Psychosocial Determinants of Health Behaviour Change in an E-Counseling Intervention for Hypertension

Abstract

We evaluated the influence of psychological stress and depression on motivation to adhere to recommended guidelines for exercise and diet. This study was conducted within a larger e-counseling trial. Subjects diagnosed with hypertension (n = 387, age = 44–74 years, 59% female) completed assessments at baseline and within 2 weeks after a 4-month intervention period. Outcomes included mean level of readiness to change diet and exercise and symptoms of depression and stress. Per protocol analysis defined e-counseling support as follows: ≥8 e-mails = therapeutic dose, 1–7 e-mails = subtherapeutic dose, and 0 e-mails = Controls. Baseline adjusted symptoms of depression and stress were inversely correlated with improvement in exercise (partial R = −.14, P = .01, and partial R = −.17, P = .01, resp.) but not diet or e-counseling. Subjects who received a therapeutic dose of e-counseling demonstrated greater readiness for diet adherence versus Controls (P = .02). Similarly, subjects receiving a therapeutic level of e-counseling demonstrated significantly greater readiness for exercise adherence versus Controls (P = .04). In sum, e-counseling is associated with improved motivation to adhere to exercise and diet among patients with hypertension, independent of symptoms of psychological stress and depression.

The Effects of Stress on Physical Activity and Exercise

“…Finally, intervention studies targeting stress [284] or exercise/health behaviors [89, 124, 204, 281, 285-287] have found inverse associations between stress and indicators of PA over time. For instance, Urizar et al [89] found that PA changes over a 10-week period were moderately correlated with maternal stressors over the same period ( r = –0.42).…”

“…Some interventions, however, have found no association [145, 273, 276, 277] or that higher stress relates to greater PA [279]. Improvements in exercise readiness over time are compromised by the experience of stress [124]. Whether stress has a stronger association with adoption or continued participation of an exercise routine/PA programming is undetermined [184, 278, 288].…”

“…In other words, is stress detrimental towards the effort of adopting and maintaining exercise behavior? It has been noted extensively that a dynamic, bi-directional relationship likely exists [19, 21, 24, 38, 49, 50, 83, 115-124], but this direction of influence is often overlooked [53]. Salmon [19] mused that the stress and PA-exercise relationships are open to interpretation, and “people who are less disturbed by stress might simply be more ready to take up exercise training” (p. 46).…”

Adesão à dieta por idosos com síndrome metabólica assistidos na Estratégia Saúde da Família: frequência e associação com depressão

“…Em uma metanálise, que teve como propósito investigar novas estratégias para que indivíduos portadores de SM modifiquem o seu estilo de vida, os autores observaram que o aconselhamento pelos profissionais de saúde pode aumentar significativamente a motivação em adquirir hábitos saudáveis de vida, incluindo a dieta [38]. Nesse sentido, torna-se importante, também, conhecer os sintomas de estresse psicológico e de depressão, visto que esses aspectos podem influenciar significativamente a adesão para mudar comportamentos [39].…”

Adherence to physical activity for adults with depression: the role of the nurse practitioner - an integrative literature review

“…With the widespread accessibility and uptake of daily internet use and email in today' s society, it is important to consider the potential role of electronic forms of exercise counselling for use in primary care as a mechanism to increase motivation and adherence to physical activity (Durrani, et al, 2012). uptake is essential for patients with depression.…”