J Community Health DOI 10.1007/s10900-015-0058-5

ORIGINAL PAPER

What Motivates Older Adults to Improve Diet and Exercise Patterns? Shoshana H. Bardach1



Nancy E. Schoenberg2,3 • Britteny M. Howell2,4,5

 Springer Science+Business Media New York 2015

Abstract Dietary intake and physical activity are lifestyle behaviors that are learned, developed, and practiced throughout an individual’s lifetime. These lifestyle behaviors have a profound role on health and quality of life—with late-life changes still resulting in notable improvements. Despite well documented benefits of behavior change, such changes are extremely challenging. The purpose of this study is to better understand from the perspective of older adults themselves, the factors that may influence their likelihood of making lifestyle changes. Participants were recruited two primary care clinics. 104 older adults ranging in age from 65 to 95 were included. Participants were interviewed about their motivations and plans to change diet and physical activity behaviors following a routine primary care visit. All interviews were transcribed and transcripts were analyzed using a line-byline coding approach. Older adults reported that their likelihood of making a lifestyle change related to perceptions of old age, personal motivation, and perceived

Britteny M. Howell was a Research Analyst for the Governor’s Council on Disabilities and Special Education for the state of Alaska. & Shoshana H. Bardach [email protected] 1

Sanders Brown Center on Aging and Graduate Center for Gerontology, University of Kentucky, Lexington, KY, USA

2

Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA

3

College of Public Health, University of Kentucky, Lexington, KY, USA

4

Northern Kentucky University, Highland Heights, KY, USA

5

Gateway Community and Technical College, Florence, KY, USA

confidence in the ability to make effective changes. These findings suggest the importance of creating more positive images of old age and tailoring health promotion efforts to older adults’ motivations and confidence in their ability to make behavior changes. Keywords Qualitative research  Older adults  Diet and physical activity  Health promotion

Diet and physical activity are lifestyle behaviors that are learned, developed, and practiced throughout an individual’s lifetime, with behaviors in early life often predicting later-life behaviors. These lifestyle behaviors play a profound role in determining health outcomes and quality of life - even if behavior changes do not occur until later in life [1]. Despite the potential benefits, of lifestyle change, healthy diet and physical activity remain suboptimal among older adults [2, 3]. Behavior change is challenging due to a variety of personal and socio-environmental factors including economic status, social influences from significant others, and accessibility and availability of healthy food choices and opportunities for physical activity [4]. The driving forces for change vary and behavior change may be abrupt or gradual. While researchers have identified a number of factors that predict the success of behavior change interventions, the purpose of this manuscript is to better understand from the perspective of older adults themselves, what influences their likelihood of making lifestyle changes. While there is limited literature among patients with specified health conditions examining patient perspectives on making and sustaining lifestyle changes and the identification of barriers and facilitators to engagement in healthy behaviors, we were unable to identify research exploring in-depth

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perspectives of a broad older adult population regarding the complexity of lifestyle change [5, 6]. While environmental changes can result in behavior change, typically health behavior change is dependent on individual choice. Consequently, this first-hand account of what factors enable lifestyle change and influence behavioral choices is fundamental to promoting healthier patterns. This is part of a larger study exploring patient-provider communication regarding diet and physical activity [7].

Method One hundred and four older adults, ranging in age from 65 to 95 were recruited from two primary care clinics at The University of Kentucky Medical Center and participated in semi-structured interviews immediately following a routine visit. Eligibility criteria were: seeing a provider who had agreed to allow patient recruitment; age of 65 years or older; and able to hear, speak English, and understand the informed consent and interview questions. We chose age 65 because many lifestyle recommendations for older adult use this delineation and age 65 is consistent with Medicare eligibility [8]. Data collection focused on current diet and physical activity behaviors and the likelihood of making any changes to these behaviors. Dietary behaviors were assessed using the BRFSS questions on fruit and vegetable consumption and physical activity was measured using the Godin Leisure Time Exercise Questionnaire [9, 10]. Measures included both close-ended and open-ended items and the full interview protocol was pilot-tested at the onset of the study. Initial questions focused on discussion with the primary care provider about diet and physical activity and then branched out to provide a more comprehensive understanding of individuals’ beliefs about diet and physical activity and likelihood of making changes. Questions were accompanied by follow up probes to obtain more detailed responses. All protocols were approved by the University of Kentucky Institutional Review Board and all participants consented to participate and have the interviews recorded. Interviews were transcribed and then coded line-by-line and analyzed using a constant comparative approach [11]. Codes were developed and revised in an iterative fashion, enabling the exploration of relationships and themes [12]. Two of the authors, experienced qualitative coders, independently coded a sample of the interviews, resulting in an 83 % agreement, a level considered appropriate [13]. While existing theories and prominent factors from the literature shaped the interview questions, coding focused on participant responses rather than pre-existing notions of factors influential in lifestyle change.

