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Physical activity promotes health and longevity after metabolic/bariatric surgery (MBS), but most patients do not meet recommended levels. The Gaining Optimism After weight Loss Surgery (GOALS) Project was a positive psychological intervention designed to address common emotional barriers to physical activity in patients who have recently undergone MBS (e.g., low confidence around exercise, internalized weight bias, fear of injury) and use motivational interviewing and standard behavior change techniques (e.g., self-monitoring) to increase physical activity. This single-arm proof-of-concept trial was designed to refine the intervention, test feasibility and acceptability, and explore pre-post changes in behavioral and psychological outcomes. Participants were 12 adults 6-12 months post-MBS (M age of 46, 58% female, 67% non-Hispanic white). GOALS was a 10-week telephone counseling program that introduced new positive psychological skills and physical activity topics each week. Participants tracked physical activity with a Fitbit and set weekly goals. Results showed that the intervention was feasible (85% of sessions completed) and acceptable (average participant ratings of session ease and utility above 8.0 on a 0-10 scale). There were medium-to-large effect size improvements in physical activity and psychological well-being (e.g., depressive symptoms). The GOALS intervention will next be tested in a pilot randomized controlled trial with longer-term follow-up to assess its effect more robustly.
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Positive psychological interventions (PPIs), which aim to cultivate psychological well-being, have the potential to improve health behavior adherence. This systematic review summarized the existing literature on PPI studies with a health behavior outcome to examine study methodology, quality, and efficacy. Of the 27 identified studies, 20 measured physical activity, eight measured medication adherence, seven measured diet, and three measured smoking (eight targeted multiple behaviors). Twenty studies were randomized controlled trials (RCTs; 13 fully powered), and seven had a single-arm design. Study samples were usually adults (n = 21), majority non-Hispanic white (n = 15) and female (n = 14), and with a specific disease (e.g., diabetes, n = 16). Most interventions combined a PPI with health behavior-focused content (n = 17), used a remote delivery method (n = 17), and received a moderate or low study quality rating. Overall, 19/27 studies found a health behavior improvement of at least medium effect size, while six of the 13 studies powered to detect significant effects were statistically significant. Of the behaviors measured, physical activity was most likely to improve (14/20 studies). In summary, PPIs are being increasingly studied as a strategy to enhance health behavior adherence. The existing literature is limited by small sample size, low study quality and inconsistent intervention content and outcome measurement. Future research should establish the most effective components of PPIs that can be tailored to different populations, use objective health behavior measurement, and robustly examine the effects of PPIs on health behaviors in fully powered RCTs.
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Conductas Relacionadas con la Salud , Intervención Psicosocial , Adulto , Dieta , Ejercicio Físico , Femenino , Humanos , Cumplimiento de la MedicaciónRESUMEN
BACKGROUND: This pilot study aimed to test whether increase in daily steps and day-to-day consistency in daily steps during the first several weeks of a physical activity intervention predicted outcomes. METHODS: This was a secondary analysis from two concurrent studies testing a positive psychology-motivational interviewing intervention to increase physical activity and positive affect in individuals with type 2 diabetes. Steps were measured with accelerometers at study assessments (baseline, end-of-treatment, and 8-week follow-up) and were measured daily throughout the intervention by participants using provided pedometers. We calculated change in steps from intervention week 1 to week 3, along with variability in daily steps over the first 3 weeks, using the best fitting regression line modeling their change. Multiple regression analyses tested whether these predictors were associated with change in physical activity at the end of treatment and at 8-week follow-up. Additionally, we explored the utility of specific cutoffs (e.g., 500 steps) for early step change using a minimum p-value approach. RESULTS: In 52 participants, larger step increases by week 3 predicted activity increase at end-of-treatment and follow-up. Variability in early steps was not associated with outcomes. Early increase cutoffs of 500 and 2000 steps may have practical relevance. CONCLUSION: Early response to a physical activity intervention appears to be a useful predictor of outcome and could be used to identify those unlikely to succeed in a given intervention early in treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifiers NCT03150199 and NCT03001999.
