lynch
  • Thomas J. Birk
  • Michael T. Weaver
  • Amira F. Gohara
  • Richard F. Leighton
  • Frank J. Repka
  • M. Eileen Walsh


The goals of this study were to determine the rate of adherence to exercise treatment of hypercholesterolemia and to identify personality and demographic factors associated with adherence. Of the 31 subjects entering the 26-week program, 12 attended 80% or more of the scheduled sessions. Adherence was positively associated with the perceived seriousness of hypercholesterolemia, the expectation of benefit from treatment, and depressed feelings of helplessness and hopelessness. Negative associations were identified between adherence and the perception of health status being under the control of chance or of powerful others. Older subjects were more likely to be adherers at 8 and 16 weeks but not at 26 weeks.

Key words

adherence exercise hypercholesterolemia personality 


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  1. Adreoli, K. (1981). Self concept and health beliefs in compliant and noncompliant hypertensive patients.Nursing Res. 30: 323–328.Google Scholar
  2. Andrew, G. M., Oldridge, N. B., Parker, J. O., Cunningham, D. A., Rechnitzer, P. A., Jones, N. L., Buck, C., Kavanaugh, T., Shepard, R. J., Sutton, J. R., and McDonald, W. (1981) Reasons for dropout from exercise programs in post coronary patients.Med. Sci. Sports Exercise 13: 164–168.Google Scholar
  3. Becker, M., and Maiman, L. (1975). Sociobehavioral determinants of compliance with health and medical care recommendations.Med. Care 13: 10–16.Google Scholar
  4. Becker, M. and Maiman, L. (1980). Strategies for enhancing patient complicance.J. Community Health, 6, 113–135.Google Scholar
  5. Dishman, R. (1982). Compliance/adherence in health related exercise.Health Psychol. 1: 237–267.Google Scholar
  6. Dishman, R., Ickes, W., and Morgan, W. (1980). Self motivation and adherence to habitual physical activity.J. Appl. Soc. Psychol. 10: 115–132.Google Scholar
  7. Dishman, R., Sallis, J., and Orenstein, D. (1985). The determinants of physical activity and exercise.Public Health Rep. 100: 158–172.Google Scholar
  8. Haynes, R., Taylor, D., and Sackett, D. (eds.) (1979).Compliance in Health Care, Johns Hopkins University Press, Baltimore.Google Scholar
  9. Jenkins, D., Zyzanski, S., and Rosenman, R. H. (1979).The Jenkins Activity Survey for Health Prediction, Psychological Corp., New York.Google Scholar
  10. Jöreskog, K., and Sörbom, D., (1988).Prelis. A Program for Multivariate Data Screening and Data Summarization, Scientific Software, Inc., Mooresville, IN.Google Scholar
  11. Kaplan, R., and Simon, H. (1990). Compliance in medical care: Reconsideration of self predictions.Ann. Behav. Med. 12: 66–71.Google Scholar
  12. Keleman, M., Effron, M., Valenti, S., and Steward, K. (1990). Exercise training combined with antihypertensive drug therapy.JAMA 263: 2766–2771.Google Scholar
  13. Leighton, R., Repka, F., Birk, T., Lynch, D., Bingle, J., Gohara, A., Saffron, J., Weaver, M., Brewster, P., and Walsh, E. (1990). The Toledo Exercise and Diet Study.Arch. Intern. Med. 150: 1016–1020.Google Scholar
  14. Leventhal, H., Prohaska, T. J., and Hirschman, R. (1985). Preventive health behavior across the life span. In Rosen, J. C., and Solomon, L. J. (eds.),Preventing Health Risk Behaviors and Promoting Coping with Illness, Vol. 8, Vermont Conference on the Primary Prevention of Psychopathology, University Press of New England, Hanover, NH.Google Scholar
  15. Lipid Research Clinics Program (1984a). The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease.JAMA 261: 351–364.Google Scholar
  16. Lipid Research Clinics Program (1984b). The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering.JAMA 251: 365–374.Google Scholar
  17. Lynch, D., Birk, T., Leighton, T., Repka, F., Walsh, E., Weaver, M., and Gohara, A. (1988). Cholesterol reduction interventions: Adherence factors. Proceedings of the First National Cholesterol Conference, Arlington, VA.Google Scholar
  18. Mann, G., Garrett, H., Farhi, A., Murray, H., and Billings, G. (1969). Exercise to prevent coronary heart disease: An experimental study of the effects of training on risk factors for coronary heart disease in men.Am. J. Med. 46: 12–27.Google Scholar
  19. Millon, T., Green, C., and Meagher, R. (1982).Millon Behavioral Health Inventory Manual, Interpretive Scoring Systems, Minneapolis, MN.Google Scholar
