Abstract P120: Long-Term Adherence to Heart Healthy Behaviors in Older Adults: A Theory-Based Approach
Despite evidence-based recommendations, long-term adherence to heart-healthy behaviors is generally low in older adults. Many behavioral strategies have induced short term improvements in physical activity, diet adherence, and medication use, but sustained change in health behaviors beyond six months remains a challenge. No single approach seems to result in durable, long-term lifestyle change. We hypothesized that a Social-Ecological Model incorporating Social Cognitive Theory, combined with Diffusion of Innovation would increase long term heart-healthy behaviors in community-dwelling older adults. We conducted a single group study using repeated measures at baseline, 3, 6, 12 and 24 months to evaluate adherence to exercise, diet, and prescribed medications. We evaluated the effects of a two phase theory-based behavioral intervention on overall physical activity, physical performance, fat and sodium intake, prescribed medication use, blood pressure, self-efficacy (exercise, diet, medications), resilience, depression, and pain. Twenty-nine low income seniors with cardiovascular risk factors completed the intervention, which consisted of a 12-week education and initiation phase led by a nurse and lay exercise trainer in the participants’ congregate residence. The second phase focused on motivation and dissemination. Ongoing health behaviors were facilitated by 1) group intervention with social support, 2) extended intervention exposure over 24 months, with twice-weekly exercise classes continued with the lay trainer and within-community champions, 3) eminders and cues, and 4) monthly inoculation visits by healthcare providers to reinforce motivation and target behaviors. Across the study, 50% of the participants consistently attended the classes and engaged in exercise activities. The percentage of individuals participating in at least 10 minutes of exercise per week increased. Although below recommended guidelines, the trend toward greater exercise participation is encouraging given the challenges to adherence noted in this population. In addition we found that outcome expectations for exercise increased significantly (p = 0.05). Dietary intake showed significant decreases in fat consumption (p = 0.001), and medication adherence was consistently strong. Results of the study demonstrate the feasibility of using this model to successfully engage participants within their own environment over 24 months, and to use lay trainers and community champions to sustain the exercise and education intervention with periodic inoculations by healthcare providers. While individual improvements were modest, they nonetheless provide support for the efficacy of theory-based interventions to facilitate long-term adherence to heart-healthy behaviors, and may guide future work to develop and test robust efficacy-enhancing interventions.
Author Disclosures: K.M. Michael: None. M. Hammersla: None. J. Klinedinst: None. B. Resnick: None.
- © 2015 by American Heart Association, Inc.