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Diabetes Mellitus Tipo 2 , Entrevista Motivacional , Actigrafía , Diabetes Mellitus Tipo 2/terapia , Ejercicio Físico , Humanos , Proyectos PilotoRESUMEN
OBJECTIVE: Physical activity is associated with superior health outcomes in patients with type 2 diabetes (T2D), but most T2D patients do not follow physical activity recommendations. The objective of this study was to assess the feasibility and impact of a novel combined positive psychology-motivational interviewing (PP-MI) intervention to promote physical activity in T2D. METHODS: This controlled clinical trial compared an 8-week, phone-delivered PP-MI intervention to an attention-matched MI-enhanced behavioral counseling condition among 60 participants with T2D and suboptimal moderate to vigorous physical activity (MVPA; <150 min/wk). The primary study outcome was feasibility (proportion of sessions completed) and acceptability (0-10 ease and utility ratings of each session). Secondary outcomes were between-group differences in changes in positive affect (main psychological outcome) and accelerometer-measured physical activity (MVPA and steps per day), using mixed-effects regression models, at 8 and 16 weeks. RESULTS: Ninety-two percent of PP-MI sessions were completed, and mean participant ratings of ease/utility were 8.5 to 8.8/10, surpassing a priori benchmarks for feasibility and acceptability. PP-MI participants had small-medium effect size (ES) difference improvements in positive affect compared with MI (8 weeks: estimated mean difference [EMD] = 3.07 [SE = 1.41], p = .029, ES = 0.44; 16 weeks: EMD = 2.92 [SE = 1.73], p = .092, ES = 0.42). PP-MI participants also had greater improvements in MVPA (8 weeks: EMD = 13.05 min/d [SE = 5.00], p = .009, ES = 1.24; 16 weeks: EMD = 7.96 [SE = 4.53], p = .079, ES = 0.75), with similar improvements in steps per day. CONCLUSIONS: The PP-MI intervention was feasible and well accepted. Next-step efficacy studies can more rigorously explore the intervention's effects on physical activity and clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Registration No. NCT03150199.
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Diabetes Mellitus Tipo 2 , Entrevista Motivacional , Ejercicio Físico , Femenino , Humanos , Psicología Positiva , TeléfonoRESUMEN
Psychological well-being may play an important role in health behavior adherence and cardiovascular health, but there has been limited study of well-being in patients with heart failure. In this descriptive qualitative research study, we interviewed 30 patients with heart failure to explore their psychological experiences with heart failure and the perceived associations between positive psychological constructs and adherence to physical activity, diet, and medication recommendations. Interviews were transcribed, then coded in NVivo using directed and conventional content analysis, and the Consolidated Criteria for Reporting Qualitative Research checklist was applied to report our findings. Participants spontaneously reported positive psychological constructs both during an acute phase of illness and 3 months later. Participants most commonly experienced gratitude, acceptance, connectedness, and faith in the setting of heart failure. In contrast, pride, determination, and hope were identified most frequently as playing a role in health behavior adherence. Finally, participants reported a reinforcing relationship between positive constructs and health behavior engagement. These findings suggest that interventions to boost positive constructs have the potential to improve well-being and health behavior adherence in patients with heart failure.
