Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial
- 1.1k Downloads
Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence.
We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes.
Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms.
Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms.
We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.
KeywordsPhysical activity Dietary change Multiple health behaviors Sequential Simultaneous Stress
The research was supported by a Public Health Service Grant R01AG021010 from the National Institute on Aging (King) and a Public Health Service Training Grant 5T32HL007034 from the National Heart, Lung, and Blood Institute. The authors thank Carolyn Prosak, Catharine Cassayre, Julia Wu, Arturo Fernandez, Susannah Belding, and Sarah French for implementing the interventions; Dr. Leslie Pruitt and Stephanie Koltiska for their work with respect to study evaluations; and Dr. Judith Prochaska for comments on the manuscript.
Conflict of Interest
The authors have no conflicts of interest to disclose.
- 1.Physical Activity Guidelines Advisory Committee. Report of the Physical Activity Guidelines Advisory Committee, 2008. Washington, DC: U.S. Dept. of Health & Human Services; 2008.Google Scholar
- 2.U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th ed. Washington, DC: U.S. Govt. Printing Office; 2005.Google Scholar
- 3.U.S. Department of Health & Human Services. Healthy People 2010, Final Review. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion; 2011.Google Scholar
- 25.National Center for Health Statistics. National Health Interview Survey. Washington, DC: National Center for Health Statistics; 2002.Google Scholar
- 27.Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapam S, Oskamp S, eds. The social psychology of health: Claremont Symposium on applied social psychology. Newbury Park: Sage; 1988:31-67.Google Scholar
- 36.Pearson TA, Bazzarre TL, Daniels SR, et al. American Heart Association guide for improving cardiovascular health at the community level: A statement for public health practitioners, healthcare providers, and health policy makers from the American Heart Association Expert Panel on Population and Prevention Science. Circulation. 2003;107:645-651.PubMedCrossRefGoogle Scholar
- 38.Luskin F, Pelletier K. Stress Free for Good: 10 Scientifically Proven Life Skills for Health and Happiness. New York: Harper Collins; 2005.Google Scholar
- 41.Pruitt LA, King AC, Obarzanek E, et al. Reliability of the 7-day physical activity recall in a biracial group of inactive and active adults. J Phys Act Health. 2006;3:423-438.Google Scholar
- 48.Garcia AW, King AC. Predicting long-term adherence to aerobic exercise: A comparison of two models. J Sport Exerc Psychol. 1991;13:394-410.Google Scholar
- 50.Kraemer HC, Thiemann S. How many subjects? Statistical power analysis in research. Newbury Park: Sage; 1987.Google Scholar
- 51.Spector PC, Goodnight JH, Sall JP, Sarle WS. The GLM procedure. SAS user's guide: Statistics. Version 5. Cary: SAS Institute Inc; 1985:433-506.Google Scholar
- 53.SAS Institute Inc. SAS/STAT 9.2 User's Guide. 2nd ed. Cary: SAS Institute; 2009.Google Scholar