1 VA New York Harbor Healthcare System 2 University of Hawaii John A. Burns School of Medicine

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 DisclosuresNatalie 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 • 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 6-30 point scale • Exercise-Related Social Support • Measures the perceived social support from others • Assessed using a validated 3-15 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 regressionsexamined independent variables’ relationship to duration of exercise (continuous) • Robust regression used because data not normally distributed • Logistic regressionevaluated predictors of adherence to exercise (dichotomous)

10. Sample Characteristics N= 227

11. Summary Statistics N= 227

12. Results- Robust Regression for Exercise Duration *p<.01; **p<.05 †p<.10

13. Results- Logistic Regression for Exercise Adherence *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!