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Insuficiencia Cardíaca/psicología , Cumplimiento y Adherencia al Tratamiento/psicología , Anciano , Anciano de 80 o más Años , Femenino , Conductas Relacionadas con la Salud , Insuficiencia Cardíaca/complicaciones , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricosRESUMEN
BACKGROUND: While leisure-time physical activity (PA) has been associated with reduced risk of cardiometabolic disease, less is known about the relationship between work-related PA and health. Work-related PA is often not a chosen behavior and may be associated with lower socioeconomic status and less control over job-related activities. This study examined whether high work-related PA and leisure-time PA reported by hospital employees were associated with healthier dietary intake and reductions in cardiometabolic risk. METHODS: This was a cross-sectional analysis of 602 hospital employees who used workplace cafeterias and completed the baseline visit for a health promotion study in 2016-2018. Participants completed the International Physical Activity Questionnaire and clinical measures of weight, blood pressure, HbA1c, and lipids. Healthy Eating Index (HEI) scores were calculated from two 24-h dietary recalls, and a Healthy Purchasing Score was calculated based on healthfulness of workplace food/beverage purchases. Regression analyses examined Healthy Purchasing Score, HEI, and obesity, hypertension, hyperlipidemia, and diabetes/prediabetes by quartile of work-related PA, leisure-time PA, and sedentary time. RESULTS: Participants' mean age was 43.6 years (SD = 12.2), 79.4% were female, and 81.1% were white. In total, 30.3% had obesity, 20.6% had hypertension, 26.6% had prediabetes/diabetes, and 32.1% had hyperlipidemia. Median leisure-time PA was 12.0 (IQR: 3.3, 28.0) and median work-related PA was 14.0 (IQR: 0.0, 51.1) MET-hours/week. Higher leisure-time PA was associated with higher workplace Healthy Purchasing Score and HEI (p's < 0.01) and lower prevalence of obesity, diabetes/prediabetes, and hyperlipidemia (p's < 0.05). Work-related PA was not associated with Healthy Purchasing Score, HEI, or cardiometabolic risk factors. Increased sedentary time was associated with lower HEI (p = 0.02) but was not associated with the workplace Healthy Purchasing Score. CONCLUSIONS: Employees with high work-related PA did not have associated reductions in cardiometabolic risk or have healthier dietary intake as did employees reporting high leisure-time PA. Workplace wellness programs should promote leisure-time PA and healthy food choices for all employees, but programs may need to be customized and made more accessible to meet the unique needs of employees who are physically active at work. TRIAL REGISTRATION: This trial was prospectively registered with clinicaltrials.gov (Identifier: NCT02660086) on January 21, 2016. The first participant was enrolled on September 16, 2016.
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Comportamiento del Consumidor/estadística & datos numéricos , Dieta/normas , Ejercicio Físico , Estado de Salud , Personal de Hospital/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Actividades Recreativas , Masculino , Persona de Mediana Edad , Personal de Hospital/estadística & datos numéricos , Lugar de TrabajoRESUMEN
Eating beyond physiological need contributes to obesity onset. Measuring this behavior could help identify those at risk for weight gain. This study measured eating in the absence of hunger (EAH) and its relationship with weight change and self-report measures related to appetite and eating behavior. EAH was assessed in 46 lean young women (69% pre-selected for weight gain proneness) after lunch and defined as the number of calories subsequently consumed from snacks. Participants also completed questionnaires, and their body weights were measured regularly over the next year. Participants consumed a mean 188 calories (±140) during the EAH test. Caloric intake during the EAH test was associated with hedonic hunger (pâ¯<â¯.01, R2â¯=â¯0.18), loss of control eating (pâ¯<â¯.001, R2â¯=â¯0.29), and weight gain over two months (pâ¯<â¯.01, R2â¯=â¯0.19), controlling for baseline body mass index. All were large effect sizes. In contrast, EAH was unrelated to emotional eating, disinhibition, and longer-term weight change. Amount of the test meal eaten in a hungry state was unrelated to these variables. While EAH has mainly been examined in children, these results expand its utility to adults. EAH seems to reflect naturalistic eating behavior, as shown by its relationship with short-term weight gain, drive to overconsume foods, and loss of control over eating. EAH may be a useful test to identify young adults at risk for weight gain and/or disordered eating, and may be a target for intervention.
