Psychological Predictors of Physical Activity in the Diabetes Prevention Program

Abstract

Objective-To identify the baseline psychological variables before receiving a Diabetes Prevention Program (DPP) lifestyle intervention that predict physical activity levels (PALs) at baseline, 1 year, and end of study (2 to 3 years after randomization).Design and subjects-Of the final 293 DPP lifestyle participants randomized, 274 (94%) completed validated questionnaires at baseline assessing stage of change for PAL, exercise selfefficacy, perceived stress, depression, and anxiety. Statistical analyses performed-Correlations and stepwise multiple regression analyses.Results-At baseline, this subset was similar to the entire DPP lifestyle cohort: mean age was 52.5 years, 65% were women, and mean PAL was 15.7 metabolic equivalent hours per week. Higher levels of baseline leisure PAL correlated with greater readiness to change PAL (r=0.44, P<0.0001), higher exercise self-efficacy (r=0.18, P=0.002), and lower levels of perceived stress (r=−0.16, P=0.009), depression (r=−0.18, P=0.003), and anxiety (r=−0.14, P=0.03), with similar correlations at 1 year and end of study. In multivariate models, being a man, lower levels of depression, and lower body mass index were independent correlates of higher baseline leisure PAL; being a man, greater baseline exercise self-efficacy, and activity level were independent correlates of greater leisure PAL levels at 1 year and end of study. Greater readiness to change PAL at baseline was also an independent correlate of greater PAL at end of study.Conclusions-In this representative sample of DPP lifestyle participants, being a man, lower body mass index, greater readiness for change in PAL, higher exercise self-efficacy, and lower perceived stress, depression, and anxiety scores correlated with higher levels of baseline PAL with similar patterns at 1 year and end of study. These findings may help determine which patients are most likely to increase PAL in lifestyle intervention programs.Lack of physical activity is a major risk factor for premature morbidity and mortality and contributes to the death of 200,000 Americans every year (1). Despite strong evidence for the benefits of regular physical activity (2,3), 24% of US adults engage in no recreational physical activity at all, and only 25% meet recommended physical activity levels (PALs) (4).One of the many major health benefits of regular physical activity is the prevention of type 2 diabetes (5-7), mediated by weight control and other mechanisms (6,8,9). Given that both inactivity and obesity seem to be strongly and independently associated with diabetes and diabetes-related cardiovascular comorbidities (10), it is particularly crucial to understand how to promote physical activity in persons at high risk for diabetes.Physical activity is a complex behavior that has been correlated with numerous demographic and psychological variables (11-13). However, much of the current literature focuses on the general population rather than on people at high risk for diabetes, like those with impaired glucose tolerance (IGT).The Diab...

Associations among physical activity, comorbidities, depressive symptoms and health-related quality of life in type 2 diabetes

“…Lower basal levels of PA have been associated with poor mental health (8), depression and perceived stress (9)(10)(11). Lifestyle intervention programs for T2DM have been previously verified in many controlled trials: PA shows better effects on glycemic control and blood pressure than other therapies alone (12,13).…”

Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: a systematic review and economic evaluation.

“…Higher levels of baseline physical activity correlated with greater readiness to change physical activity levels (p < 0.0001) and lower levels of perceived stress (p = 0.009), depression (p < 0.003), and anxiety (p = 0.03) at baseline, 1-year and end-of study levels. 196 Perhaps time is a factor, with those who are older having more time post retirement. The older age groups had the highest MET-hours of activity and did better with lifestyle change than younger groups, although it should be noted that they started leaner and with better insulin sensitivity.…”

Effect of Baseline Self-Efficacy on Physical Activity and Psychological Stress after a One-Week Pedometer Intervention

“…It is known that self-efficacy correlates with physical activity (e.g., Rodgers & Gauvin, 1998;Delahanty, et al, 2006). Physical activity did not differ between the three groups at baseline.…”

“…Interventions aimed at increasing physical activity have thus far been performed to modify cognition (Dunn, Marcus, Kampert, Garcia, Kohl, & Blair, 1997), knowledge (Parcel, Simons-Morton, O'Hara, Baranowski,&Wilson,1989), self-concept (Schneider, Dunton,&Coope, 2008), selfefficacy (Calfas, Sallis, Oldenburg, & French, 1997), social support (Luepker, Perry,McKinlay, Nader, Parcel, Stone,et al, 1996), and psychological stress (Warschburger, Fromme, Petermann, Wojtalla,&Oepen, 2001). The relationship between self-efficacyand physical activity is particularly well documented (Rodgers &Gauvin, 1998;Delahanty, Conroy,& Nathan, 2006). After an intervention increases physical activity, self-efficacy increases (Calfas,et al, 1997).…”