Towards a physically more active lifestyle based on one's own values: the results of a randomized controlled trial among physically inactive adults

Anu Maarit Kangasniemi, Raimo Lappalainen, Anna Kankaanpää, Asko Tolvanen, Tuija Tammelin, Anu Maarit Kangasniemi, Raimo Lappalainen, Anna Kankaanpää, Asko Tolvanen, Tuija Tammelin

Abstract

Background: The high prevalence of physical inactivity has led to a search for novel and feasible interventions that will enhance physical activity, especially among the least physically active individuals. This randomized controlled trial aimed to determine the effectiveness of a value-based intervention to promote a physically more active lifestyle among physically inactive adults. The framework of the study was based on Acceptance and Commitment Therapy (ACT).

Methods: Physically inactive participants aged 30 to 50 years (n = 138) were randomly allocated to a feedback (FB, n = 69) or an acceptance- and commitment-based group (ACT + FB, n = 69). Both groups received written feedback about their objectively measured physical activity and were offered a body composition analysis. In addition, the participants in the ACT + FB group attended six group sessions and were given a pedometer for self-monitoring their physical activity during the nine-week intervention. The primary outcome was physical activity. In addition, participants' cognitions related to exercise and physical activity were evaluated at baseline and at three- and six-month follow-ups. The changes in mean physical activity level were analysed using multilevel random regression and rank order stability, using the structural equation model.

Results: Participants in both groups increased their objectively measured and self-reported physical activity with high individual differences. No difference was observed in the change of physical activity level between the FB and ACT + FB groups over time. However, the cognitions related to physical activity and exercise improved more in the ACT + FB group than in the FB group. In addition, after re-analyzing the data among the non-depressive participants, higher stability was observed in objectively measured physical activity at the individual level between the three- and six-month follow-ups in the ACT + FB group as compared to FB group.

Conclusions: Acceptance- and commitment-based group intervention, combined with the self-monitoring of physical activity, was beneficial in supporting the cognition related to exercise and physical activity, and brought more stability to the individual level physical activity behaviour change, especially among the non-depressive participants.

Trial registration: ClinicalTrials.gov, number NCT01796990. Registered in February 2013.

Figures

Figure 1
Figure 1
Flow diagram and the progress of the study.
Figure 2
Figure 2
The path model of time spent on health-enhancing physical activity (HEPA). The path model was fitted in FB and ACT+FB groups. Standardized parameter estimates and standard errors (s.e.) are presented. n.s. p≥0.05;*p<0.05; **p<0.01; ***p<0.001.
Figure 3
Figure 3
The path model of time spent on health-enhancing physical activity (HEPA), among non-depressed participants (BDI-II<14). The path model was fitted in FB and ACT+FB groups. Standardized parameter estimates and standard errors (s.e.) are presented. n.s. p≥0.05;*p<0.05; **p<0.01; ***p<0.001.

