A Positive Psychology-Motivational Interviewing Intervention to Promote Positive Affect and Physical Activity in Type 2 Diabetes: The BEHOLD-8 Controlled Clinical Trial.

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.

A positive psychology-motivational interviewing intervention for patients with type 2 diabetes: Proof-of-concept trial.

OBJECTIVE: Eighteen million Americans with type 2 diabetes (T2D) do not follow recommended guidelines for physical activity. Motivational interviewing (MI) has had modest effects on activity and related behaviors in T2D. Positive psychological attributes (e.g., optimism) are associated with superior medical outcomes in T2D, and positive psychology (PP) interventions promote such attributes. There had been no study in T2D of a combined PP-MI intervention to promote well-being and health behavior adherence. We developed a novel, telephone-delivered, 16-week PP-MI intervention and explored its feasibility and impact in T2D patients in a single-arm, proof-of-concept trial. METHOD: Participants completed PP-based exercises and MI-based physical activity goal-setting activities and reviewed these activities weekly with a study trainer for 16 weeks. Feasibility and acceptability were assessed via exercise completion rates and post-exercise ratings of ease/utility (0-10 scales). Impact was explored by examining changes in physical activity (via accelerometers and self-report), other health behaviors, psychological measures, and medical outcomes (e.g., hemoglobin A1c (A1C)) from baseline to 16 weeks, using paired t tests. RESULTS: Twelve participants enrolled, and 10 provided follow-up data. Seventy-eight percent of PP-MI activities were completed, and participants rated the PP-MI content and sessions as easy (mean = 8.2/10, standard deviation (SD) = 1.9) and useful (mean = 9.1/10, SD = 1.5). PP-MI was associated with improved adherence to health behaviors and overall self-care, variable effects on accelerometer-measured activity and psychological outcomes, and modest beneficial effects on body mass index and A1C. CONCLUSION: Further testing of this intervention is warranted in a larger, controlled trial to assess its effects on important health outcomes.

A positive psychology-motivational interviewing program to promote physical activity in type 2 diabetes: The BEHOLD-16 pilot randomized trial.

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.