Increasing Physical Activity in Patients With Asthma Through Positive Affect and Self-affirmation

Abstract

Background Patients with asthma engage in less physical activity than peers without asthma. Protocols are needed to prudently increase physical activity in asthma patients. We evaluated whether an educational intervention enhanced with positive affect induction and self-affirmation was more effective than the educational protocol alone in increasing physical activity in asthma patients. Methods We conducted a randomized trial in New York City from September 28, 2004, through July 5, 2007, of 258 asthma patients, 252 completed the trial. At enrollment, control subjects completed a survey measuring energy expenditure, made a contract to increase physical activity, received a pedometer and an asthma workbook, and then underwent bimonthly follow-up telephone calls. Intervention patients received this protocol plus small gifts and instructions in fostering positive affect and self-affirmation. The main outcome was the within-patient change in energy expenditure in kilocalories per week from enrollment to 12 months with an intent-to-treat analysis. Results Mean (SD) energy expenditure at enrollment was 1767 (1686) kcal/wk among controls and 1860 (1633) kcal/wk among intervention patients (p=.65) and increased by 415 (95% CI, 76–754; p=.02) and 398 (95% CI, 145–652; p=.002) kcal/wk, respectively, with no difference between groups (p=.94). For both groups, energy expenditure was sustained through 12 months. No adverse events were attributed to the trial. In multivariate analysis, increased energy expenditure was associated with less social support, decreased depressive symptoms, more follow-up calls, use of the pedometer, fulfillment of the contract, and the intervention among patients who required urgent asthma care (all p<.10, 2-sided test). Conclusions A multiple-component protocol was effective in increasing physical activity in asthma patients, but an intervention to increase positive affect and self-affirmation was not effective within this protocol. The intervention may have had some benefit, however, in the subgroup of patients who required urgent asthma care during the trial.

A Positive Psychology Intervention for Patients with an Acute Coronary Syndrome: Treatment Development and Proof-of-Concept Trial

“…In cardiac patients, a simpler non-customized PP intervention in recently hospitalized patients was feasible and well-accepted (Huffman et al 2011). Finally, three linked randomized studies of an intervention that used positive affect induction, self-affirmation, and random provision of small gifts among patients with asthma, coronary disease, or hypertension resulted in improvements in health behaviors in some but not all studies (Mancuso et al 2012; Ogedegbe et al 2012; Peterson et al 2012). Our work builds on prior PP literature in several ways.…”

Mediators and moderators of behavior change in patients with chronic cardiopulmonary disease: the impact of positive affect and self-affirmation

“…The 252 asthma patients had mild-moderate disease [14], and more than two thirds of the 256 African-American hypertensives had uncontrolled hypertension [15]. Patients with either asthma or hypertension were recruited through an academic primary care practice.…”

“…In the angioplasty and hypertension trials, the positive affect intervention resulted in significant improvement in outcomes vs. the control [15, 16]; in the asthmatics, there was no difference between treatment and control [14]. The overall goal of this preplanned cross-trial analysis is to elucidate the psychosocial mediators and moderators of success in behavior change, and specifically the impact of induced positive affect, across multiple populations.…”

An online positive affect skills intervention reduces depression in adults with type 2 diabetes

“…Research on individuals newly diagnosed with HIV indicates that positive affect prospectively predicts greater liklihood of engagement in care and better medication adherence [11]. A series of studies by Isen and colleagues provided a self-affirmation, coping, and positive emotion intervention to several different patient populations and found an overall relationship between positive affect change and health behavior change[12,13,14,15]. …”