A phone and text message intervention to improve physical activity in midlife: initial feasibility testing

Figures & data

Figure 1. Theoretical model outlining potential mechanisms of intervention effects.

Table 1. Initial PP-MI phone intervention content (7 phone sessions over 6 weeks)

Session	PP component	MI component
1 (in person)	Gratitude for positive events (Emmons & McCullough, 2003; Seligman et al., 2005) Participants identify and reflect on three positive events that occurred in the past week.	Moving for better health/activity tracking Participants report their current activity level, set an overall activity goal, discuss the importance and confidence in making the change, and consider the pros/cons of changing their activity.
2	Gratitude letter (Seligman et al., 2005) Participants write a letter of gratitude thanking a person for their kindness.	Setting a SMART physical activity goal Participants learn about and set a SMART (specific, measurable, attainable, relevant, and time-based) activity goal.
3	Recalling past success (Selimbegovic, Regner, Sanitioso, & Huguet, 2011) Participants recall a successful past life event and then write about the event, their personal contribution to the success, and positive feelings elicited by recalling it.	Barriers and problem solving Participants consider barriers and facilitators to being more physically active.
4	Using personal strengths (Seligman et al., 2005) Participants find a specific new way to use one of their ‘signature strengths’ in the next 7 days.	Resources for activity: Participants identify neighborhood, social, and equipment resources that can help them achieve physical activity goals.
5	Enjoyable and meaningful activities (Peterson, Park, & Seligman, 2005) Participants complete an enjoyable activity alone, an enjoyable activity with another person, and an activity that is more deeply meaningful to them.	Stress reduction session 1 Participants learn and utilize new techniques focused on problem-oriented coping skills.
6	The ‘Good Life’ (Seligman et al., 2005) Participants write about what their ‘good life’ would look like in the future in one or more life domains.	Stress reduction session 2 Participants learn and utilize new techniques focused on emotion-focused coping skills.
7	Skills application + future planning Participants make a plan for continuing to use their PP-based skills in the future.	Reviewing progress/considering the future Trainers assist participants with reviewing their accomplishments and help them to create a plan for physical activity for the near future.

Each week, as part of the MI-informed behavior change portion of the program, prior to reviewing the specific weekly topics noted above, interventionists reviewed progress on the prior week’s activity goal, discussed intra-activity positive affect, used the 5A’s approach, tracked activity, and problem-solved cognitive or instrumental barriers to activity.

Table 2. One-way text messages (weeks 1-6).

Session	Session Topic	Component	Message
1	Gratitude for Positive Events	PP	One way to increase gratitude is to deliberately take note of small positive things that happen. This week, think about and write down three good things that happened!
1	Moving for Better Health	MI	Keeping track of your physical activity can be very helpful to maintain motivation. Try using a notebook, spreadsheet, smartphone app, or whatever works best for you!
2	Expressing Gratitude	PP	Almost half of your happiness is under your control. This week, write a thank you letter for something someone did for you. It can lift your spirits (and theirs)!
2	SMART goals	MI	Setting reachable goals can be really helpful in establishing a new routine. Try setting a new exercise goal today that is do-able based on your fitness level.
3	Remembering past success	PP	Remembering your past successes is not always easy but can increase happiness. This week, remind yourself of your strengths by visualizing a past success!
3	Barriers	MI	Barriers, such as a lack of time, can make it hard to reach your goals. If you struggle to find enough time to be active, try spreading your activity throughout the day.
4	Using strengths	PP	This week, focus on one of your strengths and use it in a new way. Pick an activity you might not usually do and use your strength to make it happen. It can feel great!
4	Resources	MI	Resources like family, parks, walking trails, and even comfortable clothes and shoes can help you be active. This week, use your resources to reach your activity goals!
5	Enjoyable and meaningful activities	PP	A great way to boost your mood is to engage in fun or meaningful activities. This week, set aside 15 min for yourself to do something enjoyable or meaningful!
5	Stress reduction (problem-focused coping)	MI	Sources of stress can get in the way of being active. This week, use problem-solving strategies to reduce stress and meet your physical activity goal!
6	The Good Life	PP	This week, spend some time thinking about what a ‘good life’ would look like for you. Then, think about what you can do this week to start to make this life a reality!
6	Stress reduction (emotion-focused coping)	MI	Emotion-focused coping strategies, like deep breathing or visualization, can help reduce stress and put you in the right frame of mind for exercise. Try them this week!
7	Conclusion	Conclusion	Thank you again for participating in MASTERY. Your trainer will continue to communicate using text messages to help you meet your goals moving forward!

