Skip to main content

Advertisement

SpringerLink
Log in

Stage of change and motivation to healthy diet and habitual physical activity in type 2 diabetes

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Lifestyle changes to healthy diet (HD) and habitual physical activity (HPA) are recommended in type 2 diabetes mellitus (T2DM). Yet, for most people with diabetes, it may be difficult to start changing. We investigated the stage of change toward healthier lifestyles according to Prochaska’s model, and the associated psychological factors in T2DM patients, as a prerequisite to improve strategies to implement behavior changes in the population. A total of 1,353 consecutive outpatients with T2DM attending 14 tertiary centers for diabetes treatment completed the validated EMME-3 questionnaire, consisting of two parallel sets of instruments to define the stage of change for HD and HPA, respectively. Logistic regression was used to determine the factors associated with stages that may hinder behavioral changes. A stage of change favoring progress to healthier behaviors was more common in the area of HD than in HPA, with higher scores in action and maintenance. Differences were observed in relation to gender, age and duration of disease. After adjustment for confounders, resistance to change toward HD was associated with higher body mass index (BMI) (odds ratio (OR) 1.05; 95 % confidence interval (CI) 1.02–1.08). Resistance to improve HPA also increased with BMI (OR 1.06; 95 % CI 1.03–1.10) and decreased with education level (OR 0.74; 95 % CI 0.64–0.92). Changing lifestyle, particularly in the area of HPA, is not perceived as an essential part of treatment by many subjects with T2DM. This evidence must be considered when planning behavioral programs, and specific interventions are needed to promote adherence to HPA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Diabetes Association (2012) Executive summary: standards of medical care in diabetes–2012. Diabetes Care 35(Suppl 1):S4–S10

    Google Scholar 

  2. Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT et al (2009) 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 374:1677–1686

    Article  PubMed  Google Scholar 

  3. Tang M, Armstrong CL, Leidy HJ, Campbell WW (2013) Normal vs. high-protein weight loss diets in men: effects on body composition and indices of metabolic syndrome. Obesity (Silver Spring) 21:E204–E210

    Article  CAS  Google Scholar 

  4. Schwingshackl L, Hoffmann G (2013) Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis. Nutr J 12:48

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L et al (2013) Hypoglycemia and diabetes: a report of a workgroup of the American diabetes association and the endocrine society. Diabetes Care 36:1384–1395

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Aas AM, Bergstad I, Thorsby PM, Johannesen O, Solberg M, Birkeland KI (2005) An intensified lifestyle intervention programme may be superior to insulin treatment in poorly controlled Type 2 diabetic patients on oral hypoglycaemic agents: results of a feasibility study. Diabet Med 22:316–322

    Article  CAS  PubMed  Google Scholar 

  7. Moore SM, Hardie EA, Hackworth NJ, Critchley CR, Kyrios M, Buzwell SA et al (2011) Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention? A randomised control trial. Psychol Health 26:485–499

    Article  PubMed  Google Scholar 

  8. Sarkar U, Fisher L, Schillinger D (2006) Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care 29:823–829

    Article  PubMed  Google Scholar 

  9. The Diabetes Prevention Program Research Group (2002) The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 25:2165–2171

    Article  Google Scholar 

  10. Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N et al (2003) Validation of a counseling strategy to promote the adoption and the maintenance of physical activity by type 2 diabetic subjects. Diabetes Care 26:404–408

    Article  PubMed  Google Scholar 

  11. Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N et al (2005) Make your diabetic patients walk: long-term impact of different amounts of physical activity on type 2 diabetes. Diabetes Care 28:1295–1302

    Article  PubMed  Google Scholar 

  12. Balducci S, Zanuso S, Nicolucci A, De Feo P, Cavallo S, Cardelli P et al (2010) Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Arch Intern Med 170:1794–1803

    Article  PubMed  Google Scholar 

  13. Prochaska JO, Redding CA, Evers KE (2002) The transtheoretical model and stages of change. In: Glanz K, Rimer BK, Lewis FM (eds) Health behavior and health education: theory, research, and practice. Jossey-Bass, San Francisco, CA

    Google Scholar 

  14. Prochaska JO, Velicer WF (1997) The transtheoretical model of health behavior change. Am J Health Promot 12:38–48

    Article  CAS  PubMed  Google Scholar 

  15. Critchley CR, Hardie EA, Moore SM (2012) Examining the psychological pathways to behavior change in a group-based lifestyle program to prevent type 2 diabetes. Diabetes Care 35:699–705