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Ingestión de Alimentos/psicología , Hambre , Hiperfagia/psicología , Aumento de Peso , Adolescente , Adulto , Apetito , Índice de Masa Corporal , Femenino , Conductas Relacionadas con la Salud , Humanos , Obesidad/psicología , Autoinforme , Bocadillos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: Prior research suggests that both body mass index (BMI) and weight suppression (highest past weight minus current weight; WS) are important in determining adult anorexia nervosa (AN) severity. We examined associations between amenorrhea and WS, DSM-5 BMI severity category, and highest premorbid BMI among patients with AN. METHOD: Participants (N = 69) were adult female AN-spectrum patients at two residential treatment facilities. At admission, height, and weight were measured, and participants completed questionnaires assessing menstrual status and weight history. RESULTS: Greater WS, adjusted for BMI, was associated with menstrual function at admission. First amenorrhea onset occurred at a normal BMI for 38.5% of participants. Premorbid highest BMI positively correlated with BMI at amenorrhea onset, and higher BMI at amenorrhea onset was associated with higher BMI at menses resumption. DISCUSSION: These findings add to the literature indicating that relative and absolute weight status are dual indicators of illness severity in AN, and preliminarily suggest that a large proportion of adults who present for treatment initially may have shown symptoms of starvation at a normal BMI. Results underscore the need to focus on weight loss in early detection efforts and may inform target weight setting in the treatment of AN.
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Amenorrea/fisiopatología , Anorexia Nerviosa/fisiopatología , Anorexia Nerviosa/terapia , Índice de Masa Corporal , Peso Corporal/fisiología , Ciclo Menstrual/fisiología , Adolescente , Adulto , Amenorrea/etiología , Anorexia Nerviosa/complicaciones , Femenino , Humanos , Adulto JovenRESUMEN
BACKGROUND: Recent evidence suggests increased risk for mortality in bulimia nervosa (BN). However, little is yet known about suicidal behavior in BN. AIMS: To examine frequency and correlates of suicidal ideation and attempts in adolescents and adults with BN in two population-based samples. METHOD: A total of 10,123 adolescents and 2980 adults in two nationally representative surveys of mental disorder were queried regarding eating disorder symptoms and suicidal ideation and attempts. RESULTS: Less than 1 percent (0.9%) of adolescents and 1.0% of adults met the criteria for BN. Suicidal ideation was more common among adolescents with BN (53.0%) compared with those with binge eating disorder (BED) (34.4%), other psychopathology (21.3%) or no psychopathology (3.8%). Similar trends emerged for the association between BN and self-reported suicidal plans or attempts. Among adults, suicidality was more common in BN than in the no psychopathology group, but not significantly different from the anorexia nervosa (AN), BED, or other psychopathology subgroups. CONCLUSION: There is a high risk of suicidal ideation and behavior among those with BN. These results underscore the importance of addressing suicide risk in adolescents and adults with eating disorder symptoms.
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Bulimia Nerviosa/psicología , Ideación Suicida , Intento de Suicidio/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anorexia Nerviosa/diagnóstico , Anorexia Nerviosa/mortalidad , Anorexia Nerviosa/psicología , Trastorno por Atracón/diagnóstico , Trastorno por Atracón/mortalidad , Trastorno por Atracón/psicología , Bulimia Nerviosa/mortalidad , Causas de Muerte , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Psicopatología , Medición de Riesgo , Estados Unidos , Adulto JovenRESUMEN
Positive psychological well-being is prospectively associated with superior health outcomes. Positive psychology interventions have promise as a potentially feasible and effective means of increasing well-being and health in those with medical illness, and several initial studies have shown the potential of such programs in medical populations. At the same time, numerous key issues in the existing positive psychology literature must be addressed to ensure that these interventions are optimally effective. These include (1) assessing the nature and scope of PPWB as part of intervention development and application; (2) identifying and utilizing theoretical models that can clearly outline potential mechanisms by which positive psychology interventions may affect health outcomes; (3) determining consistent, realistic targets for positive psychology interventions; (4) developing consistent approaches to the promotion of positive psychological well-being; (5) emphasizing the inclusion of diverse samples in treatment development and testing; and (6) considering implementation and scalability from the start of intervention development to ensure effective real-world application. Attention to these six domains could greatly facilitate the generation of effective, replicable, and easily adopted positive psychology programs for medical populations with the potential to have an important impact on public health.
