Simple personalized program delivered by mail is more effective than one-on-one phone counseling.As Americans struggle to become more physically active, simple programs that provide feedback and motivation can play a crucial role in getting people off to a good start.
Researchers found feedback delivered via mail was equally as effective at increasing physical activity in the short-term and potentially more effective long-term than feedback delivered via phone counseling.
The study enrolled 239 healthy, underactive adults into two individualized programs either with telephone-based or print-based feedback for one year. A control group received generic health information with no physical-activity specific information. They then could chose either the print or phone program after one year. Study participants submitted data about their physical activity in personal logs and surveys.
The print and telephone based programs incorporated social cognitive theory and the transtheoretical model both of which emphasize the importance of increasing motivational readiness for physical activity, balancing the pros vs. cons of activity, and developing strategies for becoming and remaining physically active, said Melissa Napolitano, Ph.D,.
"Both programs offer a cost-effective way to promote healthy behaviors, such as exercise," Napolitano said.
Feedback, whether delivered via phone by a health educator or via a printed letter, pointed out areas for improvement and recognized successful efforts by the participants.
Researchers designed the program to encourage participants to reach the national guidelines for physical activity at 150 minutes per week. They completed a physical activity log and brief survey each month, and two in person visits. Compensation was provided for each completed activity.
Currently, people can find phone counseling programs through outlets such as their health insurance providers. Other programs are available online and in print-based formats. For example, the American Heart Association has a program designed for women, Choose to Move print materials available by calling 1-888-MY-HEART), which promotes healthy eating and physical activity.
Inactive adults nearly double their risk for cardiovascular disease. Only 25 percent of Americans meet the recommended levels of physical activity, defined by engaging in moderate intensity activity four days or more each week for 30 minutes or vigorous activity for 30 minutes for 3 days or more each week, according to the Centers for Disease Control and Prevention.
However, CDC data suggests more Americans are trying to increase their physical activity levels. People engaging in no physical activity decreased from about 31 percent in 1989 to 25 percent in 2005 in an analysis of 36 states.
"With print, computer and telephone-based programs it is possible for larger numbers of inactive and underactive adults to receive critical help, support, and advice for becoming more physically active and ultimately preventing disease and disability," Napolitano said.
At 6 months, the print group and telephone group reported 129 and 123 minutes of physical activity, respectively. By the end of the study at 12 months, those in the print program reported 160 minutes of physical activity a week compared to 100 minutes in the phone group and 90 minutes in the control group.
While this finding was unanticipated, there are some explanations why the researchers think this might have happened. First, the print group received hard-copies of all the materials which they could use as a resource throughout the 12 months, whereas the phone group only received verbal feedback and information.
Secondly, it is possible that the print group had to develop more internal or intrinsic motivation as they didn't have the specific social support and contact with a personal health educator.
Whereas the phone participants may have been relying more on extrinsic motivation, or the support and encouragement of the counselor. The counseling was helpful in the short-term, but may not have been as effective as the contact tapered off through the maintenance phase.
Future studies should examine whether the combination of the print and phone programs could produce even better results, and different delivery channels, such as email, text messaging and the Internet, Napolitano said.