Effectiveness of Acceptance and Commitment Therapy (ACT) interventions for promoting physical activity: a systematic review and meta-analysis.

Physical inactivity is a key risk factor for non-communicable diseases, and there is a need for interventions to increase the adoption and maintenance of regular physical activity. Interventions based on Acceptance and Commitment (ACT) have shown promise for promoting a range of health behaviours, including physical activity. The aims of this review were to (1) determine the effectiveness of ACT interventions for physical activity; and (2) identify the ACT processes, behaviour change techniques (BCTs) and intervention characteristics associated with ACT interventions. Eight electronic databases were searched for ACT interventions that aimed to increase physical activity. Seven eligible studies were included in the systematic review, and ACT processes, Behaviour Change Techniques and other intervention components and characteristics of the included interventions were coded. Six studies were randomised controlled trials that were included in a random-effects meta-analysis, which indicated small-to-moderate effects on physical activity (SMD = 0.32, 95% CI (0.07, 0.57), p = 0.01). ACT interventions show promise for increasing physical activity, but very few of the 'active ingredients' of ACT interventions could be characterised as BCTs. Future development of ACT interventions for physical activity should attempt to describe and name the ACT processes targeted by the intervention, and the BCTs used to target those processes.

Evaluation of a very brief pedometer-based physical activity intervention delivered in NHS Health Checks in England: The VBI randomised controlled trial.

BACKGROUND: The majority of people do not achieve recommended levels of physical activity. There is a need for effective, scalable interventions to promote activity. Self-monitoring by pedometer is a potentially suitable strategy. We assessed the effectiveness and cost-effectiveness of a very brief (5-minute) pedometer-based intervention ('Step It Up') delivered as part of National Health Service (NHS) Health Checks in primary care. METHODS AND FINDINGS: The Very Brief Intervention (VBI) Trial was a two parallel-group, randomised controlled trial (RCT) with 3-month follow-up, conducted in 23 primary care practices in the East of England. Participants were 1,007 healthy adults aged 40 to 74 years eligible for an NHS Health Check. They were randomly allocated (1:1) using a web-based tool between October 1, 2014, and December 31, 2015, to either intervention (505) or control group (502), stratified by primary care practice. Participants were aware of study group allocation. Control participants received the NHS Health Check only. Intervention participants additionally received Step It Up: a 5-minute face-to-face discussion, written materials, pedometer, and step chart. The primary outcome was accelerometer-based physical activity volume at 3-month follow-up adjusted for sex, 5-year age group, and general practice. Secondary outcomes included time spent in different intensities of physical activity, self-reported physical activity, and economic measures. We conducted an in-depth fidelity assessment on a subsample of Health Check consultations. Participants' mean age was 56 years, two-thirds were female, they were predominantly white, and two-thirds were in paid employment. The primary outcome was available in 859 (85.3%) participants. There was no significant between-group difference in activity volume at 3 months (adjusted intervention effect 8.8 counts per minute [cpm]; 95% CI -18.7 to 36.3; p = 0.53). We found no significant between-group differences in the secondary outcomes of step counts per day, time spent in moderate or vigorous activity, time spent in vigorous activity, and time spent in moderate-intensity activity (accelerometer-derived variables); as well as in total physical activity, home-based activity, work-based activity, leisure-based activity, commuting physical activity, and screen or TV time (self-reported physical activity variables). Of the 505 intervention participants, 491 (97%) received the Step it Up intervention. Analysis of 37 intervention consultations showed that 60% of Step it Up components were delivered faithfully. The intervention cost £18.04 per participant. Incremental cost to the NHS per 1,000-step increase per day was £96 and to society was £239. Adverse events were reported by 5 intervention participants (of which 2 were serious) and 5 control participants (of which 2 were serious). The study's limitations include a participation rate of 16% and low return of audiotapes by practices for fidelity assessment. CONCLUSIONS: In this large well-conducted trial, we found no evidence of effect of a plausible very brief pedometer intervention embedded in NHS Health Checks on objectively measured activity at 3-month follow-up. TRIAL REGISTRATION: Current Controlled Trials (ISRCTN72691150).

Behavioural analysis of postnatal physical activity in the UK according to the COM-B model: a multi-methods study.

