# Presentation: 046586

## The SENIOR Project:Study of Exercise and Nutritionin Older Rhode Islanders

- Health Promotion Partnership
- University of Rhode Island

## Acknowledgements

- The SENIOR Project acknowledges contributions of:
- Funded by Grant No. 1RO1AG16588, National Institute on Aging, National Institutes of Health (Program Staff: S. Stahl, M. Ory)
- URI Health Promotion Partnership Researchers
- Gerontology and Human Development and Family Studies (P. Clark, S. Saunders)
- Psychology (J. Prochaska, J. Rossi, L. Ruggiero, C. Nigg)
- Exercise Science (D. Riebe, C. Garber, K. Stillwell)
- Nutrition and Food Science (G. Greene, N. Fey-Yensan, C. English)
- Nursing (P. Burbank, C. Padula, S. Rossi)
- Pharmacy (N. Owens, R. Dufresne, A. Luisi)
- Research Project Staff (M. Greaney, F. Lees, G. Fonseca, G. Edwards)

## Background and Needs

- Development of large-scale, community-based health promotion programs for older adults to delay onset of chronic disease and improve quality of life.
- Combine community-wide recruitment, public health model with individually tailored interventions.
- Evaluate behavioral change strategies that focus on two important areas: exercise and diet.

## Theoretical Framework

- Transtheoretical Model (TTM) of Health Behavior Change
- Stages of change:
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Decisional balance
- Processes of change
- Self-efficacy

## Two-Behavior Research

- Increased interest in interactions between interventions for two behaviors:
- Overburdening
- Match intervention to stage of readiness for each behavior
- Enhancement
- Gateway behaviors

## Study Design

- 2x2 experimental design with four groups:
- Exercise only
- Fruit & vegetable only
- Exercise and fruit & vegetable
- Control group
- 12-month intervention
- Outcomes assessed at times 0, 12, and 24 months

## Intervention Components

- Stage-based manuals (exercise and diet)
- Stage-based newsletters (monthly)
- Expert system feedback report
- Survey center assessment calls
- Stage-based telephone coaching by trained counselors

## Project Timeline

## Baseline Sample (N = 1276)

- Age Groups:				N		%
- 	65-74				574		45.0
- 	75-84				572		44.8
- 	85+					130		10.2
- Gender:
- 	Male				388		30.4
- 	Female				888		69.6
- Marital Status:
- 	Married				597		46.7
- 	Widowed				476		37.2
- 	Separated/divorced			140		10.9
- 	Never married			57		4.5

## Baseline Sample(cont’d.)

- Education:
- 	Did not graduate from high school		283	22.2
- 	Graduated from high school		490	38.4
- 	Some college, college degree, or more	496	38.9
- Race/Ethnicity:
- 	White					986	77.3
- 	Black				  	27	  2.1
- 	Portuguese/Cape Verdean			178	13.9
- 	Other					  80	  6.2

## Baseline Research Questions(for Two Behaviors)

- Is  there a relationship between stage of change for exercise (pre-action vs. action & maintenance) and the stage of change for F&V consumption (pre-action vs. action & maintenance)?
- Is exercise stage of change related to diet behaviors?
- Is diet stage of change related to exercise behaviors?

## Percent by Stage (N=1276)

## Percent by Stage for Two Behaviors (N=1276) 

## Results

- Neither the interaction between the two stage of change variables (p = 0.571) nor current smoking status (p = 0.073) were significant.
- Removed variables and reran analysis.
- F&V stage associated (p < 0.05) with  the dietary measures, but not with the PA measures.
- Exercise stage associated (p < 0.05) with the PA measures and servings of fruit, but not with servings of vegetables or estimated percent calories of fat.

## Interpretation

- Stage of change for one behavior is  associated with stage of change for the other behavior,  but the effect is small.
- Diet stage is not associated with the physical activity measures.
- Exercise stage is associated with only one dietary measure (servings of fruit).

## 12-Month Data

- Caveat: preliminary analyses only!
- Last intervention occurred after 12-month data collection and previous studies have found change continues for 6 – 12 months following TTM interventions.
- Sample size: N = 1008 (950 available for these analyses).