    Article  PubMed Central  PubMed  Google Scholar 

  16. Weinstein ND, Rothman AJ, Sutton SR (1998) Stage theories of health behavior: conceptual and methodological issues. Health Psychol 17:290–299

    Article  CAS  PubMed  Google Scholar 

  17. Jones C, Jancey J, Howat P, Dhaliwal S, Burns S, McManus A et al (2013) Utility of stages of change construct in the planning of physical activity interventions among playgroup mothers. BMC Res Notes 6:300

    Article  PubMed Central  PubMed  Google Scholar 

  18. Schulz DN, Kremers SP, de Vries H (2012) Are the stages of change relevant for the development and implementation of a web-based tailored alcohol intervention? A cross-sectional study. BMC Public Health 12:360

    Article  PubMed Central  PubMed  Google Scholar 

  19. Greene GW, Redding CA, Prochaska JO, Paiva AL, Rossi JS, Velicer WF et al (2013) Baseline transtheoretical and dietary behavioral predictors of dietary fat moderation over 12 and 24 months. Eat Behav 14:255–262

    Article  PubMed Central  PubMed  Google Scholar 

  20. Spiller V, Scaglia M, Meneghini S, Vanzo A (2009) Assessing motivation to change towards healthy nutrition and regular physical activity. Validation of two sets of instruments. Mediterr J Nutr Metab 2:41–47

    Article  Google Scholar 

  21. Spiller V, Zavan V, Guelfi GP (2006) Assessing motivation for change in subjects with alcohol problems: the MAC2-A questionnaire. Alcohol Alcohol 41:616–623

    Article  PubMed  Google Scholar 

  22. Miller WR, Rollnick S (2002) Motivational interviewing, 2nd edn. The Guilford Press, New York

    Google Scholar 

  23. Steele CM (1988) The psychology of self-affirmation: sustaining the integrity of the self. In: Berkowitz L (ed) Advances in experimental social psychology. Academic Press, New York, pp 261–302

    Google Scholar 

  24. Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191–215

    Article  CAS  PubMed  Google Scholar 

  25. Vahasarja K, Salmela S, Villberg J, Rintala P, Vanhala M, Saaristo T et al (2012) Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes: a cross-sectional analysis within a community-based diabetes prevention project FIN-D2D. BMC Public Health 12:514

    Article  PubMed Central  PubMed  Google Scholar 

  26. Centis E, Moscatiello S, Bugianesi E, Bellentani S, Fracanzani AL, Calugi S et al (2013) Stage of change and motivation to healthier lifestyle in nonalcoholic fatty liver disease. J Hepatol 58:771–777

    Article  PubMed  Google Scholar 

  27. Littell JH, Girvin H (2002) Stages of change. A critique. Behav Modif 26:223–273

    Article  PubMed  Google Scholar 

  28. Dunn EC, Neighbors C, Larimer M (2003) Assessing readiness to change binge eating and compensatory behaviors. Eat Behav 4:305–314

    Article  PubMed  Google Scholar 

  29. Parchman ML, Arambula-Solomon TG, Noel PH, Larme AC, Pugh JA (2003) Stage of change advancement for diabetes self-management behaviors and glucose control. Diabetes Educ 29:128–134

    Article  PubMed  Google Scholar 

  30. Peterson KA, Hughes M (2002) Readiness to change and clinical success in a diabetes educational program. J Am Board Fam Pract 15:266–271

    PubMed  Google Scholar 

  31. Helitzer DL, Peterson AB, Sanders M, Thompson J (2007) Relationship of stages of change to attendance in a diabetes prevention program. Am J Health Promot 21:517–520

    Article  PubMed  Google Scholar 

  32. Festinger L (1957) A theory of cognitive dissonance. Row & Peterson, Evanston, IL

    Google Scholar 

  33. Rollnick S, Heather N (1982) The application of Bandura’s self-efficacy theory to abstinence oriented alcoholism treatment. Addict Behav 7:243–250

    Article  CAS  PubMed  Google Scholar 

  34. Peek ME, Tang H, Alexander GC, Chin MH (2008) National prevalence of lifestyle counseling or referral among African-Americans and whites with diabetes. J Gen Intern Med 23:1858–1864