References

    1. Lee I, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219–29. doi: 10.1016/S0140-6736(12)61031-9.
    1. Lucas M, Mekary R, Pan A, Mirzaei F, O’Reilly ÉJ, Willett WC, et al. Relation between clinical depression risk and physical activity and time spent watching television in older women: a 10-year prospective follow-up study. Am J Epidemiol. 2011;174(9):1017–27. doi: 10.1093/aje/kwr218.
    1. Teychenne M, Ball K, Salmon J. Physical activity and likelihood of depression in adults: a review. Prev Med. 2008;46(5):397–411. doi: 10.1016/j.ypmed.2008.01.009.
    1. Roshanaei-Moghaddam B, Katon WJ, Russo J. The longitudinal effects of depression on physical activity. Gen Hosp Psychiatry. 2009;31(4):306–15. doi: 10.1016/j.genhosppsych.2009.04.002.
    1. Conn VS. Depressive symptom outcomes of physical activity interventions: Meta-analysis findings. Ann Behav Med. 2010;39(2):128–38. doi: 10.1007/s12160-010-9172-x.
    1. Penninx BW, Leveille S, Ferrucci L, van Eijk JT, Guralnik JM. Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. Am J Public Health. 1999;89(9):1346–52. doi: 10.2105/AJPH.89.9.1346.
    1. Wing RR, Phelan S, Tate D. The role of adherence in mediating the relationship between depression and health outcomes. J Psychosom Res. 2002;53(4):877–81. doi: 10.1016/S0022-3999(02)00315-X.
    1. Johnson BT, Scott-Sheldon LA, Carey MP. Meta-synthesis of health behavior change meta-analyses. Am J Public Health. 2010;100:2193–2158. doi: 10.2105/AJPH.2008.155200.
    1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690. doi: 10.1037/a0016136.
    1. Foster C, Hillsdon M, Thorogood M, Kaur A, Wedatilake T. Interventions for promoting physical activity. Cochrane Database Syst Rev. 2005, (1). Art. No.: CD003180. doi: 10.1002/14651858.CD003180.pub2.
    1. Noar SM, Benac CN, Harris MS. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. 2007;133(4):673. doi: 10.1037/0033-2909.133.4.673.
    1. Rhodes RE, Pfaeffli LA. Review mediators of physical activity behaviour change among adult non-clinical populations: a review update. Int J Behav Nutr Phys Act. 2010, 7(37).
    1. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health. JAMA. 2007;298(19):2296. doi: 10.1001/jama.298.19.2296.
    1. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. Can Med Assoc J. 2006;174(6):801–9. doi: 10.1503/cmaj.051351.
    1. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25. doi: 10.1016/j.brat.2005.06.006.
    1. Hayes SC, Pistorello J, Levin ME. Acceptance and commitment therapy as a unified model of behavior change. Couns Psychol. 2012;40(7):976–1002. doi: 10.1177/0011000012460836.
    1. Kashdan TB, Rottenberg J. Psychological flexibility as a fundamental aspect of health. Clin Psychol Rev. 2010;30(7):865–78. doi: 10.1016/j.cpr.2010.03.001.
    1. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4(1):33–47. doi: 10.1016/0163-8343(82)90026-3.
    1. Kabat‐Zinn J. Mindfulness‐based interventions in context: past, present, and future. Clin Psychol Sci Pract. 2003;10(2):144–56. doi: 10.1093/clipsy.bpg016.
    1. Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125–43. doi: 10.1093/clipsy.bpg015.
    1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2):169–83. doi: 10.1037/a0018555.
    1. Baer RA, Fischer S, Huss DB. Mindfulness and acceptance in the treatment of disordered eating. J Ration Emot Cogn Behav Ther. 2005;23(4):281–300. doi: 10.1007/s10942-005-0015-9.
    1. Chatzisarantis NL, Hagger MS. Mindfulness and the intention-behavior relationship within the theory of planned behavior. Pers Soc Psychol Bull. 2007;33(5):663–76. doi: 10.1177/0146167206297401.
    1. Ulmer CS, Stetson BA, Salmon PG. Mindfulness and acceptance are associated with exercise maintenance in YMCA exercisers. Behav Res Ther. 2010;48(8):805–9. doi: 10.1016/j.brat.2010.04.009.
    1. Gilbert D, Waltz J. Mindfulness and health behaviors. Mindfulness. 2010;1(4):227–34. doi: 10.1007/s12671-010-0032-3.
    1. Roberts KC, Danoff-Burg S. Mindfulness and health behaviors: is paying attention good for you? J Am Coll Health. 2010;59(3):165–73. doi: 10.1080/07448481.2010.484452.
    1. Murphy MJ, Mermelstein LC, Edwards KM, Gidycz CA. The benefits of dispositional mindfulness in physical health: a longitudinal study of female college students. J Am Coll Health. 2012;60(5):341–8. doi: 10.1080/07448481.2011.629260.
    1. Kangasniemi A, Lappalainen R, Kankaanpää A, Tammelin T. Mindfulness skills, psychological flexibility, and psychological symptoms among physically less active and active adults. Ment Health Phys Act. 2014;7(3):121–7. doi: 10.1016/j.mhpa.2014.06.005.
    1. Butryn ML, Forman E, Hoffman K, Shaw J, Juarascio A. A pilot study of acceptance and commitment therapy for promotion of physical activity. J Phys Act Health. 2011;8(4):516–22.
    1. Goodwin CL, Forman EM, Herbert JD, Butryn ML, Ledley GS. A pilot study examining the initial effectiveness of a brief acceptance-based behavior therapy for modifying diet and physical activity among cardiac patients. Behav Modif. 2012;36(2):199–217. doi: 10.1177/0145445511427770.
    1. Katterman SN, Goldstein SP, Butryn ML, Forman EM, Lowe MR. Efficacy of an acceptance-based behavioral intervention for weight gain prevention in young adult women. J Contextual Behav Sci. 2013;3:45–50. doi: 10.1016/j.jcbs.2013.10.003.
    1. Tapper K, Shaw C, Ilsley J, Hill AJ, Bond FW, Moore L. Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite. 2009;52(2):396–404. doi: 10.1016/j.appet.2008.11.012.
