Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Am J Cardiol. 2019 Jun 15;123(12):1906-1914. doi: 10.1016/j.amjcard.2019.03.023. Epub 2019 Mar 19.
Most patients are not able to achieve recommended levels of physical activity following an acute coronary syndrome (ACS). Existing interventions to promote activity have not focused on promoting psychological well-being, which is independently linked to superior cardiac health. To address this gap, we developed and tested a combined positive psychology-motivational interviewing (PP-MI) intervention in post-ACS patients to assess its feasibility and explore potential benefits in an initial randomized trial. We compared a 12-week, phone-delivered, PP-MI intervention to an attention-matched, MI-based health education control condition among 47 post-ACS patients with low baseline health behavior adherence. Feasibility/acceptability were assessed through rates of session completion and participant session ratings; we also explored between-group differences in positive affect, other self-reported outcomes, and accelerometer-measured physical activity, through mixed effects regression models, at 12 and 24 weeks. PP-MI participants completed a mean of 10.0 (standard deviation 2.2) sessions (84%), and mean participant ratings of sessions' ease/utility were >8/10, above a priori thresholds for success. Compared with the control condition, PP-MI was associated with greater improvements in positive affect at 12 and 24 weeks (12 weeks: estimated mean difference [EMD] = 3.90 [SE = 1.95], p = 0.045, effect size [ES] = 0.56; 24 weeks: EMD = 7.34 [SE = 2.16], p <0.001, ES = 1.12). PP-MI was also associated with more daily steps at 12 weeks (EMD = 1842.1 steps/day [SE = 849.8], p = 0.030, ES = 0.76) and greater moderate-vigorous activity at 24 weeks (EMD = 15.1 minutes/day [SE = 6.8], p = 0.026, ES = 0.81). In conclusion, PP-MI was feasible in post-ACS patients and showed promising effects on well-being and physical activity; additional studies are needed to confirm these findings.
大多数急性冠状动脉综合征 (ACS) 患者在康复后无法达到推荐的身体活动水平。现有的促进活动的干预措施并未关注促进心理健康，而心理健康与心脏健康的改善密切相关。为了解决这一差距，我们在 ACS 患者中开发并测试了一种结合积极心理学和动机性访谈 (PP-MI) 的干预措施，以评估其在初步随机试验中的可行性并探索其潜在益处。我们将 47 名 ACS 后低基线健康行为依从性患者随机分配至为期 12 周的电话提供的 PP-MI 干预组或匹配注意力的基于 MI 的健康教育对照组，比较了这两组的可行性/可接受性。我们通过混合效应回归模型，在 12 周和 24 周时，评估了积极情绪、其他自我报告结果和加速度计测量的身体活动等方面的组间差异。PP-MI 组参与者完成了 10.0 次（标准差 2.2）课程（84%），平均参与者对课程的易读性/实用性评分均>8/10，超过了预先设定的成功标准。与对照组相比，PP-MI 与积极情绪在 12 周和 24 周时的改善更显著（12 周：估计平均差异 [EMD] = 3.90 [SE = 1.95]，p = 0.045，效应量 [ES] = 0.56；24 周：EMD = 7.34 [SE = 2.16]，p <0.001，ES = 1.12）。PP-MI 还与 12 周时的每日步数增加有关（EMD = 1842.1 步/天 [SE = 849.8]，p = 0.030，ES = 0.76），与 24 周时的中度至剧烈活动增加有关（EMD = 15.1 分钟/天 [SE = 6.8]，p = 0.026，ES = 0.81）。总之，PP-MI 在 ACS 患者中是可行的，并且对幸福感和身体活动具有良好的效果；需要进一步的研究来确认这些发现。
