Behavioral Approach to Fitness

Behavioral fitness programs proved no more effective than informational pamphlets, a new study reports.

Researchers from the University of Cambridge, UK, explained that declining physical activity is associated with a rising burden of global disease. Efforts to reverse this trend have not been successful.

The study assessed the efficacy of a facilitated behavioral intervention to increase the physical activity of sedentary individuals at familial risk of diabetes. Researchers recruited 365 sedentary adults who had a parental history of type 2 diabetes from either diabetes or family history registers at 20 general practice clinics in the UK.

Participants were randomly assigned to one of two intervention groups or to a comparison group. All participants were sent a brief advice leaflet. One intervention group was offered a one-year behavior-change program to be delivered by trained facilitators in participants' homes, and the other the same program by telephone. The program was designed to alter behavioral determinants, as defined by the theory of planned behavior, and to teach behavioral-change strategies.

The principal outcome at one year was daytime physical activity, which was objectively measured as a ratio to resting energy expenditure. Analysis was by intention to treat.

Out of 365 patients, researchers analyzed primary endpoints for 321 (88 percent) for whom they had data after one-year of follow-up. At one year, the physical-activity ratio of participants who received the intervention, by either delivery route, did not differ from the ratio in those who were given a brief advice leaflet. The physical-activity ratio did not differ between participants who were delivered the intervention face-to-face or by telephone.

The study authors concluded that a facilitated theory-based behavioral intervention was no more effective than an advice leaflet for promotion of physical activity in an at-risk group. The authors suggested that healthcare providers remain cautious about commissioning behavioral programs into individual preventive healthcare services.

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Comments

[Runner4life]

I wonder if this has to do with that new story that obesity is linked primarily to genetics? Aka, maybe it doesn't matter what approach you use. Maybe certain people will just not be motivated to exercise because they believe that can't overcome it (because of genetics or studies that suggests that genetics are the culprit). I know it's a precarious situation, but I think we really need to at least, as a country, better educate ourselves about nutrition and exercise. I don't think the government can make it illegal to be severely overweight, but I do think we need to not just accept the bulge. I think we need to be honest with ourselves and especially future generations. There are very SERIOUS consequences to not taking care of our bodies, and we will be a much more peaceful and productive society if we start by taking care of ourselves and striving to be active, energetic and passionate people instead of couch potatoes. We are not going to carry on the legacy of greatest country in the world if we are all too large to leave our living rooms.

[darwin]

One of the greatest barriers people seem to have with exercise (whether overweight or normal-weight) is relevance. Unless there is a clear short-term AND long-term benefit, many people will not make positive changes like eating more healthfully and exercising. Also, it’s important that individuals select forms of exercise that are realistic (and relevant) to them. Promotion of activities like walking, swimming and cycling — all of which can realistically be done throughout the life cycle — has been successful in many public health programs.

[Lily]

I agree with Darwin - people have to find what works best for them and also set up motivators. In the winter especially, I find it difficult to motivate myself to exercise because I can't afford a gym membership, and it's too cold to go running outside. Also, with the shorter days (esp in Boston/New England) and lack of sun, all I want to do when I go home is crawl into bed. Same thing with getting up in the morning - I don't want to wake up when it's dark, and I don't want to get out of bed when it's cold.

Any suggestions for how to stay motivated in the winter when scheduling is tight, it's freezing outside and all I want to do is cover myself in blankets and drink tea?

[Stella]

You would think as a society, we would want to exercise. We are living in such an automated world where everything is done for us, and our lifestyles are so sedentary. On the flip side, we are so consumed with careers and social schedules that we wonder how we can fit it all in. I hear from so many people: "I don't have time," but I think we all would agree that things we want badly, we make time for. And, don't we all want added years to our lives and good health? I think we should all think about that before we make excuses.

[Rick]

I agree with Darwin. Most people need something to motivate them to exercise and eat healthfully. But, this study used patients that were at a high risk of getting type 2 diabetes. Isn’t losing weight, feeling healthy and reducing your chance of getting diabetes enough motivation? Diabetes comes with a lot of health complications, such as cardiovascular disease, retinopathy, neuropathy, and some can even lose their legs if the disease is not properly managed. If the idea of all these health risks isn’t motivating them to better their lives, then what will?

[Jen]

Lily – I know it’s hard to keep the motivation up in the winter, but if you exercise, it will actually help to increase your overall mood. If you can’t afford a gym, maybe it would be easier to invest in some home fitness equipment. I know a friend that bought a treadmill on eBay for a good price, and the seller even delivered it to her house! Even getting some weights, an exercise ball, or pilates or yoga DVDs will allow you to exercise in the comfort of you own home. Also, you can find an indoor pool in your area or try out some winter sports, like skiing or snowboarding. Good luck keeping up the motivation in these cold months!

[mo]

Rick: The statistics on activity levels of Americans say that “losing weight, feeling healthy and reducing your chance of getting diabetes” are not necessarily enough motivation! This is unfortunate but shows just how resistant people can be to doing what is “right” for them. Especially in people with diabetes, being an active partner in care is imperative. People with diabetes, should become so familiar with the research, how to manage their disease, and their own unique characteristics, that they develop a different perspectives on things, such as integrating exercise into their lifestyles. Perhaps looking to successful programs among people with diabetes like the “Do It” program at the Joslin Diabetes Center (http://www.dlife.com/dLife/do/ShowContent/dlife_media/tv/_joslin_do_it_060705.html) will reveal some things that encourage integration of healthy activities for the long run.

[katherine]

There is another program from the American Diabetes Association called ClubPed. All you need is a pedometer to track the number of steps you take in one day and a walking goal. There are even some rewards if you reach your goals. You can find more information on the American Diabetes Association website: www.diabetes.org.

[Sunny]

Great to read your post and your advice to use Behavioral fitness programs.
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