Transcript Exercise Adherence in Diabetes: Potential role of

Exercise Adherence in Patients
with Diabetes:
Evaluating the role of psychosocial factors
in managing diabetes
Natalie N.Young,1, 2 Jennifer P. Friedberg,1, 3 Michelle E. Ulmer,1
Hoyune E. Cho,1 Stuart R. Lipitz,4 Sundar Natarajan1,3
New York Harbor Healthcare System
of Hawaii John A. Burns School of Medicine
3NYU School of Medicine
4Brigham and Women’s Hospital/Harvard Medical School
2University
1VA
Presenter Disclosures
Natalie Young
The following personal financial
relationships with commercial
interests relevant to this presentation
existed during the past 12 months:
No relationships to disclose
Background

Patients with diabetes and high blood pressure (BP), or
hypertension, suffer from high rates of cardiovascular
complications
◦ Hypertension in patients with diabetes: Systolic BP >130 mmHg
and/or Diastolic BP > 80mmHg

Regular exercise effective for uncontrolled hypertension in
patients with diabetes

Despite established benefits, adherence to exercise remains
low

Factors that affect exercise in patients with diabetes and
hypertension is unclear
Specific Aims

Identify psychosocial factors related to
exercise duration in patients with diabetes and
hypertension

Assess the relationships of these factors with
adherence to exercise
MethodsData Source

Data collected from 227 participants with diabetes and
uncontrolled BP in a Randomized Control Trial (RCT) to
control HTN

Study Sites: VA New York Harbor Healthcare System- New
York and Brooklyn campuses

Patients assessed multiple times over a year in the RCT

Exercise duration and exercise adherence were examined

Looked at a priori demographic, health, and psychosocial
variables
◦ Data from Baseline Visits
Variables of Interest

Dependent Variables
◦ Exercise Duration
◦ Exercise Adherence

Independent Variables
◦
◦
◦
◦
◦
Age
Exercise Self-Efficacy
Exercise-Related Social Support
Number of Prescribed Blood Pressure Medications
Body Mass Index
Dependent VariablesExercise Outcomes

Exercise Duration
◦ Hours/week
◦ Measured using the 7-day Physical Activity Recall (PAR), a
validated measure

Exercise Adherence
◦ Yes/No
◦ Classified using previous aerobic exercise recommendations by
the Centers for Disease Control and Prevention (CDC) and the
American College of Sports Medicine (ACSM)
 >3 days/ week for at least 20 minutes each day
Independent VariablesDemographic, Health, and Psychosocial Factors

Age

◦ Years



◦ Specific to encouragement or
discouragement from others
related to exercise (i.e. given
rewards for exercising vs.
criticized or made fun of for
exercising)
Obtained from patient records at the
Baseline visits
Exercise Self-Efficacy
◦ Examines how confident one is
to exercise when other
variables interfere (i.e. stress,
lack of time, weather)
◦ Assessed using a validated 6-30
point scale

Exercise-Related Social
Support
◦ Measures the perceived social
support from others
◦ Assessed using a validated 3-15
point scale
Exercise-Related Social
Support (continued)
Number of Prescribed
Blood Pressure
Medications
◦ Proxy for severity of HTN


Obtained from patient records at the
Baseline visits
Body Mass Index (BMI)
◦ Measure of obesity in kg/m2

Calculated at the Baseline visits
Statistical Analysis

Regression models used to evaluate relationship between
the independent variables and exercise outcomes
◦ Dependent Variables: Exercise Duration (hrs/wk) and Exercise
Adherence (yes/no)
◦ Independent Variables: Demographic, Health, and Psychosocial
Factors among Patients

Robust regressions examined independent variables’
relationship to duration of exercise (continuous)
 Robust regression used because data not normally distributed

Logistic regression evaluated predictors of adherence to
exercise (dichotomous)
Sample Characteristics
N= 227
Demographics
Sex
Race
Employment
Status
Marital Status
Education
Status
Frequency (%)
Male
227 (100%)
Black
89 (40.1%)
White
81 (36.5%)
Hispanic
40 (18.0%)
Other
12 (5.4%)
Retired
131 (58.0%)
Unemployed
52 (23.0%)
Employed
43 (19.0%)
Married
85 (37.8%)
Separated or Divorced
78 (34.7%)
Never Married
41 (18.2%)
Widowed
21 (9.3%)
Some College and Beyond
119 (52.9%)
High School Graduate or GED
75 (33.3%)
Some High School or Less
31 (13.8%)
Summary Statistics
N= 227
Variables
Exercise Adherence
Exercise Duration
Scale
% Yes/%No
Median
Range
40.3 Yes/ 59.7 No
Hours/ Week
2.5
1.0-2.5
Age
Years
63.2
57.8-73.1
Exercise Self-efficacy
6-30
20.0
16.0-24.0
Exercise-Related Social Support
3-15
3.0
3.0-4.5
Number of
Prescriptions
3.0
2.0-4.0
kg/m2
30.4
27.5-33.7
BP Medications
BMI
ResultsRobust Regression for Exercise Duration
Coefficient
Independent Variables
Bivariate
Multivariate
-.0089
-.0085
Exercise Self-efficacy
.11*
.11*
Exercise-Related Social Support
.23**
.21**
Number of BP medications
-.21†
-.26**
-.0096
-.0096
Age
BMI
*p<.01; **p<.05
†p<.10
ResultsLogistic Regression for Exercise Adherence
Odds Ratio [95% CI]
Independent Variables
Bivariate
Multivariate
1.00 [.97-1.03]
1.00 [.97-1.03]
1.09 [1.03-1.15]*
1.08 [1.02-1.15]*
Exercise-Related Social
Support
.98 [.84-1.14]
.94 [.79-1.11]
Number of BP medications
.81 [.67-.99] **
.81 [.66-1.00] **
BMI
.97 [.92-1.03]
.99 [.93-1.05]
Age
Exercise Self-efficacy
*p<.01; **p<.05
Conclusions

Lower number of blood pressure medications associated
with increased exercise adherence
◦ Higher number of BP medications could indicate more severe HTN
 affect adherence to exercise
◦ Increased BP medications could increase side effects  decrease
exercise adherence
◦ May promote negative perception of health  negatively influence
adherence to exercise

Age and BMI had less impact on exercise than self-efficacy
and social support
◦ Psychosocial factors may have more significant role than
demographic and physiological factors
Implications

May be beneficial to focus on psychosocial factors when
trying to increase exercise duration and adherence in the
treatment of patients with diabetes and hypertension

Intervention should address psychosocial aspects:
◦ Increase self-efficacy
◦ Emphasize social support
◦ Reduce number of medications

Goal is to achieve better exercise adherence and longer
duration of exercise and improve management of diabetes
Questions?
Thank You!