A Randomized Controlled Trial of Positive-Affect Induction to Promote Physical Activity After Percutaneous Coronary Intervention
Open accessAbstract
BACKGROUND: Within 1 year after percutaneous coronary intervention, more than 20% of patients experience new adverse events. Physical activity confers a 25% reduction in mortality; however, physical activity is widely underused. Thus, there is a need for more powerful behavioral interventions to promote physical activity. Our objective was to motivate patients to achieve an increase in expenditure of 336 kcal/wk or more at 12 months as assessed by the Paffenbarger Physical Activity and Exercise Index. METHODS: Two hundred forty-two patients were recruited immediately after percutaneous coronary intervention between October 2004 and October 2006. Patients were randomized to 1 of 2 groups. The patient education (PE) control group (n = 118) (1) received an educational workbook, (2) received a pedometer, and (3) set a behavioral contract for a physical activity goal. The positive-affect/self-affirmation (PA) intervention group (n = 124) received the 3 PE control components plus (1) a PA workbook chapter, (2) bimonthly induction of PA by telephone, and (3) small mailed gifts. All patients were contacted with standardized bimonthly telephone follow-up for 12 months. RESULTS: Attrition was 4.5%, and 2.1% of patients died. Significantly more patients in the PA intervention group increased expenditure by 336 kcal/wk or more at 12 months, our main outcome, compared with the PE control group (54.9% vs 37.4%, P = .007). The PA intervention patients were 1.7 times more likely to reach the goal of a 336-kcal/wk or more increase by 12 months, controlling for demographic and psychosocial measures. In multivariate analysis, the PA intervention patients had nearly double the improvement in kilocalories per week at 12 months compared with the PE control patients (602 vs 328, P = .03). CONCLUSION: Patients who receive PA intervention after percutaneous coronary intervention are able to achieve a sustained and clinically significant increase in physical activity by 12 months. Trial Registration clinicaltrials.gov Identifier: NCT00248846.
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Prior studies of positive psychology interventions in other medical cohorts have found improvements in psychological and health behavior outcomes.
“These findings are also consistent with prior studies 14,16,17 of positive psychology interventions in other medical cohorts that have found improvements in psychological and health behavior outcomes.”
From Feasibility and acceptability of a positive psychological intervention for patients with type 2 diabetes (2016) · cites this paper as [17]
Positive psychology-based programs have led to improvements in health behaviors in studies of patients with hypertension or heart disease.
“Positive psychology-based programs have also led to improvements in health behaviors in studies of patients with hypertension or heart disease, 15-17”
From Feasibility and acceptability of a positive psychological intervention for patients with type 2 diabetes (2016) · cites this paper as [17]
A majority, but not all, of randomized studies found positive psychology-based interventions to be associated with greater improvements in physical activity compared with control conditions.
“Several such programs, either alone or combined with motivational interviewing, have focused on the promotion of physical activity in patients with cardiac disease or cardiac risk conditions in randomized studies, with a majority, 203-207 but not all, 208 of such studies finding positive psychology-based interventions to be associated with greater improvements in physical activity compared”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [204]
Interventions that explicitly target positive emotion show promise for improving health outcomes in a number of chronic illnesses.
“Interventions that explicitly target positive emotion show promise for improving health outcomes in a number of chronic illnesses, including diabetes [16,17], heart disease [18,19], hypertension [20,21], depression [22,23], and HIV [24].”
Randomized controlled trials of positive psychology-related interventions in heart and lung disease patients led to improvements from baseline health behaviors, including medication adherence and physical activity.
“More recently, randomized controlled trials of PP-related interventions in heart and lung disease patients led to improvements from baseline health behaviors (medication adherence and physical activity) [46–48].”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [48]
Randomized trials of PP-type interventions in patients with cardiovascular illness found significantly greater improvements in health behaviors (e.g., physical activity and medication adherence) than in control conditions.
“Even more promising are the findings from randomized trials [47, 48] of PP-type interventions in patients with cardiovascular illness that found such interventions to be associated with significantly greater improvements in health behaviors (e.g., physical activity [48] and medication adherence [47]) than in the control conditions.”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [48]
The established benefits of PP on mood, resilience, well-being, and optimism are associated with increased physical activity.
“Regarding direct effects of PP on activity, the established benefits of PP on mood, resilience, well-being, and optimism (pathway B1) [41, 54, 124, 125] are associated with increased physical activity (pathway B2) [48, 88, 123, 131, 132].”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [48]
Positive psychology programs improve psychological and health outcomes in people with chronic conditions like heart disease, hypertension, and HIV.
“PP programs have also been found to improve psychological and health outcomes in individuals with chronic medical conditions such as heart disease, hypertension, and HIV [26–31].”
From Well-being interventions for individuals with diabetes: A systematic review (2019) · cites this paper as [30]
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“Given growing evidence that positive affect has unique beneficial psychological and physical health effects, researchers have begun testing interventions that target positive affect and found emerging evidence of efficacy in various populations (Boutin-Foster et al., 2016; Cohn et al., 2014; Huffman et al., 2015; Mosk…”
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- Authors
- Peterson, J. C.
- Affiliations
- Weill Cornell Medicine (US)
- Corresponding author
- Peterson, Janey C.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2012-02-27
- Volume
- 172
- Issue
- 4
- Pages
- 329
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC3717982
- OpenAlex
- W2027203436
- Cited by
- 178
- References
- 69
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 6 · 2023: 11 · 2022: 16 · 2021: 9 · 2020: 16 · 2019: 15 · 2018: 22 · 2017: 14 · 2016: 13 · 2015: 12 · 2014: 17 · 2013: 11 · 2012: 8
- FWCI
- 10.29
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc25196-0-0-0)
- National Heart, Lung, and Blood Institute (N01 HC025196, 1N01-HC-25196)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- self-affirmation, physical activity promotion, percutaneous coronary intervention, coronary artery disease, behavioral interventions, telephone follow-up, pedometers, behavioral contracts, patient education, energy expenditure, post-myocardial infarction rehabilitation
- MeSH terms
- Antihypertensive Agents, Female, Humans, Hypertension, Male, Patient Education as Topic, Cognitive Behavioral Therapy, Medication Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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