Abstract
ObjectiveAn increase in psychological flexibility has been found to be associated with health behavior changes. Peer-led interventions have been advantageous in improving physical activity among individuals at health risk. This study aimed to discover whether an ACT-based peer-tutored online intervention can increase self-reported physical activity participation and psychological flexibility among adults with overweight. DesignThe study was a non-randomized longitudinal intervention study. The intervention participants (N = 177) were primary health care clients with overweight. They participated in a 24-month program provided by health services, including three online modules of ACT of six week each, and tutoring by trained peers via five group meetings and four phone calls. Main outcome measures and resultsPhysical activity participation was measured with Kasari's FIT index concerning the frequency, intensity and time of the physical activity. Psychological flexibility was measured with AAQ-II, and thought suppression, as a dimension of psychological flexibility, with WBSI. Measures were taken at baseline, and at 6, 12, and 24 months. The statistical analysis was conducted with Mplus to identify latent groups with similar change patterns of physical activity, and to examine differences between the profiles. Two change profiles for physical activity participation were found: Low and High. At baseline in High profile group, physical activity and psychological flexibility were higher and thought suppression was lower than they were in Low profile group, as was expressing other psychological symptoms measured by DASS. During the intervention, physical activity increased significantly only within Low profile (within Cohen's d = .48). Psychological flexibility (AAQ-II) increased within High profile (within Cohen's d = .34), and thought suppression (WBSI) decreased in both profiles (within Cohen's d = .33). ConclusionThe ACT-based peer-tutored online intervention was promising especially for participants with low physical activity participation.
Highlights
Low physical activity (PA) increases the risk of cardiovascular dis eases (Li & Siegrist, 2012; Zhang, Cash, Bower, Focht, & Paskett, 2020) as well as overweight and obesity (Lee et al, 2012)
In order to study the changes over the 24-month period, the data were analyzed with Mplus version 8.4 (Muthen & Muthen, 2017) with the full infor mation maximum likelihood (FIML) estimation method
The missing data were assumed to be missing at random (MAR), and all the partic ipants who met the inclusion criteria (N = 177) and completed the baseline measurements were included in the analyses
Summary
Low physical activity (PA) increases the risk of cardiovascular dis eases (Li & Siegrist, 2012; Zhang, Cash, Bower, Focht, & Paskett, 2020) as well as overweight and obesity (Lee et al, 2012). ACT-based interventions concentrate on increasing awareness of inthe-moment decision-making processes and behavior, as well as on coping with distress (Forman & Butryn, 2015; Graham et al, 2016; Hayes et al, 2012). The number of participants in previous ACT-based health-related behavior change trials has often been relatively small, or the length of the intervention and/or follow-up short, which indicates a need for future research to investigate long-term effects and larger samples. There is a lack of evidence whether peer-led interventions based on acceptance and commitment therapy could be beneficial in increasing physical ac tivity among adults with overweight
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