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Findings The 104 patients who were included in the analysis were on average 73 years old, ranging in age from 65 to 95. There were slightly more female (54 %) than male participants (46 %). The majority (59 %) were married. The sample was highly educated, with 69 % reporting some post-secondary education. The majority (58 %) of the participants perceived they had more than enough to get by financially, with just over a third (38 %) indicating household incomes above $50,000 a year. The majority (82 %) of the sample was white, non-Hispanic (See Table 1). While no specific weight, disease, or lifestyle criteria were used for participant recruitment, responses regarding current weight status and behaviors indicated a pervasive Table 1 Patient sociodemographic characteristics, N = 104 Characteristics Age, mean (SD, range)

73.0 (6.4, 65–95)

Sex, no. (%) Male

48 (46.2)

Female

56 (53.9)

Marital status, no. (%) Married/partnered

61 (58.7)

Separated/divorced

18 (17.3)

Widowed

22 (21.2)

Single, never married

3 (2.9)

Education, no. (%) \High school

16 (15.4)

High school/GED

16 (15.4)

Some college/AA degree/tech school College graduate

25 (24.0) 16 (15.4)

Graduate degree

31 (29.8)

Perceived financial status, no. (%) More than enough

60 (57.7)

Just enough

24 (23.1)

Struggle to get by

20 (19.2)

Household income Unknown/refused

10 (9.6)

Below $10,000

12 (11.5)

$10,000–$20,000

13 (12.5)

$20,001–$30,000

13 (12.5)

$30,001–$40,000

10 (9.6)

$40,001–$50,000 Above $50,000 Race/ethnicity, no. (%) White, not Hispanic White, Hispanic Asian, not Hispanic African American, not Hispanic

6 (5.8) 40 (38.5) 85 (81.7) 2 (1.9) 2 (1.9) 15 (14.4)

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need for lifestyle change. The majority of participants (69.2 %) self-reported height and weight placed them in the overweight or obese categories based on the National Heart Lung and Blood Institute criteria of overweight (BMI = 25–29.9) and obese (BMI of 30 or greater) [14]. Similarly, 64.7 % of participants indicated no moderate or vigorous physical activity and 58.8 % reported consuming fewer than five fruits and vegetables a day. Given that these were self-report data subject to social desirability responses, these responses may actually underestimate the need for lifestyle change. Participants conveyed an understanding of the value of healthy diet and physical activity; suboptimal participation in these behaviors did not seem to reflect a lack of awareness of their importance. Participants expressed an understanding that physical activity is: ‘‘important, I know it is. I just don’t do it,’’ and ‘‘I don’t follow it [healthy diet] as well as I should, but clearly that’s important, very.’’ Participants articulated three main factors that could influence the likelihood of making a lifestyle change: perceptions of old age, personal motivation, and perceived confidence in the ability to make effective changes. Perceptions of Old Age Perceptions of old age appeared to shape participants’ need for lifestyle change; the normalization of health symptoms and conditions as a regular part of old age interfered with participants’ recognition of opportunities for improvement. For many individuals, low expectations for old age seemed to undermine motivation for efforts to improve diet and physical activity. With low expectations for the future, and meager visions of what it would mean to be healthy at one’s current age, the potential to perceive benefits in behavior change was limited. Accordingly, when individuals thought they were doing well for their age and when they had constrained visions of old age where they were unable to envision improvements, they were unmotivated to make diet or physical activity changes. A number of participants indicated how they thought they were doing well for their age and expressed that they had no need to make changes. One 88 year-old woman expressed how she thought her overall health was poor, but that for someone her age her health was probably acceptable. By normalizing her problems she did not perceive a need to actively address them. Many mirrored this sentiment, suggesting ‘‘I can’t complain for my age’’ or ‘‘as old as I am, I’m in pretty good health.’’ One 83 year-old indicated she perceived herself as active, despite only reporting activity for approximately 10 min at a time, suggesting that, ‘‘I do about as much as I guess any average 83-year-old would do.’’ Others expressed that simply surviving until their age suggested they were doing fine. An

