A 2007 meta-analysis of health behavior change interventions tested in adults with type 2 diabetes found that interventions focused exclusively on physical activity not only improved metabolic control but achieved an effect that was twice as large as interventions that attempted to change multiple behaviors. Such findings suggest that interventions sequentially targeting different health behaviors may be more effective than those that simultaneously target several health behaviors.
Behavioral approaches. The 2008 meta-analysis of interventions used to promote physical activity in chronic illness investigated both behavioral and cognitive approaches. Behavioral practices included incorporating consequences, patient contracts, feedback, goal setting, self-monitoring, and stimuli and cues, Cognitive approaches included barriers management, decisional balance, motivational counseling, problem solving, and social cognitive interventions. Interventions incorporating any behavioral strategy were found to bemore effective than those that included none, and interventions employing only behavioral strategies were more effective than those with both behavioral any cognitive components—findings that
-strongly favor behavioral interventions.
-highlight the importance of using action-oriented approaches to improve physical activity.
-Have important implications for health care providers, who typically attempt to encourage physical activity in chronically ill patients through education.
It’s possible that people already know why they should exercise (the typical emphasis of cognitive strategies) but require behavioral strategies to achieve and maintain higher levels of physical activity. Such findings provide evidence for replacing attempts to provide a scientific rationale for the benefits of physical activity with behavioral strategies to encourage physical activity.
Effective interventions using behavioral strategies to promote physical activity among women after cardiac surgery were found to include self-reinforcement through keeping logs, specific goal setting, and nurse feedback. Specific goal setting and nurse feedback were also found to be effective in promoting physical activity in patients with coronary heart disease, and an intervention including individualized graphic (as opposed to verbal) feedback on exercise and goal setting was effective in promoting physical activity among patients with heart failure.
In contrast, cognitive interventions focused on discussing the advantages of healthful behaviors and situations in which healthful behaviors would be difficult to achieve weren’t found to be effective in promoting physical activity in the 2008 meta-analysis involving chronically ill adults. Likewise, a health education and counseling intervention in which clinicians explained the health consequences of inadequate physical activity was ineffective over the long term (at one year) in increasing physical activity among adults in cardiac rehabilitation.
Self-monitoring is a behavioral strategy that requires the participant to record her or his daily or weekly physical activity over time, perhaps in an exercise diary, on a tracking calendar, or on a Web site. For example, in a study of patients with diabetes, subjects used log books to record behavioral goals and physical activity. Another approach to self-monitoring would be to provide patients with pedometers to record their daily steps, a strategy that has been shown to motivate patients with type 2 diabetes to increase their physical activity.