OBJECTIVE: Develop a behavioural analysis of factors influencing postnatal physical activity (PA) according to the 'capability, opportunity, motivation and behaviour' (COM-B) model of behaviour to inform intervention development using the Behaviour Change Wheel (BCW). DESIGN: Cross-sectional, multi-method study using semi-structured interviews and a quantitative questionnaire. SETTING: Children's centres and mother and baby groups in Hertfordshire and Cambridgeshire, UK. PARTICIPANTS: Convenience samples of postnatal women were interviewed (n=16) and completed the questionnaire (n=158). METHODS: Semi-structured interviews followed a preprepared topic guide exploring the COM-B model components and analysed using framework analysis. The questionnaire, based on the self-evaluation of behaviour questionnaire, was adapted using patient and public involvement and findings from the interviews. Questionnaire participants rated their agreement with 22 predefined statements related to COM-B model components. Mean, SD and 95% CI were calculated and each item categorised according to importance. Demographic data were collected. RESULTS: The questionnaire identified that new mothers would be more active if they had more time, felt less tired, had accessible childcare, were part of a group, advised by a healthcare professional, able to develop a habit and had more motivation. Additional themes emerging from qualitative data were engaging in PA groups with other new mothers, limited physical stamina following complicated births, social interaction, enjoyment and parental beliefs as motivation, provision of child-friendly PA facilities and environments and babies' unpredictable routines. CONCLUSION: The behavioural analysis presented in this paper identifies and adds detail on the range of factors influencing the target behaviour. Some are unique to the target population, requiring targeted interventions for postnatal women, whereas some are individualised, suggesting the need for individually tailored interventions. We will use the behavioural analysis presented to design an intervention using the subsequent steps in the BCW.

Optic ataxia and the dorsal visual steam re-visited: Impairment in bimanual haptic matching performed without vision.

The 'two visual systems' account proposed by Milner and Goodale (1992) argued that visual perception and the visual control of action depend upon functionally distinct and anatomically separable brain systems: a ventral stream of visual processing that mediates visual perception (object identification and recognition) and a dorsal stream of visual processing mediating visually guided action. Compelling evidence for this proposal was provided by the neuropsychological studies of brain injured patients, in particular the contrasting pattern of impaired and preserved visual processing abilities of the visual object agnostic patient [DF] and optic ataxic patients who it was argued presented with impaired dorsal stream function. Optic ataxia [OA] has thus become a cornerstone of this 'two visual system' account (Pisella et al., 2009). In the current study we re-examine this assumption by investigating how several individuals presenting with OA performed on a bimanual haptic matching task performed without vision, when the bar to be matched was presented haptically or visually. We demonstrate that, unlike neurologically healthy controls who perform the task with high levels of accuracy, all of the optic ataxic patients were unable to perform the task. We interpret this finding as further evidence that the key difficulty experienced by optic ataxic patients across a range of behavioural tasks may be an inability to simultaneously and directly compare two spatial representations so as to compute the difference between them.

What do we know about brief interventions for physical activity that could be delivered in primary care consultations? A systematic review of reviews.

This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5min or less) that could be delivered in a primary care consultation.

A randomised controlled trial of three very brief interventions for physical activity in primary care.

BACKGROUND: Very brief interventions (VBIs) for physical activity are promising, but there is uncertainty about their potential effectiveness and cost. We assessed potential efficacy, feasibility, acceptability, and cost of three VBIs in primary care, in order to select the most promising intervention for evaluation in a subsequent large-scale RCT. METHODS: Three hundred and ninety four adults aged 40-74 years were randomised to a Motivational (n = 83), Pedometer (n = 74), or Combined (n = 80) intervention, delivered immediately after a preventative health check in primary care, or control (Health Check only; n = 157). Potential efficacy was measured as the probability of a positive difference between an intervention arm and the control arm in mean physical activity, measured by accelerometry at 4 weeks. RESULTS: For the primary outcome the estimated effect sizes (95 % CI) relative to the Control arm for the Motivational, Pedometer and Combined arms were respectively: +20.3 (-45.0, +85.7), +23.5 (-51.3, +98.3), and -3.1 (-69.3, +63.1) counts per minute. There was a73% probability of a positive effect on physical activity for each of the Motivational and Pedometer VBIs relative to control, but only 46 % for the Combined VBI. Only the Pedometer VBI was deliverable within 5 min. All VBIs were acceptable and low cost. CONCLUSIONS: Based on the four criteria, the Pedometer VBI was selected for evaluation in a large-scale trial. TRIAL REGISTRATION: Current Controlled Trials ISRCTN02863077 . Retrospectively registered 05/10/2012.