    Article  PubMed Central  PubMed  Google Scholar 

  35. Dalle Grave R, Calugi S, Centis E, El Ghoch M, Marchesini G (2011) Cognitive-behavioral strategies to increase the adherence to exercise in the management of obesity. J Obes 2011:348293

    Article  PubMed Central  PubMed  Google Scholar 

  36. Grandes G, Sanchez A, Torcal J, Sanchez-Pinilla RO, Lizarraga K, Serra J (2008) Targeting physical activity promotion in general practice: characteristics of inactive patients and willingness to change. BMC Public Health 8:172

    Article  PubMed Central  PubMed  Google Scholar 

  37. Van Dyck D, De Greef K, Deforche B, Ruige J, Tudor-Locke CE, Kaufman JM et al (2011) Mediators of physical activity change in a behavioral modification program for type 2 diabetes patients. Int J Behav Nutr Phys Act 8:105

    Article  PubMed Central  PubMed  Google Scholar 

  38. Sone H, Tanaka S, Tanaka S, Suzuki S, Seino H, Hanyu O et al (2013) Leisure-time physical activity is a significant predictor of stroke and total mortality in Japanese patients with type 2 diabetes: analysis from the Japan Diabetes Complications Study (JDCS). Diabetologia 56:1021–1030

    Article  CAS  PubMed  Google Scholar 

  39. Henson J, Yates T, Biddle SJ, Edwardson CL, Khunti K, Wilmot EG et al (2013) Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia 56:1012–1020

    Article  CAS  PubMed  Google Scholar 

  40. Hardcastle SJ, Taylor AH, Bailey MP, Harley RA, Hagger MS (2013) Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up. Int J Behav Nutr Phys Act 10:40

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This collaborative group was promoted by the Italian Society of Diabetology (SID) and the Association of Diabetes Physicians (AMD) as part of the Interassociative Study Group on Physical Activity.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Unit of Metabolic Diseases and Clinical Dietetics, Alma Mater University of Bologna, Policlinico S. Orsola, Via Massarenti, 9, 40138, Bologna, Italy

    E. Centis, A. S. Sasdelli & G. Marchesini

  2. Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Turin, Italy

    M. Trento

  3. Diabetes Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy

    A. Dei Cas

  4. Internal Medicine, University of Milan, Milan, Italy

    A. E. Pontiroli

  5. Healthy Lifestyle Institute, University of Perugia, Perugia, Italy

    P. De Feo

  6. Unified Diabetes Center, Turin, Italy

    A. Bruno

  7. Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy

    F. Arturi

  8. Diabetes and Nutrition, Santo Spirito Hospital, Rome, Italy

    F. Strollo

  9. Division of Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy

    S. Vigili de’ Kreutzenberg

  10. Department of Metabolic Diseases and Diabetes, Auxological Institute, Milan, Italy

    C. Invitti

  11. Department of Internal Medicine, Pozzuoli Hospital, Naples, Italy

    P. Di Bonito

  12. Diabetes Unit, G. Rodolico, Catania, Italy

    M. Di Mauro

  13. Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy

    G. Pugliese

  14. Diabetes and Metabolic Diseases, Clinical Institute Villa Aprica, Como, Italy

    A. Molteni

Authors
  1. E. Centis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Trento
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Dei Cas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. E. Pontiroli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. De Feo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. S. Sasdelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Arturi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F. Strollo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Vigili de’ Kreutzenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. C. Invitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P. Di Bonito
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Di Mauro
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. G. Pugliese
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. A. Molteni
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. G. Marchesini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Marchesini.

Additional information

Communicated by Massimo Porta.

For the AMD-SID Interassociative Study Group on Physical Activity.

Other participants are C. Caselli (Bologna); E. Logullo (Como); I. Carucci, L. Borgia (Roma); A. M. Veronelli (Milano); A. Conti (Milano); A. Avogaro (Padova); I. Zavaroni (Parma); E. Succurro (Catanzaro).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 17 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Centis, E., Trento, M., Dei Cas, A. et al. Stage of change and motivation to healthy diet and habitual physical activity in type 2 diabetes. Acta Diabetol 51, 559–566 (2014). https://doi.org/10.1007/s00592-013-0551-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-013-0551-1

Keywords

Search

Navigation