From the Harvard Medical School (Celano, Millstein, Chung, Campbell, Legler, Park, Healy, Januzzi, Huffman); Departments of Psychiatry (Celano, Albanese, Millstein, Mastromauro, Chung, Campbell, Legler, Park, Huffman) and Neurology (Healy), Massachusetts General Hospital, Boston; The Methodology Center and Department of Human Development and Family Studies (Collins), Pennsylvania State University, University Park; and Division of Cardiology (Januzzi), Department of Medicine, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston.
Psychosom Med. 2018 Jul/Aug;80(6):526-534. doi: 10.1097/PSY.0000000000000584.
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.
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.
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.
These findings will enable optimization of the PP-based intervention in preparation for a well-powered controlled trial.
Clinicaltrials.gov, NCT02754895.
尽管身体活动和相关行为对预后有明显益处，但大多数经历急性冠状动脉综合征 (ACS) 的患者仍不遵守这些行为。积极心理结构（例如乐观）的缺陷与健康行为参与度降低有关，这支持在 ACS 后患者中使用基于积极心理学 (PP) 的干预措施的潜在效用。因此，我们旨在确定基于 PP 的干预措施的最佳组成部分，以促进 ACS 后的身体活动。
作为多阶段优化策略的一部分，我们对 128 名 ACS 后患者进行了一项随机因子试验，共有 8 个条件，以有效地确定表现最佳的干预措施组成部分。所有参与者都接受了基于 PP 的干预措施，条件在持续时间（有无强化课程）、强度（每周/每日 PP 练习）和内容（仅 PP 或与动机访谈相结合）上有所不同，在试验中允许进行三次并行比较。该研究的目的包括评估干预措施的整体可行性、可接受性和影响，以及确定哪些组成部分与 16 周时的客观测量身体活动和自我报告健康行为依从性相关的主要目的，这是使用纵向模型进行评估的。
该干预措施得到了很好的接受，并与行为和心理结果的显著改善相关。强化课程与活动量的增加呈显著相关（β=8.58，95%置信区间=-0.49-17.65，效应大小差异=0.43，p=0.064），动机访谈与整体依从性相关（β=0.95，95%置信区间=0.02-1.87，效应大小差异=0.39，p=0.044），而每周完成的练习通常优于每天。
这些发现将为基于 PP 的干预措施的优化提供依据，为一项具有充分效力的对照试验做准备。
Clinicaltrials.gov，NCT02754895。