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OBJECTIVE: Psychological factors (e.g., depression, anxiety) are known to contribute to the development and maintenance of irritable bowel syndrome (IBS). Less is known, however, about the role of positive psychological well-being (PPWB) in IBS. Accordingly, we completed a systematic review of the literature examining relationships between PPWB and clinical characteristics in IBS. METHOD: A systematic review using search terms related to PPWB and IBS from inception through July 28, 2022, was completed. Quality was assessed with the NIH Quality Assessment Tool. A narrative synthesis of findings, rather than meta-analysis, was completed due to study heterogeneity. RESULTS: 22 articles with a total of 4285 participants with IBS met inclusion criteria. Individuals with IBS had lower levels of PPWB (e.g., resilience, positive affect, self-efficacy, emotion regulation) compared to healthy populations, which in turn was associated with reduced physical and mental health and health-related quality of life (HRQoL). Limited exploration of potential biological mechanisms underlying these relationships has been described. CONCLUSIONS: PPWB is diminished in individuals with IBS compared to other populations, and greater PPWB is linked to superior physical, psychological, and HRQoL outcomes. Interventions to increase PPWB may have the potential to improve IBS-related outcomes. REGISTRATION: Prospective Register of Systematic Reviews CRD42022304767.
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Síndrome del Colon Irritable , Humanos , Ansiedad , Síndrome del Colon Irritable/psicología , Bienestar Psicológico , Calidad de Vida/psicologíaRESUMEN
PURPOSE: Physical activity is critical for weight loss maintenance and cardiometabolic disease prevention after metabolic/bariatric surgery (MBS), but few patients meet recommended levels. While difficulties meeting physical activity recommendations are common in the general population, those who have undergone MBS may have unique psychological barriers to activity that impede success, including negative associations with physical activity that are related to a long history with obesity, weight stigma, and physical limitations. This qualitative study aimed to better understand the positive and negative emotional experiences of post-MBS patients with regard to physical activity to inform the development of an emotion-focused intervention to increase physical activity after MBS. METHODS: Adults who had MBS in the past 2 years completed semi-structured interviews and psychological/behavioral questionnaires. After transcription, a codebook was developed using inductive and deductive methods. Coded data were analyzed using content analysis. RESULTS: Participants were 23 adults (78% female). Contexts that contributed to positive emotions during physical activity included an enjoyable type of exercise, social interaction, mindfulness during exercise, and mastery. Contexts that contributed to negative affect were more unique to the MBS population, including all-or-nothing thinking about exercise, using distraction, depression, negative body image, exercising only for weight loss, and the COVID-19 pandemic. CONCLUSION: For most participants, emotional factors were relevant in the decision to be physically active and in their ability to maintain their habits. An intervention that encourages factors that lead to positive affect and addresses factors that lead to negative affect could be effective in increasing physical activity following MBS.
