TY - JOUR
T1 - Optimizing a Positive Psychology Intervention to Promote Health Behaviors after an Acute Coronary Syndrome
T2 - The Positive Emotions after Acute Coronary Events III (PEACE-III) Randomized Factorial Trial
AU - Celano, Christopher M.
AU - Albanese, Ariana M.
AU - Millstein, Rachel A.
AU - Mastromauro, Carol A.
AU - Chung, Wei Jean
AU - Campbell, Kirsti A.
AU - Legler, Sean R.
AU - Park, Elyse R.
AU - Healy, Brian C.
AU - Collins, Linda M.
AU - Januzzi, James L.
AU - Huffman, Jeff C.
N1 - Publisher Copyright:
© 2018 Lippincott Williams & Wilkins.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Objective Despite the clear benefits of physical activity and related behaviors on prognosis, most patients experiencing an acute coronary syndrome (ACS) remain nonadherent to these behaviors. Deficits in positive psychological constructs (e.g., optimism) are linked to reduced participation in health behaviors, supporting the potential utility of a positive psychology (PP)-based intervention in post-ACS patients. Accordingly, we aimed to identify optimal components of a PP-based intervention to promote post-ACS physical activity. Methods As part of a multiphase optimization strategy, we completed a randomized factorial trial with eight conditions in 128 post-ACS patients to efficiently identify best-performing intervention components. All participants received a PP-based intervention, with conditions varying in duration (presence/absence of booster sessions), intensity (weekly/daily PP exercises), and content (PP alone or combined with motivational interviewing), allowing three concurrent comparisons within the trial. The study aims included assessments of the overall feasibility, acceptability, and impact of the intervention, along with the primary aim of determining which components were associated with objectively measured physical activity and self-reported health behavior adherence at 16 weeks, assessed using longitudinal models. Results The intervention was well accepted and associated with substantial improvements in behavioral and psychological outcomes. Booster sessions were associated with greater activity to a nearly significant degree (β = 8.58, 95% confidence interval =-0.49-17.65, effect size difference =.43, p =.064), motivational interviewing was associated with overall adherence (β = 0.95, 95% confidence interval = 0.02-1.87, effect size difference =.39, p =.044), and weekly exercise completion was generally superior to daily. Conclusions These findings will enable optimization of the PP-based intervention in preparation for a well-powered controlled trial. Clinical Trial Registration Clinicaltrials.gov, NCT02754895.
AB - Objective Despite the clear benefits of physical activity and related behaviors on prognosis, most patients experiencing an acute coronary syndrome (ACS) remain nonadherent to these behaviors. Deficits in positive psychological constructs (e.g., optimism) are linked to reduced participation in health behaviors, supporting the potential utility of a positive psychology (PP)-based intervention in post-ACS patients. Accordingly, we aimed to identify optimal components of a PP-based intervention to promote post-ACS physical activity. Methods As part of a multiphase optimization strategy, we completed a randomized factorial trial with eight conditions in 128 post-ACS patients to efficiently identify best-performing intervention components. All participants received a PP-based intervention, with conditions varying in duration (presence/absence of booster sessions), intensity (weekly/daily PP exercises), and content (PP alone or combined with motivational interviewing), allowing three concurrent comparisons within the trial. The study aims included assessments of the overall feasibility, acceptability, and impact of the intervention, along with the primary aim of determining which components were associated with objectively measured physical activity and self-reported health behavior adherence at 16 weeks, assessed using longitudinal models. Results The intervention was well accepted and associated with substantial improvements in behavioral and psychological outcomes. Booster sessions were associated with greater activity to a nearly significant degree (β = 8.58, 95% confidence interval =-0.49-17.65, effect size difference =.43, p =.064), motivational interviewing was associated with overall adherence (β = 0.95, 95% confidence interval = 0.02-1.87, effect size difference =.39, p =.044), and weekly exercise completion was generally superior to daily. Conclusions These findings will enable optimization of the PP-based intervention in preparation for a well-powered controlled trial. Clinical Trial Registration Clinicaltrials.gov, NCT02754895.
KW - Acute coronary syndrome
KW - multiphase optimization strategy
KW - myocardial infarction
KW - physical activity
KW - positive psychology
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UR - http://www.scopus.com/inward/citedby.url?scp=85048567271&partnerID=8YFLogxK
U2 - 10.1097/PSY.0000000000000584
DO - 10.1097/PSY.0000000000000584
M3 - Article
C2 - 29624523
AN - SCOPUS:85048567271
SN - 0033-3174
VL - 80
SP - 526
EP - 534
JO - Psychosomatic Medicine
JF - Psychosomatic Medicine
IS - 6
ER -