## Proportion of Sample in A/M Stages at BL and 12 Months for Exercise and Diet

** **

## Results

- No difference at baseline on either behavior.
- For exercise, group receiving Exercise Only intervention had significantly higher proportion in A/M than any of other groups at 12 mos. and only this group showed significant increase over baseline.
- For diet, all groups increased compared with baseline; at 12 mos. the Exercise Only group had significantly fewer in A/M for fruit and vegetable consumption than other groups.

## Interpretation

- Data appear to suggest that:
- Exercise Only intervention increased physical activity but limited the increase in fruit and vegetable consumption
- Combined intervention limited increases in physical activity
- It appears when intervening on two behaviors that participants focused on fruit and vegetables; was this due to unique characteristics of this sample, an artifact of preliminary analyses, or a difference between behaviors?

## Proportion of Baseline Pre-Action Sample in A/M at 12 Months for Exercise and Diet

## Results

- Show effectiveness of intervention on the most “at risk” sample (i.e., pre-action stages).
- Large proportion in A/M at baseline for both behaviors limits sample size and statistical power.
- Exercise Only intervention resulted in more A/M than control group, but effect was marginal due to small sample size.
- For diet, none of the four groups differed.

## Interpretation

- Difference between the combined Ex + F&V group and the control group was 8.4%
- This is in consistent with other TTM-tailored diet intervention effects:
- 7.6% for a sample of parents of teens
- 9.3% for a sample of patients
- 8.8% for a sample of persons with diabetes

## Proportion of Baseline Pre-Action Sample Progressing in Stage at 12 Months for Exercise and Diet

## Results/1

- For exercise, individuals in Exercise Only group showed more forward movement through stages than other three groups.
- For diet, both groups receiving diet intervention showed more forward movement through stages for F&V consumption than those in control and exercise only groups.

## Results/2

- For behavioral outcome variables, no significant effects of exercise intervention on either Yale or Up-and-Go.
- Diet intervention, however, showed a significant increase in number of servings of fruits and vegetables relative to controls, adjusting for baseline consumption.

## Baseline Predictors ofProgress and Relapse

- Conducted series of simple analyses to examine baseline predictors of relapse and  progress through stages of change at 12 months for both exercise and diet.
- Very preliminary, as have not yet conducted more sophisticated multiple regression analyses or longitudinal cross-lagged structural equation models.
- Helpful in developing interventions for long term maintenance.

## Results

- Figure shows baseline scores for behavioral process of counterconditioning (substitution of healthier alternative behaviors for problem behavior).
- Results are shown for exercise for four groups: (1) stable pre-A at baseline and 12 months, (2) pre-A at baseline that progressed to A/M at 12 months, (3) stable A/M at baseline and at 12 months, and (4) A/M at baseline that relapsed to pre-A stage at 12 months.

## Exercise Baseline Predictors of Progress and Relapse: Counterconditioning

## Interpretation

- Groups show substantial differences in use of counterconditioning at baseline.
- Using this process least is the group that remains in pre-A/M at both baseline and 12 months.
- Those in pre-A at baseline progressing to A or M at 12 months show a substantially greater use of this process at baseline.
- Those in A/M at baseline relapsing at 12 months were using substantially less than those who successfully remained in A/M.

## Implications and Further Research

- Preliminary data suggest that older adults’ readiness to change may be behavior-specific.
- Exercise and diet seem to be relatively independent behaviors in older adults.
- Issues of overburdening and enhancement are not clear and will be addressed at 24-month assessment.

## Implications and Further Research(cont’d.)

- Further analyses of outcome data at 24 months will help to clarify issue of gateway behaviors:
- Are individuals who change one behavior more likely to change the other behavior?
- Efficacy of stage-tailored interventions in older adults will also be assessed.

## Next Steps

- Application for RFA on Maintenance of Long Term Behavioral Change to extend SENIOR Project to 7 years.
- Plans for continued refinement of intervention with respect to effectiveness and cost.
- Goal is to improve reach of intervention to a larger community sample in Rhode Island.