Trial Outcomes & Findings for Positive Psychology for Acute Coronary Syndrome Patients (NCT NCT03122184)

NCT ID: NCT03122184

Last Updated: 2020-05-14

Results Overview

Feasibility will be measured by examining the number of completed exercises.

Recruitment status

COMPLETED

Study phase

Target enrollment

69 participants

Primary outcome timeframe

24 weeks

Results posted on

2020-05-14

Participant Flow

69 participants enrolled in the study but 22 either withdrew their consent or failed to attend their first in-person visit before randomization. Forty-seven individuals were randomized to a treatment condition.

Participant milestones

Participant milestones
Measure	Positive Psychology + Motivational Interviewing Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Overall Study STARTED	24	23
Overall Study COMPLETED	16	17
Overall Study NOT COMPLETED	8	6

Reasons for withdrawal

Reasons for withdrawal
Measure	Positive Psychology + Motivational Interviewing Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Overall Study Lost to Follow-up	4	6
Overall Study Withdrawal by Subject	3	0
Overall Study Terminated due to cognitive problem	1	0

Baseline Characteristics

Positive Psychology for Acute Coronary Syndrome Patients

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Positive Psychology + Motivational Interviewing n=24 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=23 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).	Total n=47 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Age, Categorical Between 18 and 65 years	18 Participants n=5 Participants	11 Participants n=7 Participants	29 Participants n=5 Participants
Age, Categorical >=65 years	6 Participants n=5 Participants	12 Participants n=7 Participants	18 Participants n=5 Participants
Sex: Female, Male Female	17 Participants n=5 Participants	4 Participants n=7 Participants	21 Participants n=5 Participants
Sex: Female, Male Male	7 Participants n=5 Participants	19 Participants n=7 Participants	26 Participants n=5 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	24 Participants n=5 Participants	23 Participants n=7 Participants	47 Participants n=5 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) Asian	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) Black or African American	0 Participants n=5 Participants	2 Participants n=7 Participants	2 Participants n=5 Participants
Race (NIH/OMB) White	24 Participants n=5 Participants	19 Participants n=7 Participants	43 Participants n=5 Participants
Race (NIH/OMB) More than one race	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Region of Enrollment United States	24 participants n=5 Participants	23 participants n=7 Participants	47 participants n=5 Participants
Medication Adherence	95 percentage of time STANDARD_DEVIATION 18 • n=5 Participants	98 percentage of time STANDARD_DEVIATION 4 • n=7 Participants	97 percentage of time STANDARD_DEVIATION 13 • n=5 Participants
Dietary Adherence	54.8 score on a scale STANDARD_DEVIATION 27.4 • n=5 Participants	55.4 score on a scale STANDARD_DEVIATION 32.2 • n=7 Participants	55.1 score on a scale STANDARD_DEVIATION 29.5 • n=5 Participants
Positive Affect	28.5 score on a scale STANDARD_DEVIATION 7.2 • n=5 Participants	33.3 score on a scale STANDARD_DEVIATION 6.3 • n=7 Participants	30.9 score on a scale STANDARD_DEVIATION 7.2 • n=5 Participants
Trait Optimism	16.1 score on a scale STANDARD_DEVIATION 5.7 • n=5 Participants	16.5 score on a scale STANDARD_DEVIATION 4.6 • n=7 Participants	16.3 score on a scale STANDARD_DEVIATION 5.1 • n=5 Participants
State Optimisim	25.8 score on a scale STANDARD_DEVIATION 6.9 • n=5 Participants	28.0 score on a scale STANDARD_DEVIATION 5.4 • n=7 Participants	26.9 score on a scale STANDARD_DEVIATION 6.2 • n=5 Participants
HADS-A Score	5.5 score on a scale STANDARD_DEVIATION 3.9 • n=5 Participants	5.2 score on a scale STANDARD_DEVIATION 4.0 • n=7 Participants	5.3 score on a scale STANDARD_DEVIATION 3.9 • n=5 Participants
HADS-D Score	4.0 score on a scale STANDARD_DEVIATION 2.9 • n=5 Participants	3.5 score on a scale STANDARD_DEVIATION 2.4 • n=7 Participants	3.7 score on a scale STANDARD_DEVIATION 2.7 • n=5 Participants
Physical Function	37.3 score on a scale STANDARD_DEVIATION 13.3 • n=5 Participants	43.2 score on a scale STANDARD_DEVIATION 13.9 • n=7 Participants	40.2 score on a scale STANDARD_DEVIATION 13.8 • n=5 Participants
SF-12 Scores (Physical)	37.0 score on a scale STANDARD_DEVIATION 7.0 • n=5 Participants	40.0 score on a scale STANDARD_DEVIATION 9.0 • n=7 Participants	38.3 score on a scale STANDARD_DEVIATION 8.0 • n=5 Participants
SF-12 Scores (Mental)	46.9 score on a scale STANDARD_DEVIATION 8.9 • n=5 Participants	49.3 score on a scale STANDARD_DEVIATION 8.0 • n=7 Participants	48.1 score on a scale STANDARD_DEVIATION 8.5 • n=5 Participants
Adherence to Health Behaviors	9.9 score on a scale STANDARD_DEVIATION 2.7 • n=5 Participants	11.1 score on a scale STANDARD_DEVIATION 2.6 • n=7 Participants	10.5 score on a scale STANDARD_DEVIATION 2.7 • n=5 Participants
Cardiac Symptoms	9.2 score on a scale STANDARD_DEVIATION 5.2 • n=5 Participants	8.5 score on a scale STANDARD_DEVIATION 5.3 • n=7 Participants	8.9 score on a scale STANDARD_DEVIATION 5.2 • n=5 Participants
Physical Activity	2439.7 MET-minutes per week STANDARD_DEVIATION 5067.6 • n=5 Participants	1809.8 MET-minutes per week STANDARD_DEVIATION 2266.8 • n=7 Participants	2131.5 MET-minutes per week STANDARD_DEVIATION 3924.2 • n=5 Participants
Perceived Stress	5.7 score on a scale STANDARD_DEVIATION 3.4 • n=5 Participants	5.7 score on a scale STANDARD_DEVIATION 2.7 • n=7 Participants	5.7 score on a scale STANDARD_DEVIATION 3.0 • n=5 Participants