84 year-old male suggested, ‘‘I’m still around so I guess I’m doing a lot better [than others my age].’’ An 85 yearold male similarly indicated, ‘‘I think I’m doing wonderful just to be out of bed. I think it’s good.’’ He went on to say how many his age are dead or in the hospital and unable to do anything at all, so in comparison he felt he was doing very well. As many of the participants’ statements indicated, social comparison with others one’s own age strengthened the impression of ‘‘doing well for one’s age.’’ One 65 year-old male indicated, ‘‘I come here [the clinic] and see how other people are doing and realize I’m not doing too bad. I’m still up and moving and doing. I may be hurting and in pain, but I see people in crutches and wheelchairs and stretchers and think that I’m not doing too badly.’’ A 65 year-old female expressed, ‘‘compared to some of my classmates I’m doing great.’’ This ability to view oneself as doing better than others one’s age while positive for mental health, may reduce motivation to improve health behaviors. By normalizing conditions or symptoms as part of old age individuals may neglect opportunities to discuss deviations from optimal health that could be addressed through diet and physical activity. For instance, when asked about his chronic conditions, a 76 year-old male discounted his high blood pressure because, ‘‘everybody has that.’’ Similarly, a 72 year-old male discounted his fatigue concerns, accepting that they were just a part of age. A 76 year-old female acknowledged being overweight and indicated, ‘‘Part of it is just getting old.’’ Similarly, a 65 year-old male attributed his unhealthy diet to normative behaviors among older adults, ‘‘You know, old folks like me, we have meat at every meal.’’ While recognizing room for improvement in his diet, he recused himself of the need to make changes by suggesting his eating patterns are part of a cultural norm of old age. While some participants tended to attribute these symptoms to normal aging and, consequently felt limited in their capacity to change behavior, others viewed aging as a motivation for behavior change. For these participants, old age served as a reminder of personal vulnerability and a need to take greater responsibility for one’s health. For instance, one participant expressed, ‘‘nobody is going to look after you but you. And the older you get, the more you understand, that you have to look after yourself, there ain’t no pill.’’ Another participant indicated, ‘‘When you get older, if you don’t keep active you lose the ability…this [increased physical activity] is a concerted effort to put some money into staying mobile.’’ Motivation While older adults’ perceptions of aging shaped motivation to make lifestyle changes, participants also discussed

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personal motivation more explicitly as key to the likelihood of making a lifestyle change. They explained how motivation to make changes in diet and physical activity was influenced by health concerns and anticipated benefits of behavior changes. Motivation: The role of health concerns. Some participants expressed how their motivation to improve their diet and physical activity was influenced by a variety of health concerns, including new diagnoses, worsening laboratory values, functional concerns, negative health experiences, and a desire to avoid medication. The initial receipt of a health diagnosis served as a motivator to improve diet or increase physical activity. One participant expressed, ‘‘When I first found out I had it [diabetes], I tried to work with the diet.’’ For other older adults, it was not the diagnosis itself that served as a motivator; instead the cue to action stemmed from rising lab values, such as high blood glucose or cholesterol levels or elevated blood pressure, and functional concerns, such as breathing difficulties, and negative experiences with existing conditions. A 70 year-old female participant discussed how a negative health experience, a recent diverticulitis flare up, served as her motivation to change her diet, ‘‘I had a really terrible bout with it and ended up here in the emergency room, so very motivated [to change diet]. I don’t want that to happen again. It was very painful.’’ Another participant, a 70 yearold male with diabetes, expressed how a past negative health experience served as a motivator to improve his diet and physical activity. He expressed how over time, his healthy habits faded and he speculated that worsening lab values, in this case liver tests, would renew his motivation, At one point I weighed 360 pounds, and I had cirrhosis of the liver and so I had a liver transplant, and that was a real kick in the pants motivator. And after that I lost all that weight. For years I was in pretty good shape…I’m going to have some lab tests tomorrow, they are important lab tests. They are about my liver. If they were very bad, that would be a motivator I think that I wouldn’t turn back at. Others who had not yet experienced negative consequences of their conditions directly expressed the possibility of how if values worsened, e.g., if blood sugars increased, then they would be motivated to make changes. For some individuals with diabetes, the fear of amputation served to motivate. A 71 year-old male participant with diabetes and high blood pressure shared, Most people just eat everything, and I’ve been around people who said, ‘I just take a pill after I eat what I’m not supposed to eat,’ but I can’t do that. Because once they start cutting on me, and I want to keep all of it.