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Cirugía Bariátrica , COVID-19 , Obesidad Mórbida , Adulto , Cirugía Bariátrica/psicología , Emociones , Ejercicio Físico , Femenino , Humanos , Masculino , Obesidad Mórbida/cirugía , Pandemias , SARS-CoV-2RESUMEN
Background: Physical activity during midlife (ages 45-64) plays a major role in the prevention of chronic and serious medical conditions. Unfortunately, many midlife adults struggle to be physically active in the setting of low levels of psychological well-being and the management of multiple confluent sources of stress. Effective, scalable, midlife-specific interventions are needed to promote physical activity and prevent the development of chronic medical conditions. Objectives: In an initial proof-of-concept trial, we assessed the feasibility and acceptability of a new, midlife-adapted, phone- and text message-based intervention using positive psychology (PP) skill-building and motivational interviewing (MI) techniques. We secondarily analyzed post-intervention changes in accelerometer-measured physical activity and self-reported outcomes. Methods: The PP-MI intervention included six weekly phone sessions with a study trainer, with completion of PP activities and physical activity goals between calls, and in the subsequent six weeks briefer phone check-ins were conducted. Text messages over the 12-week intervention period were utilized to support participants and identify barriers to goal completion. Feasibility (session completion rates) and acceptability (participant ratings of intervention ease and utility) were assessed via descriptive statistics, and pre-post improvements in psychological, functional, and physical activity outcomes at 12 weeks were examined via mixed effects regression models. Results: Twelve midlife adults with low baseline physical activity enrolled in the single-arm trial. Overall, 76.8% of all possible sessions were completed by participants, and mean ratings of weekly phone sessions were 8.9/10 (SD 1.6), exceeding our a priori thresholds for feasibility and acceptability. Participants demonstrated generally medium to large effect size magnitude improvements in accelerometer-measured physical activity, psychological outcomes, and function. Conclusions: A novel, midlife-specific phone- and text-based PP-MI intervention was feasible and had promising effects on physical activity and other clinically relevant outcomes, supporting next-step testing of this program via a randomized controlled trial.
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BACKGROUND: Physical activity levels after bariatric surgery are usually low, despite the significant protective health benefits of physical activity in this population. Positive psychological well-being is associated with improved adherence to health behaviors, but bariatric surgery patients often have negative associations with physical activity that prevent sustained engagement. OBJECTIVE: The Gaining Optimism After weight Loss Surgery (GOALS) pilot randomized controlled trial is aimed at testing a novel intervention to increase physical activity after bariatric surgery, which incorporates positive psychological skill-building with motivational interviewing and goal-setting. METHODS: The GOALS trial is a 2-arm, 24-week pilot randomized controlled trial that aims to enroll 58 adults who report less than 200 minutes per week of moderate to vigorous physical activity and a desire to become more active 6-12 months after bariatric surgery. GOALS is testing the feasibility, acceptability, and preliminary efficacy of a positive psychology-motivational interviewing telephone intervention targeting to increase physical activity and associated positive affect. Intervention components include positive psychology, goal-setting, self-monitoring via provided Fitbits, and motivational interviewing to overcome barriers and increase motivation. The intervention is compared to a physical activity education control that includes mailings with psychoeducation around physical activity and provision of a Fitbit. The primary outcomes of the pilot trial are feasibility and acceptability, measured as session completion rates and participant ratings of ease and helpfulness of each session. The main secondary outcome is change in accelerometer-measured moderate to vigorous physical activity post intervention and at 24-week follow-up. Additional outcomes include changes in attitudes related to physical activity, psychological well-being, and physical health measures. RESULTS: This multiphase project was funded in 2020 and institutional review board approval was obtained for the proposed trial in 2021. Recruitment for the randomized controlled trial began in July 2022. Upon completion of the pilot trial, we will examine the feasibility, acceptability, and preliminary efficacy of the intervention. CONCLUSIONS: Although bariatric surgery is the most effective treatment available for severe obesity, weight regain occurs, often in the context of low psychological well-being. Many individuals would benefit from learning strategies to increase positive psychological well-being after bariatric surgery, which could help them maintain lifestyle changes. Positive psychology is a novel approach to improve adherence by increasing positive associations with health behaviors including physical activity. The GOALS pilot trial will determine whether this type of intervention is feasible and acceptable to this population and will provide a foundation for a future full-scale randomized controlled efficacy trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04868032; https://clinicaltrials.gov/ct2/show/NCT04868032. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/39856.