PRIMARY outcome

Timeframe: 24 weeks

Feasibility will be measured by examining the number of completed exercises.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=24 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Feasibility of the PP-MI Based Health Behavior Intervention	10.0 exercises completed Standard Deviation 3.9	—

PRIMARY outcome

Timeframe: Weeks 1-12

Participants will provide ratings of utility after each exercise, measured on a 10-point Likert scale (0=not at all helpful; 10=very helpful). Weekly utility ratings were averaged to provide an overall utility score of the exercises.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=24 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Acceptability of the PP-MI Exercises: Utility Score Utility of the PP component	8.0 units on a scale Standard Deviation 2.3	—
Acceptability of the PP-MI Exercises: Utility Score Utility of the MI component	8.2 units on a scale Standard Deviation 2.2	—

PRIMARY outcome

Timeframe: Weeks 1-12

Participants will provide ratings of ease after each exercise, measured on a 10-point Likert scale (0=very difficult; 10=very easy). Weekly ratings were averaged to provide an overall ease of the exercises.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=24 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Acceptability of the PP-MI Exercises: Ease Score Ease of the PP component	8.3 units on a scale Standard Deviation 2.3	—
Acceptability of the PP-MI Exercises: Ease Score Ease of the MI component	8.1 units on a scale Standard Deviation 2.4	—

SECONDARY outcome

Timeframe: MVPA at 12 weeks and 24 weeks

Population: Not everyone provided follow-up data at both time points.

ActiGraph GT3X+ step counters are validated as measures of physical activity and have been used in numerous studies of physical activity in patients with medical illness. In this trial, participants will wear the accelerometer for one week at 12 weeks, and another week at 24 weeks to assess the feasibility of doing so and to ensure adequate capture of physical activity. In our analysis, data on pre-ACS activity was collected using the International Physical Activity Questionnaire (IPAQ) to control for baseline activity.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=18 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=16 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Minutes of Moderate to Vigorous Physical Activity (Actigraph) MVPA at 12-week	33.0 minutes/day Standard Deviation 19.0	23.2 minutes/day Standard Deviation 26.2
Minutes of Moderate to Vigorous Physical Activity (Actigraph) MVPA at 24-week	34.6 minutes/day Standard Deviation 22.9	18.1 minutes/day Standard Deviation 11.9