Effectiveness and cost-effectiveness of a very brief physical activity intervention delivered in NHS Health Checks (VBI Trial): study protocol for a randomised controlled trial.

BACKGROUND: Physical activity interventions that are targeted at individuals can be effective in encouraging people to be more physically active. However, most such interventions are too long or complex and not scalable to the general population. This trial will test the effectiveness and cost-effectiveness of a very brief physical activity intervention when delivered as part of preventative health checks in primary care (National Health Service (NHS) Health Check). METHODS/DESIGN: The Very Brief Intervention (VBI) Trial is a two parallel-group, randomised, controlled trial with 1:1 individual allocation and follow-up at 3 months. A total of 1,140 participants will be recruited from 23 primary care practices in the east of England. Participants eligible for an NHS Health Check and who are considered suitable to take part by their doctor and able to provide written informed consent are eligible for the trial. Participants are randomly assigned at the beginning of the NHS Health Check to either 1) the control arm, in which they receive only the NHS Health Check, or 2) the intervention arm, in which they receive the NHS Health Check plus 'Step It Up' (a very brief intervention that can be delivered in 5 minutes by nurses and/or healthcare assistants at the end of the Health Check). 'Step It Up' includes (1) a face-to-face discussion, including feedback on current activity level, recommendations for physical activity, and information on how to use a pedometer, set step goals, and monitor progress; (2) written material supporting the discussion and tips and links to further resources to help increase physical activity; and (3) a pedometer to wear and a step chart for monitoring progress. The primary outcome is accelerometer counts per minute at 3-month follow-up. Secondary outcomes include the time spent in the different levels of physical activity, self-reported physical activity and economic measures. Trial recruitment is underway. DISCUSSION: The VBI trial will provide evidence on the effectiveness and cost-effectiveness of the Step It Up intervention delivered during NHS Health Checks and will inform policy decisions about introducing very brief interventions into routine primary care practice. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN72691150 . Registered on 17 July 2014.

Erratum to: Development and feasibility study of very brief interventions for physical activity in primary care.

Upon publication of this article [1] it has been noted that due to a technical error the publisher missed to include the Open Access Licence statement in the copyright line. The correct copyright line should have read: © 2015 Pears et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​4.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.

Development and feasibility study of very brief interventions for physical activity in primary care.

BACKGROUND: There is increasing interest in brief and very brief behaviour change interventions for physical activity as they are potentially scalable to the population level. However, few very brief interventions (VBIs) have been published, and evidence is lacking about their feasibility, acceptability and which 'active ingredients' (behaviour change techniques) would maximise their effectiveness. The aim of this research was to identify and develop promising VBIs for physical activity and test their feasibility and acceptability in the context of preventive health checks in primary care. METHODS: The process included two stages, guided by four criteria: effectiveness, feasibility, acceptability, and cost. In Stage 1, we used an iterative approach informed by systematic reviews, a scoping review of BCTs, team discussion, stakeholder consultation, a qualitative study, and cost estimation to guide the development of promising VBIs. In Stage 2, a feasibility study assessed the feasibility and acceptability of the short-listed VBIs, using tape-recordings and interviews with practitioners (n = 4) and patients (n = 68), to decide which VBIs merited further evaluation in a pilot trial. RESULTS: Four VBIs were short-listed: Motivational intervention; Action Planning intervention; Pedometer intervention; and Physical Activity Diary intervention. All were deliverable in around five minutes and were feasible and acceptable to participants and practitioners. Based on the results of interviews with practitioners and patients, techniques from the VBIs were combined into three new VBIs for further evaluation in a pilot trial. CONCLUSIONS: Using a two-stage approach, in which we considered the practicability of VBIs (acceptability, feasibility and cost) alongside potential efficacy from the outset, we developed a short-list of four promising VBIs for physical activity and demonstrated that they were acceptable and feasible as part of a preventive health check in primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN02863077. Registered 5 October 2012.

Validation of food diaries as measures of dietary behaviour change.

