Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease , cancer , or Type 2 diabetes .
Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial
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 r and omized 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  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
Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease , cancer , or Type 2 diabetes .