Katherine Collins, PhD, one of the current Duke Center for Applied Genomics & Precision Medicine’s post-doctoral fellows in genomic medicine research, published a paper in the Translational Journal of the American College of Sports Medicine (TJACSM) characterizing the timing and self-reported determinants of exercise intervention dropout among sedentary adults with overweight or obesity. The study also sought to explore variations in adherence among individuals who completed the 6- to 8-month structured exercise intervention.
Participation in exercise reduces the risk of cardiovascular disease, type 2 diabetes, certain cancers, obesity, depression, and anxiety. Despite the health benefits of consistent exercise, almost 80% of adults do not meet the recommended amount of exercise for either aerobic or resistance training. Among individuals motivated to enroll and complete exercise training through a lifestyle intervention trial, 20%–30% are unable to maintain this behavior change after completion of the trial.
Previous literature, has identified the most common reasons for individuals not regularly participating in exercise includes, lack of time, caregiving responsibilities, lack of a safe environment to exercise, weather, transportation issues, and lack of social support.
In Dr. Collins’ study, 947 adults with dyslipidemia (STRRIDE I, STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were enrolled to either control, or 1 of 10 different exercise interventions, differing in amount, intensity, and mode of exercise. Two groups were prescribed resistance training, and one group included dietary intervention.
652 participants completed the exercise intervention, while 295 of the participants dropped out. On average, participants who dropped out were non-White (98% vs 80%, P < 0.01), had a higher body mass index (31.0 vs 30.2 kg·m−2, P < 0.01), and were less fit prior to the start of the exercise interventions. Of those who dropped out, 67% did so before the start of or while ramping up to the prescribed exercise amount and intensity. The most reported reason for dropout was lack of time (40%). Notably, among individuals who completed the ramp training period, subsequent exercise intervention adherence did not waiver over the ensuing 6–8 months of training.
The findings of Collins’ study are some of the first to delineate associations between the timing of dropout and dropout determinants, providing guidance for future exercise interventions to better support individuals at risk for dropout.
Although most individuals know exercise is beneficial, there are a variety of determinants influencing their decision and behavior to maintain participation in an exercise intervention or dropout, and when they do so. Emphasis should be place on individuals during the initial 2 to 3 months of an exercise intervention as this is when they are most likely to dropout, possibly because the ramp up to the exercise prescription is far too lofty for sedentary individuals with overweight or obesity. The next step in this research will be to identify predictors of exercise intervention dropout, from psychosocial and clinical predictors to genetic and molecular ones.
Collins is currently a post-doc fellow in the lab of William E. Kraus, MD, at Duke University, and joined CAGPM’s the post-doctoral fellowship last fall. Her research is focused around utilizing personalized medicine approaches for targeting at-risk individuals using identified molecular, environmental, and personal factors associated with poor lifestyle intervention adherence and non-completion. Following the fellowship, Collins hopes to become an independent researcher with expertise in both genetic/machine learning statistical analyses, as well as precision medicine interventions for promoting exercise and weight loss maintenance long-term.
Learn more about the CAGPM post-doc training program