1. Exercise Adherence in Patients with Diabetes: Evaluating the role of psychosocial factors in managing diabetes
Natalie N. Young,1, 2 Jennifer P. Friedberg,1, 3 Michelle E. Ulmer,1 Hoyune E. Cho,1 Stuart R. Lipitz,4 Sundar Natarajan1,3
1VA New York Harbor Healthcare System
2University of Hawaii John A. Burns School of Medicine
3NYU School of Medicine
4Brigham and Women’s Hospital/Harvard Medical School

2. Presenter Disclosures Natalie Young
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose

3. Background
Patients with diabetes and high blood pressure (BP), or hypertension, suffer from high rates of cardiovascular complications
Hypertension in patients with diabetes: Systolic BP >130 mmHg and/or Diastolic BP > 80mmHg
Regular exercise effective for uncontrolled hypertension in patients with diabetes
Despite established benefits, adherence to exercise remains low
Factors that affect exercise in patients with diabetes and hypertension is unclear

4. Specific Aims
Identify psychosocial factors related to exercise duration in patients with diabetes and hypertension
Assess the relationships of these factors with adherence to exercise

5. Methods- Data Source
Data collected from 227 participants with diabetes and uncontrolled BP in a Randomized Control Trial (RCT) to control HTN
Study Sites: VA New York Harbor Healthcare System- New York and Brooklyn campuses
Patients assessed multiple times over a year in the RCT
Data from Baseline Visits
Exercise duration and exercise adherence were examined
Looked at a priori demographic, health, and psychosocial variables

6. Variables of Interest Dependent Variables Independent Variables
Exercise Duration
Exercise Adherence
Independent Variables
Age
Exercise Self-Efficacy
Exercise-Related Social Support
Number of Prescribed Blood Pressure Medications
Body Mass Index

7. Dependent Variables- Exercise Outcomes
Exercise Duration
Hours/week
Measured using the 7-day Physical Activity Recall (PAR), a validated measure
Exercise Adherence
Yes/No
Classified using previous aerobic exercise recommendations by the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM)
>3 days/ week for at least 20 minutes each day

8. Independent Variables- Demographic, Health, and Psychosocial Factors
Age
Years
Obtained from patient records at the Baseline visits
Exercise Self-Efficacy
Examines how confident one is to exercise when other variables interfere (i.e. stress, lack of time, weather)
Assessed using a validated point scale
Exercise-Related Social Support
Measures the perceived social support from others
Assessed using a validated point scale
Exercise-Related Social Support (continued)
Specific to encouragement or discouragement from others related to exercise (i.e. given rewards for exercising vs. criticized or made fun of for exercising)
Number of Prescribed Blood Pressure Medications
Proxy for severity of HTN
Obtained from patient records at the Baseline visits
Body Mass Index (BMI)
Measure of obesity in kg/m2
Calculated at the Baseline visits

9. Statistical Analysis
Regression models used to evaluate relationship between the independent variables and exercise outcomes
Dependent Variables: Exercise Duration (hrs/wk) and Exercise Adherence (yes/no)
Independent Variables: Demographic, Health, and Psychosocial Factors among Patients
Robust regressions examined independent variables’ relationship to duration of exercise (continuous)
Robust regression used because data not normally distributed
Logistic regression evaluated predictors of adherence to exercise (dichotomous)

10. Sample Characteristics
N= 227
Demographics
Frequency (%)
Sex
Male
227 (100%)
Race
Black
89 (40.1%)
White
81 (36.5%)
Hispanic
40 (18.0%)
Other
12 (5.4%)
Employment Status
Retired
131 (58.0%)
Unemployed
52 (23.0%)
Employed
43 (19.0%)
Marital Status
Married
85 (37.8%)
Separated or Divorced
78 (34.7%)
Never Married
41 (18.2%)
Widowed
21 (9.3%)
Education Status
Some College and Beyond
119 (52.9%)
High School Graduate or GED
75 (33.3%)
Some High School or Less
31 (13.8%)

11. Number of Prescriptions
Summary Statistics
N= 227
Variables
Scale
Median
Range
Exercise Adherence
% Yes/%No
40.3 Yes/ 59.7 No
Exercise Duration
Hours/ Week
2.5
Age
Years
63.2
Exercise Self-efficacy
6-30
20.0
Exercise-Related Social Support
3-15
3.0
BP Medications
Number of Prescriptions
BMI
kg/m2
30.4

12. Results- Robust Regression for Exercise Duration
Independent Variables
Coefficient
Bivariate
Multivariate
Age
-.0089
-.0085
Exercise Self-efficacy
.11*
Exercise-Related Social Support
.23**
.21**
Number of BP medications
-.21†
-.26**
BMI
-.0096
*p<.01; **p<.05
†p<.10

13. Results- Logistic Regression for Exercise Adherence
Independent Variables
Odds Ratio [95% CI]
Bivariate
Multivariate
Age
1.00 [ ]
Exercise Self-efficacy
1.09 [ ]*
1.08 [ ]*
Exercise-Related Social Support
.98 [ ]
.94 [ ]
Number of BP medications
.81 [ ] **
.81 [ ] **
BMI
.97 [ ]
.99 [ ]
*p<.01; **p<.05

14. Conclusions
Lower number of blood pressure medications associated with increased exercise adherence
Higher number of BP medications could indicate more severe HTN  affect adherence to exercise
Increased BP medications could increase side effects  decrease exercise adherence
May promote negative perception of health  negatively influence adherence to exercise
Age and BMI had less impact on exercise than self-efficacy and social support
Psychosocial factors may have more significant role than demographic and physiological factors

15. Implications
May be beneficial to focus on psychosocial factors when trying to increase exercise duration and adherence in the treatment of patients with diabetes and hypertension
Intervention should address psychosocial aspects:
Increase self-efficacy
Emphasize social support
Reduce number of medications
Goal is to achieve better exercise adherence and longer duration of exercise and improve management of diabetes

16. Questions?
Thank You!