Dash 2 Wellness: Effects of a Multi-Component Lifestyle Modification Program on Nutrition, Physical Activity, and Blood Pressure in Prehypertensive Middle-Aged Adults, a Randomized Controlled Trial

The primary goal of this project was to develop, implement, and evaluate a lifestyle modification intervention that did not require extensive, ongoing personal contact to improve lifestyle behaviors shown to lower blood pressure (BP) in adults with prehypertension (N=23, mean age=54, mean BP=126.7/75.1). Incorporating clinical practices and psychological approaches to behavior change, this intervention used primarily the DASH Eating Plan, coupled with a low-sodium diet and a walking program; it applied social cognitive theory to health behavior change, specifically self-regulation for self-monitoring and management of BP, diet, exericse, and weight. The study compared two conditions, the DASH 2 Wellness Only standard of care condition to the DASH 2 Wellness Plus treatment condition on the primary outcome measures of fruit and vegetable (servings/day), sodium consumption (milligrams/day), physical activity (steps/day), weight (kgs), and blood pressure (primarily systolic BP).

Consistent with hypotheses, MANOVAs detected significant differences between the conditions with D2W Plus evidencing a larger increase in change of total daily steps (M= 2900.14, SD= 1903.83) than D2W Only, (M= 636.39, SD= 1653.26), a larger decrease in systolic BP change (MMHG) (M= 15.14, SD= 4.33) than D2W Only, (M= 4.61, SD= 8.28), and a larger decrease in weight change (kg) (M= 4.78, SD= 3.81) than D2W Only, (M= 1.47, SD= 2.57). While conditions did not significantly differ on daily sodium reduction or fruit and vegetable increase, D2W Plus evidenced a larger decrease in sodium (mg) (M= 932.22, SD= 1019.22) than D2W Only, (M= 423.64, SD= 749.15) and larger increase in fruit and vegetable increase, (M= 2.10, SD= 1.73) than D2W Only, (M= 1.02, SD= 2.24). It was also hypothesized that the D2W Plus condition would show greater improvements in nutrition-specific and PA-specific health beliefs of self-regulation, social support, self-efficacy, social support, and outcome-expectancy compared to those in the D2W Only condition. A MANOVA revealed significant group differences in PA-specific health beliefs primarily attributable to increased PA self-regulation in D2W Plus compared to D2W Only, (M= 1.78, SD= 0.75) and (M= 0.55, SD= 0.57), respectively. While no overall significant group differences were found for nutrition-specific health beliefs, analyses showed meaningful differences in nutrition-specific health beliefs attributable to increased nutrition self-regulation strategies in D2W Plus compared to D2W Only. Results provide preliminary support for the efficacy of an electronic delivery of an intervention aimed at improving lifestyle behaviors and lowering BP in middle-aged individuals with prehypertension.