Figure 2. Pages from the PP-MI treatment manual.

Figure 3. CONSORT Study Flow Diagram

Table 3. Participant characteristics.

Characteristic	Overall
Sociodemographic characteristics (N (%) unless otherwise noted)
Age (M [SD])	56.2 (5.8)
Female sex	9 (75)
Non-Hispanic White	8 (66.7)
Medical characteristics/cardiac risk factors (N (%))
Diabetes	2 (16.7)
Hyperlipidemia	6 (50)
Hypertension	7 (58.3)
Current smoking	1 (8.3)
Baseline self-report and physical activity measures (M (SD))
Positive affect (PANAS) (range 10-50)	30.3 (5.2)
Dispositional optimism (LOT-R) (range 0-24)	16.3 (4.5)
Depression (HADS-D) (range 0-21)	6.1 (2.8)
Anxiety (HADS-A) (range 0-21)	8.8 (3.6)
Self-efficacy for exercise (SEE) (range 0-90)	56.1 (18.0)
Internal locus of control (MHLC) (range 6-36)	24.8 (4.4)
Mental HRQoL (SF-12 MCS) (range 0-100)	42.9 (10.9)
Physical HRQoL (SF-12 PCS) (range 0-100)	48.6 (9.7)
Physical function (PROMIS PF-20) (range 0-100)	93.5 (7.9)
Adherence (MOS SAS) (range 3-18)	10.7 (2.6)
MVPA (minutes/day; GT3X+)	15.0 (9.2)
Total daily steps (GT3X+)	5455.1 (2880.4)
Self-reported physical activity (IPAQ)	2581.8 (3834.7)

*p < .05

Legend. HADS = Hospital Anxiety and Depression Scale (HADS-A = Anxiety Subscale, HADS-D = Depression); HRQoL = health-related quality of life; IPAQ = International Physical Activity Questionnaire; LOT-R = Life Orientation Test, Revised; MHLC = Multidimensional Health Locus of Control scale; MOS SAS = Medical Outcomes Study Specific Adherence Scale; MSPSS = Multidimensional Scale of Perceived Social Support; MVPA = Moderate to vigorous physical activity; PANAS = Positive And Negative Affect Schedule; PF-20 = PROMIS Physical Function 20-item measure; SEE = Self-Efficacy for Exercise scale; SF-12 MCS = Medical Outcomes Study Short Form-12 Mental Component Score; SF-12 PCS = Medical Outcomes Study Short Form-12 Physical Component Score. Internal locus of control scale

Table 4. Secondary outcomes: pre-post changes in study outcome measures.

Pre-post changes in self-report and physical activity outcomes (Secondary Aim)
Measure	12 weeks
	EMD	SE	z	P	ES
Accelerometer-measured physical activity outcomes
MVPA (mean min/day)	7.20	5.51	1.31	.19	.62
Mean total daily steps	431.1	913.9	0.47	.64	.23
Psychological outcomes
Positive affect (PANAS)	5.41	2.56	2.11	.035*	.94
Dispositional optimism (LOT-R)	2.38	1.84	1.29	.20	.57
Depression (HADS-D)	−3.64	1.07	−3.38	.001*	1.49
Anxiety (HADS-A)	−2.84	1.08	−2.62	.009*	1.20
Internal locus of control (MHLC)	3.74	0.90	4.16	<.001*	1.93
Perceived social support (MSPSS)	-.49	2.83	−0.17	.86	.08
Exercise self-efficacy (SEE)	8.88	5.19	1.71	.087	.79
Additional functional/behavioral measures
Mental HRQoL (SF-12 MCS)	6.55	3.77	1.74	.082	.78
Physical HRQoL (SF-12 PCS)	0.25	2.04	0.12	.90	.06
Physical function (PROMIS PF-20)	3.81	1.55	2.46	.014*	1.14
Self-reported physical activity (IPAQ)	2610.7	530.3	4.92	<.001*	2.31
Self-reported adherence (MOS SAS)	4.16	0.73	5.73	<.001*	2.81

