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Cited by 78Cardiac Health and Mental HealthPhysical Activity and HealthOptimism, Hope, and Well-being

Optimizing a Positive Psychology Intervention to Promote Health Behaviors After an Acute Coronary Syndrome: The Positive Emotions After Acute Coronary Events III (PEACE-III) Randomized Factorial Trial

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Celano, Christopher M., Albanese, Ariana M., Millstein, Rachel A., Mastromauro, Carol A., Chung, Wei-Jean, Campbell, Kirsti A., Legler, Sean R., Park, Elyse R. +4 more·2018·Psychosomatic Medicine
DOI 10.1097/psy.0000000000000584PMC PMC6023730
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Abstract

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.

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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 [203]

    The Methods and Results (Between-group comparisons on MVPA; MVPA; page unavailable) identify this as a randomized study of positive psychology interventions in post-ACS patients and report greater activity with booster sessions, though the primary comparison was near-significant (p=.064). All groups received an active positive psychology intervention, so this trial does not show that positive psychology outperformed a non-intervention control condition; one trial also cannot establish that a majority of studies did so. (LLM, conf=0.87)

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Authors
Celano, C. M., Albanese, A. M., Millstein, R. A., Mastromauro, C. A., Chung, W.-J., Campbell, K. A., Legler, S. R., Park, E. R., Healy, B. C., Collins, L. M., Januzzi, J. L., & Huffman, J. C.
Affiliations
Pennsylvania State University (US)
Corresponding author
Huffman, Jeff C.
ORCID
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-07
Volume
80
Issue
6
Pages
526-534
ISSN
  • 0033-3174 (ISSN-L)
  • 1534-7796
DOI
10.1097/psy.0000000000000584
PMC
PMC6023730
OpenAlex
W2801618844
Cited by
78
References
20
Citations by year
2026: 5 · 2025: 7 · 2024: 3 · 2023: 13 · 2022: 8 · 2021: 12 · 2020: 15 · 2019: 10 · 2018: 5
FWCI
7.93
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (K23HL123607, R01HL113272, K23HL135277)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Social Sciences › Psychology › Applied Psychology › Optimism, Hope, and Well-being
Keywords
positive psychology interventions, acute coronary syndrome, physical activity, health behavior adherence, booster sessions, motivational interviewing, intervention optimization, exercise frequency, optimism
MeSH terms
Aged, Female, Health Promotion, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Health Behavior, Cognitive Behavioral Therapy, Acute Coronary Syndrome

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