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Effectiveness of a low dose behavior change intervention on physical activity maintenance following an exercise trial in pre-type II diabetics




Sanders, Ashley B., author
Leach, Heather, advisor
Nelson, Tracy, advisor
Graham, Daniel, committee member

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Pre-type II diabetes (PT2D) is emerging as one of the fastest growing chronic diseases among adults. Increasing physical activity (PA) levels is often a first line of defense for managing PT2D; however, PA levels in this population are below the national average. PA behavior change (PABC) interventions can be useful in assisting with the adoption and maintenance of regular PA, yet the feasibility and effectiveness of embedding a low dose PABC within an exercise efficacy trial for PT2D has not been examined. The main purpose of this study is to determine the effectiveness of one PABC counseling session on PA maintenance following a 12-week exercise efficacy trial. This study also aims to examine changes in self-efficacy following the PABC counseling session. Finally, this study aims to explore both social support and perceptions of neighborhood walkability as determinants of PA following an exercise trial. Participants were randomized to receive a one-hour PABC counseling session, or not (CON), held after completion of the 12-week exercise trial. The session was based on social-cognitive theory, and the primary goal was to increase post-intervention PA maintenance through discussion of PA benefits, PA goal setting, and identifying and overcoming PA barriers. Self-reported PA was measured using the International PA Questionnaire (IPAQ), pre, post and three-months after the exercise trial. Participants also completed questionnaires assessing self-efficacy, social support and neighborhood walkability. Baseline, post-intervention questionnaires, and the PABC counseling session were done while participants were in the laboratory doing their oral glucose tolerance test, and the follow-up questionnaire was completed by mail or online. Participants (N=21, M Age = 62±5.8), were mostly female (86%), Caucasian (88%), and high socioeconomic status (70.6% completed at least 4 years of college, and 76.5% had an annual household income ≥ $50,000). Paired t-tests detected a significant difference in total PA between post-intervention to follow-up, t(15) = 3.33, p = .005, with total PA decreasing from post to follow-up for the entire sample. No significant within group changes (N=16; PABC N=8, CON N=8) were found between post and follow-up. Repeated measures analysis of variance (ANOVA) did not detect statistical significance between groups in total PA change from post-intervention to three-month follow-up, F(1, 14) = 2.93, p = .109. Barriers self-efficacy significantly improved from before to after the PABC, t(12) = -2.63, p = .022. Social support, neighborhood crime and neighborhood aesthetics were significantly associated with PA measures at three-month follow-up. Incorporating a single session PA behavior change intervention as part of an exercise efficacy trial is feasible. While the PABC counseling session did not result in a lower rate of total PA decline from post to follow-up, those who received the PABC did report higher levels of PA at follow-up. Self-efficacy, social support and perceptions of neighborhood walkability are important determinants of PA maintenance in adults at risk of developing type-II diabetes. Future studies should explore the dose response of PABC counseling sessions in this population to determine the lowest dose needed to enhance PA maintenance following an exercise trial.


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