* p < .05

Legend. ES = effect size; HADS = Hospital Anxiety and Depression Scale (HADS-A = Anxiety Subscale, HADS-D = Depression); HRQoL = health-related quality of life; IPAQ = International Physical Activity Questionnaire; LOT-R = Life Orientation Test, Revised; MI = Motivational interviewing; MHLC = Multidimensional Health Locus of Control scale; MOS SAS = Medical Outcomes Study Specific Adherence Scale; MSPSS = Multidimensional Scale of Perceived Social Support; MVPA = Moderate to vigorous physical activity; PANAS = Positive And Negative Affect Schedule; PF-20 = PROMIS Physical Function 20-item measure; PP = Positive psychology; SF-12 MCS = Medical Outcomes Study Short Form-12 Mental Component Score; SF-12 PCS = Medical Outcomes Study Short Form-12 Physical Component Score.

Table 5. Secondary outcomes: pre-post changes in study outcome measures.

Pre and Post Values for Outcome Measures in Secondary Efficacy Analyses
Measure	Baseline		12 weeks
	Mean	SD	Mean	SD
Accelerometer-measured physical activity outcomes
MVPA (mean min/day)	15.0	13.4	22.2	15.6
Mean total daily steps	5455.1	2823.1	5886.2	3169.0
Psychological outcomes
Positive affect (PANAS)	30.3	6.1	35.7	7.1
Dispositional optimism (LOT-R)	16.3	4.4	18.6	5.0
Depression (HADS-D)	6.1	2.4	2.4	2.8
Anxiety (HADS-A)	8.8	3.6	5.9	4.0
Internal locus of control (MHLC)	24.8	4.1	28.6	4.4
Perceived social support (MSPSS)	67.1	14.3	66.6	15.0
Exercise self-efficacy (SEE)	56.1	18.6	65.0	20.3
Additional functional/behavioral measures
Mental HRQoL (SF-12 MCS)	42.9	9.7	49.4	11.1
Physical HRQoL (SF-12 PCS)	48.6	10.1	48.9	10.6
Physical function (PROMIS PF-20)	93.5	6.6	97.3	7.1
Self-reported physical activity (IPAQ)	2581.8	4362.8	5192.5	4456.1
Self-reported adherence (MOS SAS)	10.7	2.9	14.8	3.2

Legend. ES = effect size; HADS = Hospital Anxiety and Depression Scale (HADS-A = Anxiety Subscale, HADS-D = Depression); HRQoL = health-related quality of life; IPAQ = International Physical Activity Questionnaire; LOT-R = Life Orientation Test, Revised; MHLC = Multidimensional Health Locus of Control scale; MOS SAS = Medical Outcomes Study Specific Adherence Scale; MSPSS = Multidimensional Scale of Perceived Social Support; MVPA = Moderate to vigorous physical activity; PANAS = Positive And Negative Affect Schedule; PF-20 = PROMIS Physical Function 20-item measure; SF-12 MCS = Medical Outcomes Study Short Form-12 Mental Component Score; SF-12 PCS = Medical Outcomes Study Short Form-12 Physical Component Score.

Table 6. Relationships between number of intervention sessions completed and improvements in secondary outcome measures.

Outcome measure	r	p value
MVPA	.30	.48
Steps/day	.43	.29
PANAS	.32	.41
LOT-R	.18	.64
HADS-D	-.19	.62
HADS-A	.11	.78
MHLC	-.44	.24
MSPSS	-.21	.58
SEE	.50	.17
SF-12 MCS	.41	.28
SF-12 PCS	-.11	.77
PROMIS PF-20	.33	.38
IPAQ	.37	.33
MOS SAS	.68	.06

Legend. HADS = Hospital Anxiety and Depression Scale (HADS-A = Anxiety Subscale, HADS-D = Depression); HRQoL = health-related quality of life; IPAQ = International Physical Activity Questionnaire; LOT-R = Life Orientation Test, Revised; MHLC = Multidimensional Health Locus of Control scale; MOS SAS = Medical Outcomes Study Specific Adherence Scale; MSPSS = Multidimensional Scale of Perceived Social Support; MVPA = Moderate to vigorous physical activity; PANAS = Positive And Negative Affect Schedule; PF-20 = PROMIS Physical Function 20-item measure; SEE = Self-Efficacy for Exercise Scale; SF-12 MCS = Medical Outcomes Study Short Form-12 Mental Component Score; SF-12 PCS = Medical Outcomes Study Short Form-12 Physical Component Score.

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