Strategies for increasing early adherence to and long-term maintenance of home-based exercise training in healthy middle-aged men and women

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Abstract

Two studies were undertaken to compare strategies for the adoption and maintenance of moderate-intensity, home-based exercise training. In the study of adoption, 52 men and women who had served for 6 months as controls for a study of moderate-intensity, home-based exercise training received 30 minutes of baseline instruction. They were then randomized to receive continuing instruction and support through 10 staff-initiated telephone contacts of 5 minutes each every 2 weeks, or to receive no telephone contacts. In subjects receiving telephone contacts, peak oxygen uptake increased significantly after 6 months, whereas no increase was observed in subjects receiving no staff support (p < 0.05). In the maintenance study, 51 men and women who had significantly increased their peak oxygen uptake by 6 months of moderate-intensity, home-based exercise training were randomized to undergo daily self-monitoring and receive adherence instructions, or undergo weekly self-monitoring only, during a second 6-month period of training. Subjects performing daily self-monitoring reported completing significantly more exercise training sessions during the 6 months of training than subjects performing weekly self-monitoring; functional capacity in both groups remained higher than before training (p < 0.05). Taken together, these studies suggest that brief baseline instruction followed by continuing telephone contact with staff can be used to help people adopt a moderate-intensity, home-based exercise training program that can be maintained by simple self-monitoring strategies.

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    An a priori power calculation on the primary outcome (self-reported aerobic exercise in minutes per week) indicated that a sample size of 104 (52 per group) was required for 80% power, with a conservatively assumed high correlation of .60 among repeated measures, a moderate group difference (Cohen's d=.50), and an anticipated attrition rate of 16%. This is considerably smaller than differences (median d=.69) observed in a previous pilot study19 and similar published studies,30-32 suggesting adequate power for the final sample of 128 participants. Protocol and intervention details were previously published.33

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This work was supported by a grant awarded to Dr. DeBusk by the PepsiCo Foundation, Purchase, New York, and by grant 36272 awarded to Dr. Haskell by the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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