Most research on health behavior change programs examines their effectiveness in producing initial behavior changes, but fails to evaluate long-term maintenance of those changes. This study examined the effectiveness of the Cooper Wellness Program (CWP) in Dallas, Texas, in promoting maintenance of lifestyle behavior changes for one year or longer in the areas of diet, exercise, and stress management.

The CWP offers an intensive live-in lifestyle behavior modification program in four-, seven-, or 13-day formats. Data were collected from 223 individuals who attended the CWP between January, 1989, to February, 1992. The study addressed the following areas: 1) long-term maintenance rates of CWP participants for diet, exercise, and stress management, 2) differences in these rates between the three program-formats, and 3) factors related to the maintenance or relapse of these behaviors. Maintenance of overall lifestyle change was evaluated using a Composite Score (CS) calculated according to specific criteria established for each of the three areas. The American College of Sports Medicine’s recommendation for exercise was used as the standard for the exercise component; since no standard criteria exist in the current literature for successful maintenance of diet and stress management behaviors, specific criteria were arbitrarily established for purposes of this study.

Analysis indicated 29.9% (n = 158) of the respondents obtained a maximum Composite Score, i.e. reached or surpassed the standards established for diet, exercise, and stress management. Separate maintenance rates were high for exercise (81.1%) and stress management (98.1%) and low for dietary behaviors (31.8%). There were no significant differences in Composite Scores among the three program-formats (p = .645). While spousal support was not a significant predictor for long-term maintenance in any of the behaviors, “Lack of an exercise partner” was seen as a significant (p < .001) barrier to exercise for non-exercisers compared to successful exercise maintainers, as well as “Lack of exercise facilities” (p = .022) and “Boredom” (p < .0001). Respondents whose Composite Score indicated successful maintenance in all three areas rated the expertise of the program staff as the most helpful aspect of the CWP, and post-program follow-up support as the least helpful.

Although caution must be used in generalizing the results of this study to other programs, due in part to the relatively low survey response rate (31%), these findings suggest that a live-in, multi-intervention lifestyle behavior modification program can promote long-term maintenance of specific healthy behaviors. Implications for health behavior change programs and preventive health care are: 1) the need for standardized criteria for evaluating successful maintenance of healthy behaviors, especially in stress management and diet, 2) the need for post-program support and follow-up, and 3) continued study of the impact of spousal support and length of program on long-term maintenance rates.


School of Public Health

First Advisor

Glen Blix

Second Advisor

Helen Hopp

Third Advisor

Christine Neish

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Health Behavior; Health Promotion -- utilization; Program Evaluation



Page Count

viii; 95

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives