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Cited by 26Physical Activity and HealthDiabetes Management and EducationBehavioral Health and Interventions

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

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Huffman, Jeff C., Golden, Julia, Massey, Christina N., Feig, Emily H., Chung, Wei-Jean, Millstein, Rachel A., Brown, Lydia, Gianangelo, Taylor +4 more·2021·General Hospital Psychiatry
DOI 10.1016/j.genhosppsych.2020.12.001PMC PMC8307449
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Abstract

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.

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  • 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 [207]

    The citation is attached to “but not all,” and BEHOLD-16 provides a mixed example. The Results (Psychological and functional outcomes, Table 4) report no statistically significant advantage for moderate-to-vigorous physical activity at either follow-up, but significantly greater improvement in daily steps at 16 weeks. The study therefore does not support treating it as a trial that found no greater physical-activity improvement. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Effects of positive psychology-based programs on cardiac biomarkers or other disease markers have been mixed, with some observed effects on markers of inflammation in small trials in patients with heart failure or coronary artery disease, modest effects on glycosylated hemoglobin in small studies in diabetes, but minimal effects on other markers.

    “Effects of such programs on cardiac biomarkers (eg, inflammatory markers, heart rate variability) or other disease markers have been mixed, with some observed effects on markers of inflammation in small trials in patients with heart failure 209 or coronary artery disease, 210 modest effects on glycosylated hemoglobin in small studies in diabetes, 206,207 but minimal effects on other”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [207]

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2 of the 57 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [54]Moskowitz JT, Epel ES, Acree M. Positive affect uniquely predicts lower risk of mortality in people with diabetes. Health Psychol. 2008; 27: S73– 82. 18248108

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Authors
Huffman, J. C., Golden, J., Massey, C. N., Feig, E. H., Chung, W.-J., Millstein, R. A., Brown, L., Gianangelo, T., Healy, B. C., Wexler, D. J., Park, E. R., & Celano, C. M.
Affiliations
  • Harvard University (US)
  • Massachusetts General Hospital (US)
Corresponding author
Huffman, Jeff C.
ORCID
Venue
General Hospital Psychiatry
Publisher
Elsevier BV
Published
2021-01
Volume
68
Pages
65-73
ISSN
0163-8343 (ISSN-L)
DOI
10.1016/j.genhosppsych.2020.12.001
PMC
PMC8307449
OpenAlex
W3111410150
Cited by
26
References
57
Citations by year
2025: 5 · 2024: 2 · 2023: 7 · 2022: 10 · 2021: 2
FWCI
2.86
Type
journal article
Language
en
Open access
Licence
Locations
  • General Hospital Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
Funders
  • American Diabetes Association (1-17-ICTS-099)
  • National Heart, Lung, and Blood Institute (K23HL123607)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK111022, R21DK109313)
  • National Center for Advancing Translational Sciences (1UL1TR002541-01)
  • Catholic Medical Center (K23HL135277)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
type 2 diabetes, physical activity, positive psychology, motivational interviewing, feasibility, acceptability, moderate-to-vigorous physical activity, positive affect, diabetes counseling, step count
MeSH terms
Psychology, Positive, Diabetes Mellitus, Type 2, Humans, Pilot Projects, Exercise, Motivational Interviewing

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