SECONDARY outcome

Timeframe: Change in score from Baseline to 12 weeks, 24 weeks

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

Measured by Self-Reported Medication Adherence (SRMA), a two-item self-report medication adherence scale measuring percentage of time (in 10% increments) patients report taking their heart medications in the past one and two weeks. Minimum: 0, Maximum:100. Change was calculated by subtracting the score at baseline from the score at 12 weeks and 24 weeks. Higher score indicates greater levels of medication adherence.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=21 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Medication Adherence 12 weeks	5 percentage of time Standard Deviation 2.2	5 percentage of time Standard Deviation 2.2
Change in Medication Adherence 24 weeks	0 percentage of time Standard Deviation 0	-6 percentage of time Standard Deviation 5.4

SECONDARY outcome

Timeframe: Change in score from Baseline to 12 weeks, 24 weeks

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone who provided data at both time points.

Measured by the MEDFICTS scale, a National Cholesterol Education Program-developed scale inquiring about saturated fat. Minimum= 0; Maximum= 216. Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate lower levels of dietary adherence.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=21 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=21 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Dietary Adherence 12 weeks	-2.8 score on a scale Standard Deviation 31.2	-17.6 score on a scale Standard Deviation 21.5
Change in Dietary Adherence 24 weeks	2.1 score on a scale Standard Deviation 33.8	-7.7 score on a scale Standard Deviation 25.6

SECONDARY outcome

Timeframe: Change in score from Baseline to 12 weeks, 24 weeks

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

The positive affect items on the Positive and Negative Affect Schedule (PANAS), a well-validated scale used in other intervention trials and in patients with medical illnesses, will be used to measure positive affect. (Range: 10-50). Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate higher levels of positive affect.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=20 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Positive Affect 12 weeks	8.8 score on a scale Standard Deviation 6.0	4.9 score on a scale Standard Deviation 6.5
Change in Positive Affect 24 weeks	9.5 score on a scale Standard Deviation 6.8	2.2 score on a scale Standard Deviation 6.6

SECONDARY outcome

Timeframe: Change in score from baseline to 12 week, 24 week

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

Life Orientation Test-Revised is a well-validated 6-item instrument used to measure dispositional optimism. (Range: 0-24) Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate higher levels of optimism.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=20 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Trait Optimism 12 weeks	2.2 score on a scale Standard Deviation 3.8	2.0 score on a scale Standard Deviation 5.3
Change in Trait Optimism 24 weeks	1.7 score on a scale Standard Deviation 5.9	2.8 score on a scale Standard Deviation 3.8

SECONDARY outcome

Timeframe: Change of score from Baseline to 12 weeks, 24 weeks

Population: Not all participants provided data at all follow-up points.

Measured by the State Optimism Scale developed by our team (SOM), which aims to capture the changeable nature of optimism based on time and situation. Minimum:7, Maximum:35. The higher number indicates a greater level of optimism. Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=19 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in State Optimism Change in SOM at 12 weeks	5.3 score on a scale Standard Deviation 6.5	-.1 score on a scale Standard Deviation 6.8
Change in State Optimism Change in SOM at 24 weeks	6.0 score on a scale Standard Deviation 7.1	.6 score on a scale Standard Deviation 4.6

SECONDARY outcome

Timeframe: Change in score from Baseline to 12 week, 24 week

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

The Hospital Anxiety and Depression Scale will be used to measure depression and anxiety. This is a well-validated scale with few somatic symptom items that can confound mood/anxiety assessment in medically-ill patients. (Range: 0-21) Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate higher levels of anxiety.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=19 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Changes in HADS-A Scores 12 weeks	-2.8 score on a scale Standard Deviation 3.3	-1.3 score on a scale Standard Deviation 2.8
Changes in HADS-A Scores 24 weeks	-2.3 score on a scale Standard Deviation 3.8	-1.9 score on a scale Standard Deviation 2.0

SECONDARY outcome

Timeframe: Change in score from Baseline to 12 week, 24 week

Population: We will use a random effects regression model with a random intercept for each participant.