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To avoid diabetic complications, particularly amputation, this participant recognized the role of diet in managing his conditions and avoiding decline. Many participants expressed being motivated to improve their diet and physical activity in order to avoid having to take additional medication. A 68 year-old male participant expressed how the threat of needles motivated him to improve his blood glucose level through dietary change. Another 68 year-old male explained how the threat of medication motivated him in the past, ‘‘My cholesterol was up on my blood tests and she [my doctor] said, ‘do you want to take Lipitor or lifestyle change?’ and I said, ‘lifestyle change’. And I’ve done that and it got better.’’ Similarly, a 72 year-old man indicated, ‘‘Dr. H. threatened to put me on blood pressure medication and I said, ‘I can do this myself.’ So I practice the DASH diet and stuff like that.’’ Motivation: The role of anticipated benefit. Participants also expressed being motivated to engage in healthier behaviors because of anticipated benefits, including maximizing upcoming events (by being healthier or looking better), feeling better, and controlling existing conditions. Past experiences of benefit supported older adults’ future expectations of benefit. Past experiences where benefits were not experienced, however, undermined motivation for current behavior change efforts. A variety of upcoming events served as motivations for individuals to engage in healthier behaviors. Participants discussed how the desire to keep up with grandchildren on upcoming vacations or family visits served as motivations to increase physical activity. One participant indicated, ‘‘I’ve got 11 and 14 year-old grandkids that run me to death. So you got to stay in shape to keep up with them…So I need to get some exercise to keep up.’’ A few participants mentioned wanting to improve their appearance or health for upcoming social gatherings as motivators for weight loss. One older adult referenced an upcoming surgery as a motivator for weight loss; he felt weight loss would ease his rehabilitation. Many participants who had prior experience with the benefits of healthy diet and physical activity were motivated to improve their health behaviors to experience similar benefits again. A 68 year-old female participant discussed how a healthy diet had helped her achieve a healthy weight. She reported that this personal experience of the benefit of healthy eating served as a current motivator, ‘‘I have the motivation to do it [eat healthy] because I know I’ll feel a lot better.’’ These prior experiences enhance awareness of the personal benefits of healthy lifestyle behaviors and improve confidence that these benefits are obtainable. Past experience of benefits from

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healthy lifestyle choices self-reinforce to provide continued motivation. A 71 year-old male expressed how he started walking to keep his sugar levels down and that he has continued to do so because his newly acceptable sugar levels provide evidence that his walking is having a positive impact, ‘‘That’s [walking’s] what I’ve been doing since he told me that keeps it [blood sugar levels] down. And I found out, you know, it does, it keeps it way down. Keeps down where it’s supposed to be at.’’ The reverse was also true; a lack of noticeable or desired benefits sometimes led older adults to cease prior efforts. A 68 year-old male participant explained how when his prostate specific antigen (PSA) levels became detectable again after his prostatectomy he began exercising, I started walking four times a day, very fast, as fast as I could walk. I did that at least six days a week…And the PSA kept going up. So the exercise I couldn’t see was doing anything. Probably getting me in better shape, certainly, doing that, but it didn’t have that effect, and that was kind of dispiriting. So I stopped doing the walking…and I didn’t go back to walking because I didn’t have the same belief in it. This participant had increased his physical activity with an anticipated benefit—a stable PSA value—in mind. When the desired reduction in PSA levels was not realized, his motivation to remain active dissolved. Although he recognized that walking was beneficial to his health in other ways, he did not perceive these benefits to warrant maintenance of his walking regimen. Similarly, a 71 year-old woman reported how past dieting attempts resulted in weight gain, rather than the desired weight loss, discouraging her from future dieting attempts, ‘‘They have put me on diets and I gain weight…So I’m not a dieter.’’ Confidence These past experiences of behavior change—and the benefits experienced or not—while contributing to motivation, also relate directly to confidence in the ability to make and sustain lifestyle changes. Confidence level was shaped by past experiences of attempted changes and the development of clear, specific, feasible plans. Confidence in the ability to make changes was a key factor in the likelihood of making a lifestyle change. Confidence: Past success encourages future attempts. Just as past behavior change successes motivate future behavior change efforts, past efforts to make physical activity and dietary changes also influenced individual’s current confidence regarding their ability to make changes. Those who had a history of engaging in healthy dietary intake or significant physical activity and reported success

