Determinants of high and low attendance to diet and exercise interventions among overweight and obese older adults: Results from the arthritis, diet, and activity promotion trial
Introduction
Knee osteoarthritis (OA) is a leading cause of decreasing physical function among older adults, and may limit their independence [1], [2], [3]. There is evidence that obesity is associated with knee OA [4], [5], [6], and that weight loss may prevent worsening of this degenerative joint disease [7]. The American College of Rheumatology therefore recommends weight loss and exercise for obese patients with knee OA [8]. Exercise programs have demonstrated improvements in mobility among patients with knee OA [4], [9], [10], [11]. However, success in efforts for pain relief and improvement of clinical outcomes in patients with OA is largely dependent on intervention adherence [12]. Attending intervention sessions is crucial for patients to acquire knowledge and skills regarding the core elements of an intervention, and is therefore an important precondition of intervention adherence.
Reviews on physical activity interventions identified advanced age, female gender, low educational level, smoking, being overweight, low social support, and medical concerns as determinants of poor intervention session attendance [13], [14], [15], [16]. As these determinants were derived from studies using short-term interventions and short follow-up durations in young and healthy samples, it remains unclear whether these determinants apply to older, more diseased persons. Determinants of attendance to diet intervention sessions are less well studied [17], [18], [19].
To date, no study has examined the impact of the same set of determinants on both diet and exercise session attendance in a sample of overweight and obese older patients with knee OA. We explored determinants of high and low attendance to sessions of an 18-month dietary weight loss and exercise intervention. We selected a broad range of determinants –demographics, health-related, and social variables– since previous research indicated that these domains might be important for intervention session attendance [14], [15]. Understanding determinants of high and low diet and exercise session attendance may help future interventions enhance session attendance and intervention efficacy for this group [6], [20], [21], [22].
Section snippets
Design
The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was a randomized controlled trial to compare effectiveness of three 18-month interventions –a dietary weight loss program (WL), an exercise program (EX), and a dietary weight loss plus exercise program (WL + EX)– with a healthy lifestyle control group on physical function of overweight and obese adults with knee OA. Main study findings indicated that especially participants in the WL + EX program improved their physical function and
Results
Follow-up data on intervention outcome measurements of 32 of the participants (N = 238) were unavailable due to illness incidence, refusal, or moving out of the region. A chi-square test showed that non-respondents were divided evenly over intervention groups (p = 0.67). We included 73 out of 82 (89.0%) participants who were randomized into the WL intervention, 69 out of 80 (86.3%) who were randomized into the EX intervention, and 64 out of 76 (84.2%) who were randomized into the WL + EX intervention
Discussion
Our study explored determinants of high and low attendance to sessions of an 18-month dietary weight loss and exercise intervention, using the same set of determinants on both types of intervention session attendance. Overall diet session attendance among older persons with knee OA was 60.7%, which varied from 68.6% in the first 4 months, to 52.3% in the last 14 months of the study. Overall exercise session attendance was 53.2%, and varied from 68.8% in the first 4 months of the study to 49.9%
Acknowledgement
Support for this study was provided by the Claude D. Pepper Older Americans Independence Center of Wake Forest University through grants from the National Institutes of Health 5P60-AG-10484-07, and a General Clinical Research Grant M01-RR00211.
References (46)
Mobility impairment in the elderly: challenges for biomechanics research
J Biomech
(1992)- et al.
Obesity and osteoarthritis of the knee: evidence from the National Health and Nutrition Examination Survey (NHANES I)
Semin Arthritis Rheum
(1990) The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study
Semin Arthritis Rheum
(1990)- et al.
The association of obesity with joint pain and osteoarthritis in the HANES data
J Chronic Dis
(1986) - et al.
Physical activity interventions targeting older adults. A critical review and recommendations
Am J Prev Med
(1998) - et al.
Correlates of maintenance of a low-fat diet among women in the Women's Health Trial
Prev Med
(1992) - et al.
