The Effect of Change Stage-Based Physical Activity Counseling on Physically Inactive Individuals With Hypertension

Hypertension (HT) is the second most commonly diagnosed condition in Turkey and represents a global health issue. Studies indicate that the prevalence of HT in Turkey ranges from 30% to 35%, with a steadily increasing trend. When healthy lifestyle behaviors become ingrained attitudes, they can contribute to maintaining well-being and improving health status, thereby preventing chronic diseases. However, patients' attitudes and behaviors regarding HT management and preventive measures have been found to be inadequate. Guidelines for HT prevention target modifiable risk behaviors such as weight loss, healthy eating, increased physical activity, and reduced alcohol consumption. Changes that can positively impact blood pressure include increased physical activity, reduced salt intake, smoking cessation, weight loss, alcohol restriction, and the adoption of a healthy dietary pattern.

In 2013, the American Heart Association, the American Hypertension Association, and the European Hypertension Association published lifestyle modification recommendations consistent with the Dietary Approaches to Stop Hypertension (DASH), emphasizing a sodium intake of less than 1.5-2.3 grams per day, weight loss for individuals with a body mass index (BMI) >25, alcohol intake limited to 10-20 grams per day, and aerobic exercise targeting 150 minutes per week. Each of these interventions is expected to reduce systolic blood pressure (SBP) by 4-6 mmHg in a dose-dependent and additive manner. Addressing factors contributing to HT etiology, such as obesity, dietary excesses (high sodium, inadequate potassium, calcium, magnesium, protein, fiber, and omega-3 fatty acids), alcohol consumption, and physical inactivity, can collectively reduce blood pressure by an average of 5 mmHg. In the SUN cohort, adherence to non-smoking, physical activity (150 minutes/week), a Mediterranean diet, and maintaining a BMI of less than 22 in men and 25 in women, along with either abstaining from or limiting alcohol consumption, was associated with nearly a 50% reduction in HT risk. Smoking has been noted to increase SBP by 4 mmHg compared to placebo.

In recent years, the importance of reducing sedentary lifestyles and increasing physical activity for public health has gained recognition. There is substantial evidence of the numerous physiological and psychological benefits of physical activity, including the prevention or improvement of coronary heart disease, hypertension, type II diabetes, colon cancer, obesity, stress, and depression. Physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure, encompassing not only sports activities but also exercise, household chores, and workplace physical activities.

Data from the World Health Organization (WHO) indicate that physical inactivity is among the top ten global causes of mortality and disability. WHO recommends that regular moderate-intensity physical activity be performed for at least 30 minutes on most days of the week. However, 60-85% of the global population does not engage in the recommended level of physical activity. In a 2004 study conducted by the Turkish Ministry of Health titled "Healthy Eating, Protecting Our Hearts," physical activity habits were surveyed among 15,468 adults from seven provinces, revealing that only 3.5% engaged in regular physical activity (defined as at least three days per week of moderate intensity for 30 minutes). According to the National Household Research (2006), 20.32% of individuals over 18 years of age in Turkey were found to be sedentary, and 15.99% exhibited insufficient levels of physical activity.

Despite extensive knowledge regarding the health benefits of physical activity, many adults do not engage in sufficient physical activity. Research suggests that mere knowledge about physical activity is insufficient for behavior change. Robbins et al. indicated that lifelong physical activity can be promoted through theory-based interventions. Studies have shown that interventions aimed at increasing physical activity grounded in the Transtheoretical Model (TM) are effective. Developed by Prochaska and DiClemente in 1982, TM is a promising internationally recognized model for health behavior change, comprising four elements: stages of change, self-efficacy, decisional balance, and processes of change. The stages of change define the time dimension of behavior modification, explaining the timing of individuals' intentions, attitudes, and behavior changes. Progress through these stages also signifies an individual's readiness to engage in regular physical activity. The physical activity behavior change process consists of five stages: pre-contemplation, contemplation, preparation, action, and maintenance.