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Positive Psychological (PP) constructs (e.g., optimism and gratitude) may impact the adherence to healthy behaviors, including diet, though prior studies have shown mixed findings. This qualitative study explored the relationships between PP constructs and dietary behaviors among 21 adults with metabolic syndrome through semi-structured interviews. Directed content analysis led to five themes: eating healthfully leads to PP constructs, PP constructs lead to eating healthfully, eating healthfully prevents negative emotions, healthy behaviors associated with diet, and an upward healthy spiral. Given the close relationship between PP constructs and diet, these may be targeted to improve diet in risk populations through interventions that promote well-being.
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Peer support, a distinctive form of social support in which patients share emotional, social, and practical help based on their own lived experience of illness and treatment, positively impacts patient-reported outcomes in cancer populations. However, data on peer support experiences among hematopoietic stem cell transplant (HSCT) recipients are limited. We conducted semi-structured qualitative interviews among 12 allogeneic HSCT recipients who were ≤6 months post transplant without any complications and 13 allogeneic HSCT recipients >6 months post transplant and living with chronic graft-versus-host disease. Interviews explored patients' experiences with peer support and their preferences for a peer support intervention tailored to the needs of HSCT recipients. While the majority (70%) of participants reported no formal experience with peer support, most (83%) articulated themes of potential benefits of peer support (e.g., managing expectations and uncertainty that accompany HSCT). Most participants (60%) reported a preference for a peer support intervention prior to the HSCT hospitalization. Despite the limited data on peer support interventions among HSCT recipients and lack of formal peer support experience in most of our cohort, our study shows that HSCT recipients clearly acknowledge the potential benefits of a peer support intervention, and they prefer that it start prior to transplantation.
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Enfermedad Injerto contra Huésped , Neoplasias Hematológicas , Trasplante de Células Madre Hematopoyéticas , Estudios de Cohortes , Neoplasias Hematológicas/terapia , Humanos , Receptores de TrasplantesRESUMEN
Background: Many midlife adults (aged 45-64 years) struggle to become physically active in the context of diminished psychological well-being and multiple concurrent stressors, despite the clear association of low physical activity with the development of chronic medical conditions.Objectives: To assess the feasibility (rates of session completion) and acceptability (participant 0-10 ratings of weekly session ease and utility) of a novel 12-week, phone-delivered, midlife-adapted positive psychology-motivational interviewing (PP-MI) intervention to promote physical activity. Secondary aims were pre-post changes in accelerometer-measured physical activity and self-reported psychological and functional measures.Methods: A single-arm proof-of-concept trial of the PP-MI intervention was conducted among 11 inactive midlife adults enrolled from the primary care practices of an urban academic medical center. Descriptive statistics were used to assess feasibility and acceptability outcomes, and mixed effects models were used to examine pre-post changes in psychological, functional, and physical activity outcomes from baseline to 12 weeks.Results: The intervention exceeded a priori thresholds for feasibility and acceptability, with 80.3% session completion across all participants and mean session ratings of 8.3/10 (SD = 2.1). Participants also had medium effect size magnitude improvements in physical activity and psychological outcomes.Conclusions: This remotely delivered, midlife-specific PP-MI intervention was feasible and well-accepted among inactive midlife adults, supporting next-step testing of this program in a randomized trial.Trial Registration: ClinicalTrials.gov identifier: NCT04745182.
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Ejercicio Físico , Entrevista Motivacional , Adulto , Terapia Conductista , Humanos , Psicología Positiva , TeléfonoRESUMEN
BACKGROUND: Physical activity is strongly associated with lower risk of recurrent cardiac events in patients who experience an acute coronary syndrome (ACS), yet most patients do not meet recommended levels of physical activity. Psychological well-being is associated with higher levels of physical activity, but midlife adults experience a multitude of stressors that can reduce well-being. OBJECTIVE: The aim of this study was to compare midlife (age 45-64) and older (age 65+) participants in a positive psychology intervention to increase physical activity and psychological well-being after an ACS. METHODS: This was a secondary analysis across 3 phases of a telephone-delivered positive psychology intervention development project. Participants were hospitalized for an ACS and had low pre-ACS health behavior adherence. They received 8-12 weekly intervention sessions. Psychological outcomes, self-reported adherence, and physical activity were measured before and after treatment. Mixed regression models were used to compare session completion rates and change in outcome measures between midlife and older participants. RESULTS: Across 164 participants, midlife participants showed larger improvements in depression, positive affect, and physical activity, but not anxiety or optimism, than older participants; session completion rates did not significantly differ. CONCLUSIONS: Midlife patients post-ACS may be particularly responsive to a telephone-delivered positive psychology intervention. Clinically, the post-ACS period may be uniquely motivating for midlife patients to improve their physical and psychological health. Future work could customize positive psychology for unique midlife stressors.
