I CAN MOVE BETTER, BABY!

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I CAN MOVE BETTER, BABY!
Determinants of Exercise Adherence in the
Diabetes Wellness Project
Amanda Gammon
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I. Background
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What is Diabetes?

• Diabetes is a group of diseases characterized by
  high levels of blood glucose resulting from
  defects in the production or use of insulin.
• (National Diabetes Information Clearing House)
• Complications
• Nerve and eye damage, kidney failure and
  premature death

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DIABETES IN AMERICA

• Diabetes affects 18 million Americans.
• 5 million undiagnosed.
• Total cost of Diabetes 132 billion dollars in
  2002.
• Risk factors include sedentary lifestyle,
  overweight and obesity.

Statistics from Center for Disease Control
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Diabetes Treatment and Prevention

• Diabetes can be prevented through diet and
  exercise changes (Diabetes Prevention Program
  Research Group 2002).
• Diabetes can be controlled with exercise and
  diet.
• Risk factors are potentially reversible.

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Problems of Exercise Adherence

• 58 of American adults are inactive.
• 50 of the individuals who start a
  self-monitored exercise program will drop out of
  that program within six months (Dishman, 1991). 
• Effective Physical Activity Interventions are
  needed.

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Research Questions

• What were the benefits and barriers to exercise
  adherence for diabetics in this program?
• How did the Diabetes Wellness Project address the
  problem of exercise adherence?
• How effective was the Diabetes Wellness Project
  in promoting regular exercise?

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II. Methods
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Diabetes Wellness Project

• YWCA Preventative Health Program
• 12 month program
• Goals to promote regular exercise for people with
  diabetes.
• Must work out 8 times a month

• Participants receive membership to the YWCA
• Group, and individual training sessions
• Monthly diabetes education

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Participants

• 20 interviews (names have been changed)
• Enrolled in program for 6 months
• Mean age 55, Range 28-83
• 16 African American, 4 Caucasian
• 16 women, 4 men
• Diverse age, race and socio-economic background.

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III. Results

• Barriers
• Overcoming Barriers
• Benefits

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Internal Barriers

• Lack of Motivation/ Time
• Difficulty Prioritizing Health
• Embarrassment
• Fear of Gym

• Im so out of shape that it would be an
  embarrassment to get with people that are in
  really good shape.

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External Barriers

• Time/Scheduling
• Caregiver Responsibilities
• Physical Condition
• Pain and Injury

• Well at first I couldnt do it. Physically I
  couldnt do it. I could not walk on treadmill
  for 5 minutes.

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Overcoming Barriers

• Internal Factors
• Possibility of negative health outcomes or death
• Learning to prioritize their health
• Making exercise fun

• Paul, a 55 year old diabetic on dialysis, is
  exercising in order to increase the chances of a
  successful kidney transplant.

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Overcoming Barriers

• External Factors
• Social Support
• Personal trainer
• Peers
• Group training
• YWCA staff/facilities
• Educational Programs

• Network of support
• Goal setting
• Encouragement
• Positive Feedback
• Information on diabetes management

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Physical Benefit

• Improved diabetes management
• Reduced A1C
• Increased energy and physical mobility
• Lower blood pressure, heart rate, cholesterol
• Lost inches from waist and hips

I can cut my toenails again.
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Emotional Benefits

• Social Interaction
• Increased Self-esteem, personal empowerment
• Mood Stability

• When Im on treadmill and I finish, I dont
  care if its ten minutes or fifteen minutes if I
  cant go the rest of the way, I feel good because
  I made time for it. That is the best feeling to
  me because I feel like for the first time I am
  doing something that is the most important to my
  life.

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Discussion

• Intervention successful in promoting exercise and
  lifestyle changes
• Participants experienced internal and external
  barriers to exercise
• Program provided multiple levels of support to
  overcome barriers
• Significant physical and emotional benefits

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Limitations and Directions for Future Research

• Small sample size
• Non-representative
• Skewed Sample

• Compare differences between adherers and
  non-adherers

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Acknowledgements
YWCA staff Eliza Lynn, Susan, Carole. Everyone
I interviewed. Teachers Siti Kusijiarti, Ben
Feinberg, Bob Swoap, Barb Routhieux. My
classmates. Family and friends Bannerman Crew.
And especially Sam.
Thank you.
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Questions?