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Moderators of a Diet and Physical Activity Intervention: who Responds Best to Sequential vs. Simultaneous Approaches

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Abstract

Background

Given that low physical activity levels and poor dietary intake are co-occurring risk factors for chronic disease, there is a need for interventions that target both health behaviors, either sequentially or simultaneously. Little is known about participant characteristics that are associated with better or worse response to sequential and simultaneous interventions.

Method

The 12-month Counseling Advice for Lifestyle Management (CALM) randomized trial (N = 150; Mage = 55.3 years) targeted these two behaviors either via a sequential approach — dietary advice first then exercise advice added (“Diet-First”) or exercise advice first then dietary advice added (“Exercise-First”) — or via a simultaneous approach. The objective was to examine demographic, clinical, and psychosocial moderators of intervention effects on 12-month change in (1) moderate-to-vigorous physical activity (MVPA), (2) fruit/vegetable intake, (3) caloric intake from saturated fat, and (4) weight. Hierarchical regressions first compared Diet-First to Exercise-First, followed by comparisons of these arms combined (“sequential”) to the simultaneous arm.

Results

Older age, higher baseline BMI, and lower social support were associated with higher MVPA in Exercise-First vs. Diet-First, while lower tangible support was associated with higher fruit/vegetable intake in Exercise-First but not in Diet-First. Poor sleep was associated with higher levels of MVPA in the sequential arm than in the simultaneous arm. Lower vitality was associated with greater weight loss in the sequential arm than in the simultaneous arm, while the opposite was true for those who were not married.

Conclusion

Identifying moderators of treatment response can allow the behavioral medicine field to enhance intervention efficacy by matching participant subgroups to their best-fitting interventions.

Trial Registration

NCT00131105.

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Data Availability

The data set used in this study is available from the corresponding author (MLP) upon reasonable request.

Abbreviations

BMI:

Body mass index

CALM:

Counseling Advice for Lifestyle Management trial

CHAMPS:

The Community Healthy Activities Model Program for Seniors questionnaire

CI:

Confidence interval

Diet-First:

A sequential intervention with a focus on dietary advice for the first 4 months and then exercise advice added for the remaining 8 months

Exercise-First:

A sequential intervention with a focus on exercise advice for the first 4 months then dietary advice added for the remaining 8 months

ISEL:

The Interpersonal Support Evaluation List

MHBC:

Multiple health behavior change

MVPA:

Moderate-to-vigorous physical activity

PAR:

The Stanford 7-Day Physical Activity Recall

Sequential:

Sequentially delivered interventions

Simultaneous:

An intervention that targeted both exercise and dietary advice concurrently

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Funding

National Institute of Diabetes and Digestive and Kidney Diseases, K23DK129805, Michele Lanpher Patel, National Heart, Lung, and Blood Institute, T32HL007034, Michele Lanpher Patel.

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Authors and Affiliations

  1. Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA

    Michele L. Patel & Abby C. King

  2. Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA

    Patricia Rodriguez Espinosa & Abby C. King

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Correspondence to Michele L. Patel.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The parent trial was approved by the Stanford Institutional Review Board. For this type of secondary data analysis study, formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Patel, M.L., Rodriguez Espinosa, P. & King, A.C. Moderators of a Diet and Physical Activity Intervention: who Responds Best to Sequential vs. Simultaneous Approaches. Int.J. Behav. Med. (2023). https://doi.org/10.1007/s12529-023-10223-9

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