    1. Wicksell RK, Ahlqvist J, Bring A, Melin L, Olsson GL. Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and Whiplash‐Associated Disorders (WAD)? A randomized controlled trial. Cogn Behav Ther. 2008;37(3):169–82. doi: 10.1080/16506070802078970.
    1. Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. J Consult Clin Psychol. 2007;75(2):336. doi: 10.1037/0022-006X.75.2.336.
    1. Weineland S, Arvidsson D, Kakoulidis TP, Dahl J. Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT. Obes Res Clin Pract. 2012;6(1):e21–30. doi: 10.1016/j.orcp.2011.04.004.
    1. Weineland S, Hayes S, Dahl J. Psychological flexibility and the gains of acceptance‐based treatment for post‐bariatric surgery: six‐month follow‐up and a test of the underlying model. Clin Obes. 2012;2(1–2):15–24. doi: 10.1111/j.1758-8111.2012.00041.x.
    1. Gifford EV, Kohlenberg BS, Hayes SC, Antonuccio DO, Piasecki MM, Rasmussen-Hall ML, et al. Acceptance-based treatment for smoking cessation. Behav Ther. 2004;35(4):689–705. doi: 10.1016/S0005-7894(04)80015-7.
    1. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther. 2004;35(4):639–65. doi: 10.1016/S0005-7894(04)80013-3.
    1. Kangasniemi AM, Lappalainen R, Kankaanpää A, Kulmala J, Hakonen H, Tammelin T. Towards a physically more active lifestyle based on one's own values: study design of a randomized controlled trial for physically inactive adults. BMC Public Health. 2013;13(1):671. doi: 10.1186/1471-2458-13-671.
    1. Haskell WL, Lee I, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–34. doi: 10.1249/mss.0b013e3180616b27.
    1. Matthews CE, Ainsworth BE, Thompson RW, Bassett DR. Sources of variance in daily physical activity levels as measured by an accelerometer. Med Sci Sports Exerc. 2002;34(8):1376–81. doi: 10.1097/00005768-200208000-00021.
    1. Matthews CE. Calibration of accelerometer output for adults. Med Sci Sports Exerc. 2005;37(11):512–22. doi: 10.1249/01.mss.0000185659.11982.3d.
    1. Sasaki JE, John D, Freedson PS. Validation and comparison of ActiGraph activity monitors. J Sci Med Sport. 2011;14(5):411–6. doi: 10.1016/j.jsams.2011.04.003.
    1. Vanhelst J, Mikulovic J, Bui-Xuan G, Dieu O, Blondeau T, Fardy P, et al. Comparison of two ActiGraph accelerometer generations in the assessment of physical activity in free living conditions. BMC Res Notes. 2012;5(1):187. doi: 10.1186/1756-0500-5-187.
    1. Freedson PS, Melanson E, Sirard J. Calibration of the computer science and applications, inc. accelerometer. Med Sci Sports Exerc. 1998;30(5):777–81. doi: 10.1097/00005768-199805000-00021.
    1. Fagt S, Andersen LF, Anderssen SA, Becker W, Borodulin K, Fogelholm M, et al. Nordic monitoring on diet, physical activity and overweight: validation of indicators: Nordic Council of Ministers; 2011. Printed in Denmark. .
    1. Schwarzer R, Renner B. Social-cognitive predictors of health behavior: action self-efficacy and coping self-efficacy. Health Psychol. 2000;19(5):487. doi: 10.1037/0278-6133.19.5.487.
    1. Hankonen N, Absetz P, Ghisletta P, Renner B, Uutela A. Gender differences in social cognitive determinants of exercise adoption. Psychol Health. 2010;25(1):55–69. doi: 10.1080/08870440902736972.
    1. Hamer M, Stamatakis E, Steptoe A. Dose–response relationship between physical activity and mental health: the Scottish Health Survey. Br J Sports Med. 2009;43(14):1111–4. doi: 10.1136/bjsm.2008.046243.
    1. Sniehotta F, Schwarzer R, Scholz U, Schüz B. Action planning and coping planning for long‐term lifestyle change: theory and assessment. Eur J Soc Psychol. 2005;35(4):565–76. doi: 10.1002/ejsp.258.
    1. Hankonen N, Absetz P, Haukkala A, Uutela A. Socioeconomic status and psychosocial mechanisms of lifestyle change in a type 2 diabetes prevention trial. Ann Behav Med. 2009;38(2):160–5. doi: 10.1007/s12160-009-9144-1.
    1. Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention–behaviour gap: planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychol Health. 2005;20(2):143–60. doi: 10.1080/08870440512331317670.
    1. Forman EM, Butryn ML, Hoffman KL, Herbert JD. An open trial of an acceptance-based behavioral intervention for weight loss. Cogn Behav Pract. 2009;16(2):223–35. doi: 10.1016/j.cbpra.2008.09.005.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561–71. doi: 10.1001/archpsyc.1961.01710120031004.
    1. Dozois DJA, Dobson KS, Ahnberg JL. A psychometric evaluation of the beck depression inventory–II. Psychol Assessment. 1998;10(2):83–9. doi: 10.1037/1040-3590.10.2.83.
    1. Muthén LK, Muthén BO. Statistical analysis with latent variables. In: Anonymous, editor. Mplus User’s Guide. 7. Los Angeles, CA: Muthén & Muthén; 2001.
    1. Roth A, Fonagy P. What works for whom? A critical review of psychotherapy research. New York: The Guilford Press; 1996.
    1. Renner B, Hankonen N, Ghisletta P, Absetz P. Dynamic psychological and behavioral changes in the adoption and maintenance of exercise. Health Psychol. 2012;31(3):306. doi: 10.1037/a0025302.
    1. Laursen BP, Hoff E. Person-centered and variable-centered approaches to longitudinal data. Merrill-Palmer Q. 2006;52(3):377–89. doi: 10.1353/mpq.2006.0029.
    1. Ivanova E, Jensen D, Cassoff J, Gu F, Knauper B. Acceptance and commitment therapy improves exercise tolerance in sedentary women. Med Sci Sports Exerc. in press.

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