The Hospital Anxiety and Depression Scale will be used to measure depression and anxiety. This is a well-validated scale with few somatic symptom items that can confound mood/anxiety assessment in medically-ill patients.(Range: 0-21). Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate worse outcome (i.e. greater levels of depression).

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=19 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in HADS-D Scores 12 weeks	-1.8 score on a scale Standard Deviation 2.8	.5 score on a scale Standard Deviation 2.5
Change in HADS-D Scores 24 weeks	-1.5 score on a scale Standard Deviation 3.3	-0.8 score on a scale Standard Deviation 2.2

SECONDARY outcome

Timeframe: Change of score from Baseline to 12 week, 24 week

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

Measured by the Duke Activity Status Index (DASI), a 12-item questionnaire that inquires about activities of daily living, basic physical activity, and more strenuous physical function to gauge overall functional capacity. Minimum: 0, Maximum: 58.2. Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate greater levels of functional capacity.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=20 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Physical Function 12 weeks	9.7 score on a scale Standard Error 11.7	4.4 score on a scale Standard Error 13.3
Change in Physical Function 24 weeks	14.1 score on a scale Standard Error 13.0	4.9 score on a scale Standard Error 10.8

SECONDARY outcome

Timeframe: Change of score from Baseline to 12 week, 24 week

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

The Medical Outcomes Study Short Form-12 (SF-12) will be used to measure quality of life. This is an instrument which has been used in multiple cardiac studies in the past. (SF-12 Mental Composite Score and Physical Composite Score Range: 0-100 each). Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate higher level of health related QoL.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=19 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in SF-12 Scores (Physical) 12 weeks	8.0 score on a scale Standard Deviation 8.0	7.2 score on a scale Standard Deviation 8.3
Change in SF-12 Scores (Physical) 24 weeks	12.3 score on a scale Standard Deviation 7.4	6.8 score on a scale Standard Deviation 7.4

SECONDARY outcome

Timeframe: Change of score from baseline to 12 and 24 weeks.

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=19 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in SF-12 Scores (Mental) 12 week	8.8 score on a scale Standard Deviation 8.7	1.3 score on a scale Standard Deviation 5.8
Change in SF-12 Scores (Mental) 24 week	6.3 score on a scale Standard Deviation 7.9	2.6 score on a scale Standard Deviation 4.8

SECONDARY outcome

Timeframe: Change of score from Baseline to 12 week, 24 week

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

Three Medical Outcomes Study Specific Adherence Scale (MOS SAS) items assessing medication, diet, and exercise, will be measured individually and as a composite score. (Range: 3-18) Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate better adherence to health behaviors.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=21 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=21 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Adherence to Health Behaviors 12 weeks	4.9 score on a scale Standard Deviation 3.1	3.5 score on a scale Standard Deviation 2.7
Change in Adherence to Health Behaviors 24 weeks	4.4 score on a scale Standard Deviation 2.9	3.3 score on a scale Standard Deviation 3.4

SECONDARY outcome

Timeframe: Change of score from Baseline to 12 week, 24 week

Population: Not all participants provided data at all follow-up points.

Measured by a checklist taken from the Women and Ischemia Syndrome Evaluation Study (WISE) to assess the presence and intensity of ten cardiac symptoms felt to best capture the range of symptoms experienced by ACS patients. Minimum: 0, Maximum: 30. Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks. Higher scores indicate greater levels of cardiac symptoms.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=19 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Cardiac Symptoms 12 weeks	-6.6 score on a scale Standard Deviation 3.7	-4.8 score on a scale Standard Deviation 4.4
Change in Cardiac Symptoms 24 weeks	-6.6 score on a scale Standard Deviation 4.6	-5.1 score on a scale Standard Deviation 4.3

SECONDARY outcome

Timeframe: Change of score from Baseline to 12 week, 24 week

Population: Number of participants analyzed in Week 12 differs from that analyzed at Week 24 because not everyone provided data at both time points.

Measured by the self-report International Physical Activity Questionnaire (IPAQ). The measure asseses the types of intensity of physical activity that people do as part of their daily lives. All activities are converted to multiples of resting energy expenditure (MET) minutes per week. Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=21 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=20 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Physical Activity 12 weeks	649.5 MET-minutes per week Standard Deviation 1857.1	159.9 MET-minutes per week Standard Deviation 4244.6
Change in Physical Activity 24 weeks	-359.4 MET-minutes per week Standard Deviation 1671.7	-171.1 MET-minutes per week Standard Deviation 2014.0

SECONDARY outcome

Timeframe: Change of score from Baseline to 12 week, 24 week

Population: Not all participants provided data at all follow-up points.

