Research Articles
Project GRAD: two-year outcomes of a randomized controlled physical activity intervention among young adults1

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Abstract

Introduction: Project Graduate Ready for Activity Daily evaluated a program to promote physical activity through the transition of university graduation in a randomized controlled trial.

Methods: Three hundred thirty-eight university seniors participated in either a cognitive-behavioral intervention course or a knowledge-oriented general health course during the semester before graduation. Behaviorally oriented phone and mail follow-up was delivered to the intervention group for 18 months. Physical activity outcomes and mediating variables were assessed at baseline, 1 and 2 years (93% retention rate).

Results: There were no significant intervention effects on physical activity outcomes at 2 years for either men or women. Experiential and behavioral processes of change were significantly improved for intervention women over 2 years.

Conclusions: Despite excellent participation in a theoretically based, well-attended intervention, few long-term effects on physical activity or its mediators were found. Additional research is needed to determine optimal interventions for physical activity and to validate or alter current behavior change theory.

Introduction

B ecause of the well-documented health benefits of physical activity,1 there is concern about the dramatic decline in physical activity over the life span,2 beginning in childhood.3 Epidemiologic data show a decrease in the percent of high school boys and girls who participate in 3 or more days per week of vigorous physical activity by 16% and 20%, respectively. There are further decreases during the typical university years, aged 18 to 21 (6% for men; 7% for women).1 In a pilot study for the current project, almost half of recent graduates reported being less active than they were in college.4 A national study of college students found approximately 40% were inadequately active,5 and these data indicate the need for interventions that target college-aged young adults.

Developmental transitions may be an important concept in understanding the age-related decline in physical activity.6, 7, 8 High school and college provide many opportunities for physical activity in the form of physical education, intramural and varsity sports, and easy access to affordable exercise facilities. Upon graduation young adults have less unstructured time and reduced access to programs and facilities. This transition is characterized by concurrently increasing demands, such as beginning a career or getting married and starting a family. Therefore this and other life transitions may be periods of greater risk for relapse to a sedentary lifestyle.

The college and university settings offer many opportunities for intervening with students, through approaches that could be institutionalized, and such programs were targeted in Healthy People 2000.9, 10 Previous physical activity interventions in colleges were quasi-experimental,11, 12, 13, 14 so improved research designs are needed.

A recent meta-analysis shows that physical activity interventions are generally effective,15 but the authors cite 2 criticisms of this literature that are addressed in the present study. The first is poor maintenance of behavior change. The lack of continued intervention effects over time is not unique to interventions of physical activity.16, 17 Promising strategies for supporting long-term change with cost-effective approaches include mail and phone interventions15, 18, 19, 20 that proved more effective than face-to-face interventions in some cases,15, 21 possibly due to greater convenience of home-based programs. The acceptance, low cost, and evidence of efficacy of phone and mail interventions supports further evaluation of these methods for their ability to enhance long-term maintenance.

A second criticism of the literature is that most studies do not evaluate the effect of the intervention upon the theoretical mediators of behavior change that are targeted in the intervention. Additionally, most studies do not evaluate whether changes in mediators are related to changes in outcome. Baranowski and colleagues22, 23 recommend conducting analyses that (1) assess the impact of the intervention on the hypothesized mediating variables and (2) assess covariation between changes in mediators and outcomes. Such analyses test hypotheses derived from behavioral change theories and may lead to improvements in theories and interventions.

The purpose of Project GRAD (Graduate Ready for Activity Daily) was to evaluate a generalizable intervention to promote adoption and maintenance of physical activity among young adults transitioning from university to adult roles. The present study improves on previous research by assessing longer-term outcomes of both physical activity and theoretically derived mediators, and the relation between the two.

Section snippets

Participants

Participants were 185 male and 153 female seniors from a large urban university who responded to an invitation to participate in a health course with follow-up intervention. Demographic data on the original and follow-up samples are provided in Table 1. Eligible students were between the ages of 18 and 29, of senior class standing, and intending to graduate in the next 2 semesters. Students not able to perform moderate-intensity physical activity were excluded. The university identified

Intervention effects on physical activity outcomes

Results at the end of the course have been reported,28, 39 so the present analyses investigate effects at 1- and 2-years after baseline. There were no significant 3-way interaction effects (condition × activity status at baseline × time) for physical activity outcomes among women or men. There were also no 2-way interactions of condition by time for any of the 5 physical activity outcomes for men.

Among women, there were significant 2-way interactions of treatment condition by time for

Discussion

Two general conclusions from the present study are discussed. First, the intervention was not effective in promoting long-term physical activity. Second, the intervention was more successful among women than among men.

Two years after baseline, there were no significant differences between intervention and control participants on any of the 5 physical activity outcomes. The rationale for the extended intervention was that reductions in physical activity were expected unless students were

Acknowledgements

The authors wish to express their appreciation to Simon Marshall, LaShanda Jones, Jennifer Torio-Hurley, and Kecia Carrasco for their important contributions to the project.

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  • 1

    Tables of correlation coefficients and regression results are available from the first author upon request.

    2

    JA Sarkin is currently with the Department of Psychology, University of Rhode Island, Kingston, Rhode Island.

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