This study will compare three methods of counseling to determine which is most effective at
motivating participants to adopt healthy lifestyle habits. The three methods are: individual
counseling, working in groups with a health educator, and receiving advice from a physician.
The health goals for subjects in this study are: 1) increase physical activity to 30 minutes
each day, 2) reduce fat intake to less than 30% of total calories, 3) increase consumption
of fruits and vegetables to at least 5 servings each day, and 4) reduce percentage of body
fat to a healthy level.
The benefits of physical activity and proper nutrition have been well established to prevent
and reduce the devastating effects of chronic illness including, cardiovascular disease,
diabetes, and obesity. Unfortunately, nearly 80% of individuals fail to get enough exercise
and eat a proper diet to alter these health disorders. In the United States, physicians do
not routinely counsel patients about physical activity and nutrition. Although few studies
have examined promotion of physical activity in the primary care setting, most have been
disappointing. Achieving and maintaining healthy behaviors remain a major challenge to
promoting health and caring for illness. This research proposals aims are to a) evaluate two
health behavior change intervention strategies to improve physical activity and dietary
behaviors among sedentary patients in a primary care office; and b) assess by cost-benefit
analysis, the impact of each model intervention. After initial recruitment from OHSU
Internal Medicine and Family Practice clinics, 105 sedentary patients will be randomly
assigned to Model 1, Model 2, or Model 3. Model #1, a one-on-one, individualized counseling
intervention known as Motivational Interviewing, based on the transtheoretical model of
behavior change, will use twelve health educator counseling meetings and ten bi-weekly
follow-up phone calls the first year and six 60-minute sessions will occur in the second
year of the intervention. Model #2, a team-centered intervention where the health promotion
curriculum is delivered by a group facilitator to a team of patients (based on the social
influence theory) consists of twelve 60-minute peer facilitated group meetings and ten
follow-up phone calls, with six sessions occurring the second year of the full outcome
study. Group facilitators will be trained and use scripted lesson plans. Model #3, a usual
practice control condition (5 minute physician advice using the Physician Advice Counseling
Exercise or PACE format). Models 1 and 2 contact hours are the same. Year 01 is the pilot
study to revise and refine the curriculum and study protocol. The full intervention will
last two years while the behavior change durability will be assessed over another full year.
The study's primary outcomes are increased physical activity as measured by peak oxygen
uptake and survey, dietary changes assessed by intake survey, and body composition changes
as measured by DEXA. Secondary outcome measures include blood pressure lipid and
lipoprotein levels, biochemical markers of inflammation (CRP) and hormonal markers of
obesity. Outcomes will be assessed using repeated measures design. Relationships among
mediators, the intervention, and the outcome measures will be identified.
- Primary care patient patients who are sedentary (less than one exercise bout per week
- 30 - 65 years old
- In stable health, defined as an absence of serious chronic disease (i.e., recent
myocardial infarction or CVA, uncontrolled metabolic conditions like thyrotoxicosis
or poorly controlled diabetes mellitus).
- If the participants are taking medication for medical conditions, they have to be on
a stable dose for at least three months with no medication change in past 3 months.
- Participants must be independent in living and able to obtain weekly transportation
- able to increase their physical activity.
- Non ambulatory
- Contraindications to exercise due to medical conditions using the AHA criteria and
the ACSM Guidelines For Exercise Testing and Prescription. Examples are CAD, CHF,
Recent CVA, poorly controlled DM (fasting glucose over 200 mg/dl), poorly controlled
HTN, Severe COPD, Thyrotoxicosis, and Morbid Obesity with BMI > 40.