Multiple unhealthy habits best addressed together

NEW YORK (Reuters Health) - People who simultaneously attempt to stop smoking, reduce their sodium intake and increase exercise may be more successful than those who try to change these lifestyle factors one at a time, Texas-based researchers report.

Dr. David J. Hyman, of Baylor College of Medicine, Houston, and colleagues came to this conclusion after studying success rates in a publicly funded behavior modification program. The 289 participants were between 45 and 64 years old and two-thirds were women. All were African American, smokers, and had high blood pressure.

As described in the Archives of Internal Medicine, the goal was to have them stop smoking, cut back on the amount of sodium in their diet, and increase physical activity by at least 10,000 pedometer steps per week.

The patients were randomly assigned to one of three groups. The first received an in-clinic counseling session on all three behaviors every 6 months, as well as motivational telephone calls for 18 months.

The second group's intervention was similar, but a different behavior was addressed every 6 months.

The third group received usual care that consisted of a one-time referral to existing group classes.

Overall, 230 of the participants completed the study.

Hyman's team found that the goal of changing two of the three behaviors was achieved in 6.5 percent of the simultaneous group, 5.2 percent of the sequential group and 6.5 percent of the usual care group.

Nevertheless, when single behaviors were assessed at 18 months, the simultaneous group did better.

Smoking abstinence was achieved by 20 percent in the simultaneous group, 17 percent of the sequential group and 10 percent of the control group.

More participants in the simultaneous group also reached the goal of increased physical activity (33 percent), followed by the sequential group (27 percent) and the control group (23 percent).

While the simultaneous group was more successful at reducing sodium levels at 6 months, this was not the case by 18 months.

The investigators call for further studies and note that although simultaneous counseling appears more successful than sequential counseling, "treatment success with the simultaneous approach is likely to be limited to a single behavior."

SOURCE: Archives of Internal Medicine, June 11, 2007.