Can Preference Predict Adherence To The Prenatal Nutrition And Exercise Lifestyle Intervention Program (NELIP)?

Adherence is key to effective nutrition and exercise intervention programs during pregnancy to reduce the incidence of adverse health and birth outcomes. However, low program adherence is a common limitation of intervention studies that include both nutrition and exercise. Previous literature has provided evidence to suggest that preference may be linked to adherence. PURPOSE: To determine whether there is greater adherence to the previously established Nutrition and Exercise Lifestyle Intervention Program (NELIP; NCT02804061) if individuals’ preference of intervention strategy (nutrition and exercise presented simultaneously (Group A), exercise first followed by nutrition (Group B), or nutrition first followed by exercise (Group C)), matched the strategy in which they were randomized and if preference can predict adherence. METHODS: Participants were asked in an Exit Survey if they were randomized to the strategy they preferred and were asked to respond either "yes," "no," or "indifferent" and were then divided into these three response groups. Mean overall adherence and if they achieved 70% adherence (Yes/No) was compared for each strategy. RESULTS: Of the 78 participants, for those whose preference matched their randomized group (‘Yes’; n = 33), 21 of them adhered to >70% of the program compared to those who did not prefer their assigned group (‘No’; n = 7 out of 19 total)(χ2(1, n = 28) = 7, p = .05). When preference was not a factor ('Indifferent'; n = 26), participants randomized to Group C had the greatest adherence to the overall program (79.2 ± 15.6%) compared to those randomized to Groups A (63.9 ± 11.2%) and B (65.3 ± 11.8%; F (2, 23) = 3.552, p = 0.045). No correlation was found between preference and adherence suggesting preference is not associated with adherence; however, intervention strategy, specifically Group C, predicted adherence (R2 = .315, F (1, 76) = 8.352, p = .005). CONCLUSIONS: When starting a lifestyle intervention program during pregnancy, preference of intervention strategy may be a factor to consider. Group C demonstrated the greatest adherence regardless of preference and predicted adherence to NELIP. Therefore, exercise followed by nutrition may be the optimal strategy and should be recommended to pregnant individuals.