Measured by the Perceived Stress Scale (PSS-4) measure. Minimum: 0, Maximum: 16. Change was calculated by subtracting the score at baseline from the score at 12 and 24 weeks Higher scores indicate greater levels of stress.

Outcome measures

Outcome measures
Measure	Positive Psychology + Motivational Interviewing n=20 Participants Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=19 Participants Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
Change in Perceived Stress 24 weeks	-2.3 score on a scale Standard Deviation 3.0	-2.5 score on a scale Standard Deviation 2.9
Change in Perceived Stress 12 weeks	-2.8 score on a scale Standard Deviation 3.0	-1.4 score on a scale Standard Deviation 3.1

Adverse Events

Positive Psychology + Motivational Interviewing

Serious events: 11 serious events

Other events: 7 other events

Deaths: 0 deaths

Motivational Interviewing Health Education

Serious events: 11 serious events

Other events: 6 other events

Deaths: 0 deaths

Serious adverse events

Other adverse events

Other adverse events
Measure	Positive Psychology + Motivational Interviewing n=24 participants at risk Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=23 participants at risk Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
General disorders Allergic reaction	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Stomach cramps and vomiting	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Throat swelling	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Abdominal pain	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	13.0% 3/23 • Number of events 5 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
Cardiac disorders Chest pain	8.3% 2/24 • Number of events 2 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 2 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
Cardiac disorders Chest discomfort	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 2 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected balance issues	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."

Additional Information

Dr. Jeff Huffman

Massachusetts General Hospital

Phone: 617-724-2910

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place

Measure	Positive Psychology + Motivational Interviewing n=24 participants at risk Participants will complete weekly positive psychology exercises and will systematically set goals related to physical activity. Study trainers will review the positive psychology exercises on the phone each week and will use motivational interviewing techniques to facilitate goal setting. Positive Psychology + Motivational Interviewing: For the positive psychology portion of the intervention, the study trainer will (a) review the week's positive psychology exercise, (b) discuss the rationale of the next week's positive psychology exercise through a guided review of the positive psychology manual, and (c) assign the next week's positive psychology exercise. For the motivational interviewing portion, participants will (a) review their physical activity goal from the prior week, (b) discuss techniques for improving physical activity, and (c) set a physical activity goal for the next week. Study trainers will use motivational interviewing techniques to facilitate goal setting.	Motivational Interviewing Health Education n=23 participants at risk Participants will speak on the telephone each week with a study trainer. During these calls, the trainer will provide education about a health behavior (physical activity, medication adherence, diet, stress reduction) and assign an activity related to one health behavior each week. Motivational interviewing techniques will be used throughout to facilitate health behavior changes. Motivational Interviewing Health Education: Each week, participants will learn about a different health behavior topic related to cardiac health. They will also be introduced to motivational interviewing topics in concert with the health behavior education topics. The intervention is divided into five sections, focusing on five different important cardiac health-related topics (recovery from an acute cardiac illness, physical activity, a heart-healthy diet, medication adherence, and stress reduction).
General disorders Unexpected chest and back pain	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
Cardiac disorders Unexpected Coronary Artery Syndrome	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	8.7% 2/23 • Number of events 2 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected aneurysm	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
Cardiac disorders Unexpected NSTEMI	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected hospital admission due to alt ms	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected fever	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
Cardiac disorders Unexpected hypotension	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected sepsis	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected GI bleed	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected calculus of gallbladder	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected melena	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected mass	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected rectal bleeding	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Lymphoma	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected A-FIB	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected Carpal Tunnel Syndrome	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 2 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
Eye disorders Unexpected eye damage	4.2% 1/24 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	0.00% 0/23 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected blood in stool	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."
General disorders Unexpected malignant neoplasm of colon	0.00% 0/24 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."	4.3% 1/23 • Number of events 1 • 24 weeks Adverse events are "any untoward or unfavorable medical occurrence in a human subject including any abnormal sign, symptom or disease...whether or not associated with the subject's participation in the research."