with past attempts to improve these behaviors were often more confident in their ability to return to healthy behaviors. For instance, a 68 year-old female participant reported, ‘‘I know I can [improve my diet] because I’ve done it before.’’ A 67 year-old female participant discussed how her past lifestyle change successes, combined with her recent retirement, provide her with the confidence and the opportunity to engage in healthier behaviors, I thought ok, I can do it [control diabetes with diet/ exercise], I did it before. I wasn’t active. I was school librarian for 20 years…By the time I got home I just wanted to curl up and help fix dinner. But I have no excuse now. I’m retired with not a thing to do yet. Those who had past experiences where they actively enjoyed being engaged in healthy behaviors were also more confident in their ability to make changes. Conversely, those who had tried to make changes in the past and were unsuccessful or who had successfully made changes but felt that those changes did not have much impact, reported less confidence in their ability to make changes. One 65 year-old male participant expressed the belief that diet is important but that improvement is ‘‘almost impossible.’’ He shared how he had tried to change his diet in the past and constantly felt hungry. While he was unable to remember the specifics of what dietary changes he had attempted, his perceived inability to make a change in his dietary practices lingered. A 75 year-old female participant also expressed how her lack of confidence in her ability to change her diet stemmed from past failures with diet attempts, ‘‘I have tried dieting, and I just do not stick with it. I can do good for two or 3 days, and then everything that is not nailed down is open territory. I’m not very good at dieting.’’ For some frailer older adults, providers suggested physical therapy to help them initiate physical activity. A few of these older adults expressed feeling discouraged given past difficulties keeping up with suggested exercises. Participants were also uncertain regarding their ability to make changes when they lacked feedback regarding the impact of past efforts. Individuals who received some indication that past efforts were effective had increased confidence regarding current efforts. A 71 year-old man expressed confidence that current efforts to improve his physical activity were working because his blood glucose levels were under control with his recent walking, negating the need to give himself an injection. A 68 year-old male participant explained, ‘‘I experiment a lot with my health and see what works, if I have a way of gauging it, measuring it.’’ He explained how he used his blood glucose levels to gauge the success of his dietary changes and felt that he could make changes if he wanted to because he knew that the

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changes work. Measurable positive feedback of behavioral choices not only enhanced confidence, but also contributed to a strengthened belief in the benefits of healthy choices, thereby also supporting sustained motivation to make healthy choices. Confidence: Feasible, actionable plans promote confidence to change behaviors. Older adults indicated feeling more confident in their ability to make changes when they had feasible, modest, and specific plans for change. Participants were more confident when the changes were not perceived to be strict or limiting, could be made gradually, and when the next steps were clearly identified. As participants developed a clear vision for change and their confidence in their ability to make changes increased, motivation for change also seemed to increase. Participants felt more confident about making health behavior changes when these changes seemed feasible. An 80 year-old female participant expressed her confidence that she could make changes in her physical activity because she felt that there were small things she could begin doing, ‘‘I could start out. There’s no such thing as not being able to unless you are totally disabled, which I am not.’’ A 70 year-old male participant indicated how he could make gradual changes, ‘‘I certainly can’t sprint anymore, but if you were to say, going from the mild, to what did you call it, moderate, I’m sure I could do that.’’ A 67 year-old woman expressed how the realization that she did not have to follow a specific diet precisely made it easier for her to sustain healthier dietary practices, ‘‘I’m not following South Beach properly, but I am making a lifestyle change.’’ Limitations The recruitment of older adults from a health care environment interferes with generalizability of findings. Older adults who seek regular medical care may differ from those who are less involved in the healthcare system. However, understanding how to encourage lifestyle change among older adult healthcare users may be especially valuable given the opportunity to intervene and promote future health [15]. These findings, grounded in real patient experiences, can help guide the development of effective health promotion efforts for older adults.