  20. Morgan, W. (1982). Psychological benefits of physical activity. In Nagle, F., and Montoye, H. (eds.),Exercise, Health and Disease, C. C Thomas, Springfield, IL.Google Scholar
  21. National Center for Health Statistics (1986). Total serum cholesterol levels of adults 20 to 74 years of age: United States, 1976–1980. Vital and Health Statistics, Ser. II, No. 236, Department of Health and Human Services (PHS) 86-1686, U.S. Government Printing Office, Washington, DC.Google Scholar
  22. NIH Consensus Conference (1985). Lowering blood cholesterol to prevent heart disease.JAMA 253: 2080–2086.Google Scholar
  23. Oldridge, N., and Streiner, D. (1990). The health belief model: Predicting compliance and dropout in cardiac rehabilitation.Med. Sci Sports Exercise 22: 678–683.Google Scholar
  24. Report of the National Cholesterol education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (1988).Arch. Intern. Med. 148: 36–69.Google Scholar
  25. Sackett, D., and Snow, J. (1979). The magnitude of compliance and noncompliance. In Haynes, R., Taylor, D., and Sackett, D. (eds.),Compliance in Health Care, Johns Hopkins University Press, Baltimore, MD, pp. 11–22.Google Scholar
  26. Sackett, D., Haynes, B., Gibson, E., and Johnson, A. (1976). The problem of compliance with antihypertensive therapy.Pract. Cardiol. 2: 35–39.Google Scholar
  27. Sallis, J., and Hovel, M. (1985). Determinants of exercise behavior.Exercise Sport Sci. Rev. 13: 137–167.Google Scholar
  28. Sarason, I., Levine, H., Basham R., and Sarason, B. (1988). Assessing social support: The social support questionnaire.J. Personal. Soc. Psychol. 44: 127–139.Google Scholar
  29. Schulman, K., Kinosian, B., Jacobson, T., Glick, N., William, M., Koffer, H., and Eisenberg, J. (1990). Reducing high blood cholesterol level with drugs.JAMA 264: 3025–3033.Google Scholar
  30. Sleight, P. (1991). Cardiovascular risk factors and the effects of intervention.Am. Heart J. 121: 990–995.Google Scholar
  31. Sonstroem, R. (1988). Psychological Models. In Dishman, R. (ed.),Exercise Adherence: Its Impact on Public Health, Human Kinetic Books, Champaign, IL, pp. 125–153.Google Scholar
  32. Stein, R., Michielli, D., Glantz, M., Sardy, H., Cohen, A., Goldbery, N., and Brown, C. (1990). Effect of different exercise training intensities on lipoprotein cholesterol fractions in healthy middle aged men.Am. Heart J. 119: 277–282.Google Scholar
  33. Strickland, B., (1978). Internal-external expectancies and health related behaviors.J. Consult. Clin. Psychol. 46: 1192–1211.Google Scholar
  34. Taylor, C., Sollis, J., and Needle, R. (1985). The relation of physical activity and exercise to mental health.Public Health Rep. 100: 195–202.Google Scholar
  35. Wallston, B., and Wallston, K. (1984). Social psychology models of health behavior: An examination and integration. In Baum, A., Taylor, S., and Singer, I. (eds.),Handbook of Psychology and Health, Vol. 4, Erlbaum, Hillsdale, NJ.Google Scholar
  36. Wallston, B., Wallston, K., Kaplan, G., and Maides, S. (1976). Development and validation of the health locus of control (HLC) scale.J. Consult. Clin. Psychol. 44: 580–585.Google Scholar
  37. Wallston, K., Wallston, B., and DeVellis, R. (1978). Development of the Multidimensional Health Locus of Control Scale.Health Educ. Monogr. 6: 161–170.Google Scholar
  38. Ward, A., and Morgan, W. (1984). Adherence patterns of healthy men and women enrolled in an adult exercise program.J. Cardiac Rehab. 4: 143–152.Google Scholar
  39. Williams, P., Krauss, R., Vranizan, K., and Wood, P. (1990). Changes in liproprotein subfractions during diet-induced and exercise-induced weight loss in moderately overweight men.Circulation 81: 1293–1304.Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Denis J. Lynch
    • 1
  • Thomas J. Birk
    • 2
  • Michael T. Weaver
    • 3
  • Amira F. Gohara
    • 4
  • Richard F. Leighton
    • 5
  • Frank J. Repka
    • 1
  • M. Eileen Walsh
    • 6
  1. 1.Department of Family MedicineMedical College of OhioToledo
  2. 2.Department of Rehabilitation MedicineMedical College of OhioToledo
  3. 3.Department of Obstetrics and GynecologyMedical College of OhioToledo
  4. 4.Department of PathologyMedical College of OhioToledo
  5. 5.Department of MedicineMedical College of OhioToledo
  6. 6.School of NursingMedical College of OhioToledo

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