The arthritis, diet and activity promotion trial (ADAPT): design, rationale, and baseline results
Control Clin Trials
(2003) - et al.
“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975) - et al.
The MOS social support survey
Soc Sci Med
(1991) - et al.
Dietary intake and changes in lipoprotein lipids in obese, postmenopausal women placed on an American Heart Association Step 1 diet
J Am Diet Assoc
(2002)
Effectiveness of physical activity interventions for older adults: a review
Am J Prev Med
Promoting physical activity for older adults: the challenges for changing behavior
Am J Prev Med
Predictors of exercise behaviors among fibromyalgia patients
Prev Med
Osteoarthritis of the knee: effects on gait, strength, and flexibility
Arch Phys Med Rehabil
Self-reported causes of physical disability in older people: the cardiovascular health study. CHS Collaborative Research Group
J Am Geriatr Soc
Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study
Ann Intern Med
Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines
Arthritis Rheum
A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST)
JAMA
Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis
Arthritis Rheum
Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis
Arch Phys Med Rehabil
Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis
Arthritis Rheum
Measuring adherence to a women's walking program
West J Nurs Res
Factors associated with exercise adherence among older adults. An individual perspective
Sports Med
Cited by (40)
Protocol for the POMELO (Prevention Of MusclE Loss in Osteoarthritis) randomized pilot feasibility trial
2022, Osteoarthritis and Cartilage OpenLinks between osteoarthritis and diabetes: Implications for management from a physical activity perspective
2015, Clinics in Geriatric MedicineCitation Excerpt :Exercises should also be easily instituted and individuals should engage in activities that they enjoy. Exercising at home instead of a fitness facility, and use of simple exercise mode such as walking, have shown to improve adherence.101 Additionally, physical activity programs need to be flexible, inexpensive, fun, and not greatly interfere with a person’s daily routine.
Food environments are relevant to recruitment and adherence in dietary modification trials
2014, Nutrition ResearchCitation Excerpt :To our knowledge, the association between an eligible participant’s food environment and their decision to enroll in a dietary modification trial has not been examined. The literature on predictors of dietary intervention adherence has largely focused on demographic characteristics, such as participant education level, fruit and vegetable affordability [21–24], patient baseline dietary patterns [25], and whether or not the taste preferences of the participants overlap with the intervention nutrient end point [21,26,27]. A few studies have identified socio-cultural barriers to adherence such as decision making, cultural context [22,28], and familial support [28].
Ottawa panel evidence-based clinical practice guidelines for aerobic walking programs in the management of osteoarthritis
2012, Archives of Physical Medicine and RehabilitationCitation Excerpt :The reviewers (L.L. and G.M.) screened 88 eligible articles on aerobic walking programs and OA. According to the selection criteria (see table 2), 10 full-text articles were included and 78 articles were excluded for the following reasons (appendix 4): no walking program intervention in 31 trials28-58 dropout rates of over 20% in 12 studies59-70 no control group in 5 trials,71-75 outcome measures not considered in this review (eg, markers of chronic inflammation, psychosocial aspects, compliance, cost estimate) in 5 trials76-80 only healthy subjects in 2 studies81,82 no intervention in 3 studies,74,83,84 methodology was a systematic review or meta-analysis in 5 studies,13-15,85,86 diet intervention with physical activity including walking, with individuals who are obese or overweight in 8 studies,87-94 not enough statistical data in 1 trial,95 main intervention focused on nutrition in 1 trial,7 only qualitative data in 1 trial,14 design but no measurement in 1 study,70 a pilot study in 2 trials,16,96 and no control group results in 1 trial (data not shown).95 Please refer to the Ottawa Panel article.97
Obesity: current state of the problem, multidisciplinary approach. (based on the consensus of the World Gastroenterological Organization “Obesity 2023” and the European guideline on obesity care in patients with gastrointestinal and liver diseases, 2022)
2023, Experimental and Clinical Gastroenterology