This study aimed to validate the ability of a 24-h food diary (the DIET-24) to accurately detect change in children's fruit and vegetable consumption at school snack time following implementation of the Food Dudes healthy eating intervention. Participants were 4- to 9-year-old children from two primary schools in England. There were 148 participants in the intervention school and 43 participants in the no intervention control school. For each child, snack-time fruit and vegetable consumption was measured separately by weight (grammes), and compared with teachers' estimates (to the nearest half portion) using the DIET-24. Both consumption measures were taken at T1 (pre-intervention) and T2 (post-intervention). At each time-point, Spearman rank correlations between the two measures were low to moderate, but significant. However, when compared with weighed measures, the DIET-24 did not always accurately detect significant changes in children's fruit and vegetable consumption following the intervention. To provide sensitive measures of behaviour change, it is important that dietary measures assess as accurately as possible the amount of food consumed, rather than, as is often the case, rely on all-or-none portion estimates. This issue is important for the establishment of a reliable evidence-base for healthy eating interventions.

Use of a clay modeling task to reduce chocolate craving.

Elaborated Intrusion theory (EI theory; Kavanagh, Andrade, & May, 2005) posits two main cognitive components in craving: associative processes that lead to intrusive thoughts about the craved substance or activity, and elaborative processes supporting mental imagery of the substance or activity. We used a novel visuospatial task to test the hypothesis that visual imagery plays a key role in craving. Experiment 1 showed that spending 10 min constructing shapes from modeling clay (plasticine) reduced participants' craving for chocolate compared with spending 10 min 'letting your mind wander'. Increasing the load on verbal working memory using a mental arithmetic task (counting backwards by threes) did not reduce craving further. Experiment 2 compared effects on craving of a simpler verbal task (counting by ones) and clay modeling. Clay modeling reduced overall craving strength and strength of craving imagery, and reduced the frequency of thoughts about chocolate. The results are consistent with EI theory, showing that craving is reduced by loading the visuospatial sketchpad of working memory but not by loading the phonological loop. Clay modeling might be a useful self-help tool to help manage craving for chocolate, snacks and other foods.

Effects of motor intention on the perception of somatosensory events: a behavioural and functional magnetic resonance imaging study.

The intention to execute a movement can modulate our perception of sensory events, and this modulation is observed ahead of both ocular and upper limb movements. However, theoretical accounts of these effects, and also the empirical data, are often contradictory. Accounts of "active touch", and the premotor theory of attention, have emphasized how movement intention leads to enhanced perceptual processing at the target of a movement, or on the to-be-moved effector. By contrast, recent theories of motor control emphasize how internal "forward" model (FM) estimates may be used to cancel or attenuate sensory signals that arise as a result of self-generated movements. We used behavioural and functional brain imaging (functional magnetic resonance imaging, fMRI) to investigate how perception of a somatosensory stimulus differed according to whether it was delivered to a hand that was about to execute a reaching movement or the alternative, nonmoving, hand. The results of our study demonstrate that a somatosensory stimulus delivered to a hand that is being prepared for movement is perceived to have occurred later than when that same stimulus is delivered to a nonmoving hand. This result indicates that it takes longer for a tactile stimulus to be detected when it is delivered to a moving limb and may correspond to a change in perceptual threshold. Our behavioural results are paralleled by the results of our fMRI study that demonstrated that there were significantly reduced blood-oxygen-level-dependent (BOLD) responses within the parietal operculum and insula following somatosensory stimulation of the hand being prepared for movement, compared to when an identical stimulus was delivered to a nonmoving hand. These findings are consistent with the prediction of FM accounts of motor control that postulate that central sensory suppression of somatosensation accompanies self-generated limb movements, and with previous reports indicating that effects of sensory suppression are observed in higher order somatosensory regions.

Modulation of somatosensory perception by motor intention.

The intention to execute a movement can modulate our perception of sensory events; however, theoretical accounts of these effects, and also empirical data, are often contradictory. We investigated how perception of a somatosensory stimulus differed according to whether it was delivered to a limb being prepared for movement or to a nonmoving limb. Our results demonstrate that individuals perceive a somatosensory stimulus delivered to the "moving" limb as occurring significantly later than when an identical stimulus is delivered to a "nonmoving" limb. Furthermore, human brain imaging (fMRI) analyses demonstrate that this modulation is accompanied by a significant decrease in BOLD signal in the right parietal operculum (SII) for stimuli delivered to the moving limb. These results indicate that during movement preparation a network of premotor brain areas may facilitate movement execution by attenuating the processing of behaviorally irrelevant signals within higher-order secondary somatosensory (SII) areas.

Cognitive neuroscience: vision and touch are constant companions.

To act on objects in the world around us, we must first construct an accurate representation of where they are physically located. Recent investigations have begun to shed light on how the brain dynamically binds together visual and somatosensory signals to create task-dependent representations that maintain object constancy.