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Síndrome Coronario Agudo , Psicología Positiva , Síndrome Coronario Agudo/terapia , Adulto , Anciano , Ejercicio Físico , Conductas Relacionadas con la Salud , Humanos , Persona de Mediana Edad , OptimismoRESUMEN
BACKGROUND: The majority of persons with type 2 diabetes (T2D) do not meet recommended levels of physical activity, despite clear links between physical activity and superior medical outcomes in this population. The objective of this trial was to assess the feasibility and impact of a novel 16-week combined positive psychology-motivational interviewing (PP-MI) program to promote physical activity among inactive persons with T2D. METHODS: This pilot randomized trial compared the 16-week, phone-delivered PP-MI intervention to an attention-matched diabetes counseling condition among 70 persons with T2D and low levels of baseline moderate to vigorous physical activity (MVPA; <150 min/week). The primary study outcomes were feasibility (assessed via rates of session completion) and acceptability (assessed via mean participant ratings [0-10] of the ease and utility of weekly sessions). Key secondary outcomes included between-group differences in improvement in positive affect, other psychological outcomes, and accelerometer-measured physical activity, assessed using mixed effects regression models, at 16 and 24 weeks. RESULTS: Participants completed a mean 11.0 (SD 4.4; 79%) of 14 PP-MI phone sessions, and composite mean ratings of ease/utility were 8.6/10, above our a priori benchmarks for feasibility/acceptability (70% session completion; 7.0/10 mean ratings). PP-MI participants had small to medium effect size (ES) difference improvements in MVPA (ES difference = 0.34) and steps/day (ES difference = 0.76) at 16 weeks, with sustained but smaller effects at 24 weeks (ES difference = 0.22-0.33). CONCLUSIONS: Next-step studies of this PP-MI program in T2D patients can more rigorously explore the intervention's effects on physical activity and clinical outcomes.
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Diabetes Mellitus Tipo 2 , Entrevista Motivacional , Diabetes Mellitus Tipo 2/terapia , Ejercicio Físico , Humanos , Proyectos Piloto , Psicología PositivaRESUMEN
This study tested the hypothesis that internalized weight bias (WBI) is negatively associated with health-related quality of life, weight loss and health behaviour adherence (eg, physical activity, diet, vitamin adherence) in patients who had weight loss surgery (WLS). It also tested whether self-efficacy for exercise, barriers to being active and depression were mediators between WBI and moderate-to-vigorous physical activity (MVPA). Participants were recruited from online support forums. They completed an anonymous online survey assessing WBI, physical activity, health behaviour adherence, depression, health-related quality of life, self-efficacy for exercise and barriers to being physically active. Multiple regression analyses and a bootstrapping approach for mediation were used. The sample included 112 primarily white and female adults, who had surgery 1 month to 24 years prior. WBI was negatively associated with weight loss since surgery, MVPA, dietary adherence, vitamin adherence and mental health-related quality of life, and was not associated with walking, physical health-related quality of life or fluid intake adherence. Self-efficacy for exercise, barriers to being active and depression were partial mediators between WBI and physical activity. After WLS, WBI may signal poorer adherence to critical health behaviours. It also is associated with less weight loss. WBI should be assessed and treated by WLS providers.