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The Role of Acceptance and Commitment Therapy (ACT) in encouraging a physically active lifestyle

Kangasniemi Anu1,2, Lappalainen Raimo2, Kulmala Janne1, Hakonen Harto1, Kankaanpää, Anna1 & Tammelin Tuija1

1 LIKES Research center, Jyväskylä, Finland 2 University of Jyväskylä

Nordic ACBS Forum 8.-10.11.2012

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Introduction

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Introduction

• Physical inactivity increases the risk of many lifestyle diseases

-> type II diabetes, cardiovascular disease, breast and colon cancers and shortens life expectancy

• Physical inactivity has been identified as the fourth leading risk factor for global mortality.

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Aim of the study

• is to investigate the efficacy of the Acceptance and Commitment Therapy method in enhacing a physically active lifestyle among 30-50 years old sedentary adults.

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Methods

• Participants• Study setting• Measurements

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Global recommendation for physical activity for adults (WHO)

• Adults should do at least 150 minutes of moderately intense physical activity throughout the week or at least 75 minutes of vigorous- activity throughout the week or an equivalent combination of moderate- and vigorous activity.

• All activity should be performed in bouts of at least 10 minutes duration.

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Eligible participants (n=70)

Randomization

ACT group (n=35):

Controlgroup(n=35)

Participated in the ACT group

(N=29)

Included in analysis (n=32)

Outlier (n=1)

Invalid data (n=1)

Drop out n=1)

Drop out (n=6) Drop out (n=3)

Included in analysis (N=26)

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Timeline of the study

Baseline

09/2011

ACT Intervention,

6 sessions

Post measurements

12/2011

Follow up 3 months, 03/2012

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Procedure

• Control and ACT group:- Written feedback about their PA level

at the baseline, after the intervention and follow up (3 months) compared to the current physical activity recommendations

- Opportunity to attend a body composition analyze

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Procedure

• ACT group participated the intervention program:

- Six group sessions, 90 minutes/session

- Group size: 5-8 members- They also used pedometer for

monitoring their PA during the 9 weeks intervention

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Measurements

• Physical activity (PA):- was measured objectively by

accelerometer (ActiGraph GT1M):MVPA, moderate to vigorous intensity PAHEPA, health enhancing PASteps in a day

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Accelerometer (ActiGraph GT1M)

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Measurements

• Psychological well-being:- GHQ-12, General health

questionnaire- Symptom Check-List-90, SCL-90- Beck Depression Inventory, BDI-II- Kentucky Inventory of

Mindfulness Skills, KIMS- Acceptance and Action

Questionnaire,AAQ-2

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The ACT program

1. Session: ”Health Behavior-analysis”2. Session: ”Values and important things in the

life”3. Session: ”Value based actions and barriers”4. Session: ”Living in the present moment and

self-regulation skills”5. Session: ”Self as a context and social support”6. Session: ”Where are you going?”

–evaluations of the learning process, set goals and values”

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The ACT program

• Every session included:- mindfulness exercise- pair/group discussions- homework between the sessions

• Varied number of defusion exercises and metaphors

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Little changes make the difference in the everyday life!

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Statistical analysis

• Analysis of independent samples t-test and Chi-square tests were used to compare the descriptive statistics and baseline measures of the control and ACT group.

• Repeated measures multivariate analysis of covariance (MANCOVA).

• The analyses of physical activity measures were conducted while controlling for baseline depressive symptoms (BDI-II score). Effect sizes were estimated using Cohen’s d.

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Results

• Physical activity: Health enhancing time, (HEPA)

• Psychological well-being:- GHQ-12, General health questionnaire- Symptom Check-List-90, SCL-90

- Beck Depression Inventory, BDI-II- Kentucky Inventory of Mindfulness Skills, KIMS- Acceptance and Action

Questionnaire,AAQ-2

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Changes in the health enhancing time (HEPA)

0

2

4

6

8

10

12

14

16

Control group

ACT group

min/day

p=.045, d=.667

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Psychological well-being: decrease in the symptoms, (GHQ-12)

Baseline After the intervention Follow up 3 months0

2

4

6

8

10

12

14

16

Control group

ACT group

P=.001, d=.601

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Conclusions

• The main results showed significant improvement in the health enhancing (HEPA) physical activity time in the ACT group compared to the control group.

• Implications of the reductions in the psychological symptoms were also observed in measures of the psychological well-being.

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Conclusions

• The ACT application offers a novel and innovative method to enhance physical activity among adults.

-> People know quite well why and how, but don´t get started or motivated enough.

-> The holistic approach is needed especially among sedentary people.

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Future directions

• The small sample size (n=70), the data collection continues

-> second wave started in the august 2012

-> follow–up measurements will give information about the maintenance of the changes.

Thank you!