Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CAL
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ORIGINAL ARTICLE
Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial Abby C. King, PhD & Cynthia M. Castro, PhD & Matthew P. Buman, PhD & Eric B. Hekler, PhD & Guido G. Urizar Jr, PhD & David K. Ahn, PhD # The Society of Behavioral Medicine 2013
Abstract Background Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence. Purpose We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes. Methods Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms. Results Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions A. C. King Department of Health Research & Policy and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA C. M. Castro : M. P. Buman : E. B. Hekler : G. G. Urizar Jr, : D. K. Ahn Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA A. C. King (*) Stanford Prevention Research Center, 1070 Arastradero Road Suite 100, Palo Alto, CA 94304-1334, USA e-mail: [email protected] Present Address: M. P. Buman : E. B. Hekler Arizona State University, Phoenix, AZ, USA Present Address: G. G. Urizar California State University, Long Beach, CA, USA
improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms. Conclusions We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation. Keywords Physical activity . Dietary change . Multiple health behaviors . Sequential . Simultaneous . Stress
Introduction Many midlife and older adults fall below nationally recommended guidelines for regular physical activity and healthful eating [1–3]. The most effective ways to improve these two key health behaviors remain unclear, particularly with respect to the timing of multiple changes (i.e., whether to promote sequential behavior changes one after the other or intervene on both behaviors at the same time). Support for sequential change is found in social cognitive theory, which emphasizes the importance of breaking complex behavior patterns into smaller, more realistic steps to enhance initial success and promote mastery and self-efficacy for progressive behavior change [4]. The strengths of this approach include building success with one behavior that may transfer to other behaviors [4], i.e., “gateway” or “spillover” effects [5, 6]. Ho
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