Discussion Older adults in this study reported that perceptions of old age, personal motivation, and perceived confidence in the ability to make effective changes influenced their likelihood of engaging in healthy diet and physical activity

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behaviors. The findings suggest the importance of helping older adults develop visions of health that are personally attainable and counteract negative societal stereotypes of old age with a positive discourse around old age. While overcoming a prominent cultural message is no small task, correcting societal misperceptions that age is synonymous with disease is fundamental. The need for such efforts may be particularly salient in medical settings where sickness may be more visible than health. Many health professionals have limited dedicated geriatrics/gerontology training, sparse experience with healthy elders, and a focus on problems associated with aging rather than optimal health in old age [16]. Accordingly, part of the effort to overcome the predominant societal discourse around aging should involve a concerted effort to ensure that educational programs involve a component focused on aging well. We are not suggesting, however, that the increased vulnerability to disease with age be ignored. Rather, as some participants in this study suggest, recognition of this vulnerability can help serve as a motivator for behavior change as long as it is accompanied by the possibility of an attainable positive future. The Extended Parallel Process Model (EPPM), a model developed to guide health communication campaigns, provides some guidance for how to balance perceptions of vulnerability with efficacy messages. The EPPM suggests that if individuals believe they are unable to respond to a threat, they react in a fear-control, rather than a danger control process [17]. If older adults view sickness and disease as inevitable, they will focus on coming to terms with impending sickness rather than being activated to sustain health. Without a vision of health as attainable and realistic, individuals do not possess a drive to improve health behaviors and do not even consider the ability to make changes. This may explain why some individuals in this study expressed the belief, ‘‘I’m doing well for my age’’ and that there was no need to continue with further health promotion efforts. This potential complacency suggests the importance of first providing older adults with images of health to fuel the desire for engagement in healthy behaviors and then tackling confidence in the ability to make changes and likelihood of those changes having a meaningful impact on future health. One challenge in this process lies in the tendency for individuals to consider themselves as above average in areas for which they compare themselves with others [18]. Social comparison may result in an overestimation of one’s own health and complacency that further improvement efforts may not be warranted. Given that it is fairly inevitable that people will compare themselves with others, researchers should explore ways to leverage social comparison in a more positive way. Prior research suggests that even very brief exposure to images and stories of positive

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aging can improve individuals’ expectations regarding aging [19]. Future research could expand on this finding to identify the contexts and strategies to best provide these positive referents to motivate behavior. The findings regarding personal motivation and perceived confidence highlight the value of tailoring health promotion efforts. Tailoring refers to individualizing health promotion messages based on factors related to the likelihood of behavior change [20]. Tailoring efforts should replace the generic message that a healthy diet and physical activity are good for you and identify how these behaviors may align with individuals’ health concerns and perceived benefits of behavior change. Similarly, tailored messaging should draw connections between individuals’ existing behaviors and experienced benefits, and problem-solve the barriers that may have interfered with prior behavior change efforts. Efforts to improve diet and physical activity should also start small and specific so as not to overwhelm the individual into inaction. The finding in the current study that past successful changes can encourage futures ones, while encouraging by demonstrating change is possible, also suggests that even successful behavior changes may not be sustained. Once an individual adopts a new health behavior sustainment becomes the next challenge. It is easy to return to ingrained habits, leading to a loss of health benefits and decreased confidence in the ability to make future changes. While the questions in the current study were focused more on behavior change than sustainment, the findings still provide valuable insights into strategies to support sustained improvements. The current study highlighted the importance of monitoring and concrete feedback such as value of liver or cholesterol tests, for sustaining optimal behaviors. Future research should explore alternate approaches—such as smart phone devices and tele-health to enable home monitoring—to provide feedback and promote long-term, sustainable lifestyle change. Prior research suggests that while action plans are influential for behavior change initiation, coping plans may be crucial for behavior change sustainment [21]. Further attention is needed to support the development of coping plans to increase the likelihood that positive changes endure. These coping plans should be sensitive to individual life context, addressing environmental, social, and financial constraints and capitalizing on enabling factors. While individuals can initiative a change based on the power of will alone, the likelihood of sustaining these efforts is greatly enhanced with attention to the multitude of facilitating and constraining factors that shape health behaviors. Acknowledgments This work was supported by the National Center for Research Resources (NCRR), funded by the Office of the Director,

National Institutes of Health (NIH) and supported by the NIH Roadmap for Medical Research (Grant Number TL1 RR033172). The content is solely the responsibility of the authors and does not necessarily represent the official views of National Center for Research Resources (NCRR) and National Institutes of Health (NIH).

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What Motivates Older Adults to Improve Diet and Exercise Patterns?

Dietary intake and physical activity are lifestyle behaviors that are learned, developed, and practiced throughout an individual's lifetime. These lif...
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