Compassionate And Loving Mindset Towards HEART Health riSk (CALM HEARTS 2): A Randomized Optimization Trial

In preparation for the proposed research, the investigators conducted a one-arm pilot intervention (N=11) to examine the feasibility and acceptability of a self-compassion intervention for women at risk for cardiovascular disease (CVD). This pilot study established proof-of-concept (Czajkowski et al., 2015) for this intervention by producing a clinically significant increase in physical activity (M=837.5 Metabolic Equivalent (MET)*minutes per week; Florido et al., 2018). Further, feasibility criteria for recruitment time (1 week), retention rate (100%), and completion of study measures (97%) successfully exceeded the pre-established standards. Exit surveys found the intervention was 100% acceptable to participants. These results are encouraging yet questions remain about how best to deliver the intervention and with whom.

An optimization trial is the appropriate iterative step that will refine the present feasible and acceptable intervention with established proof of concept prior to conducting an efficacy trial. The present optimization trial will advance a research program informed by The ORBIT Model for Behavioural Treatment Development (Czajkowski et al., 2015). Two identified shortcomings of the pilot intervention will be targeted for optimization.

Primary Optimization Target: The pilot intervention was delivered individually to each participant. For 11 participants to complete the study, 33 individual meetings totalling over 40 hours were required over three weeks. This resource intensive delivery method may not be practical. Delivering the intervention to small groups would be more practical. Therefore, the primary objective of this optimization trial is to determine if a self-compassion intervention delivered in small groups is at least as effective at increasing physical activity among women at risk for CVD compared to a self-compassion intervention delivered individually. The investigators hypothesize that group delivery should be at least as effective as individual delivery at increasing physical activity.

Secondary Optimization Target: The previous pilot intervention only included women with CVD risk who were low on self-compassion. While women low on self-compassion are an obvious intervention target, women with moderate or high self-compassion may also benefit from learning to apply their self-compassion to their CVD risk and physical activity efforts. No research exists to inform the effectiveness of self-compassion interventions when delivered to participants low, moderate, and high on self-compassion. Therefore, the secondary objective of this optimization trial is to determine if baseline self-compassion influences physical activity, behavioural outcomes, or psychological outcomes of the intervention. The investigators hypothesize that participants at all levels of self-compassion should benefit similarly from the intervention. Finally, the tertiary objective is to determine if delivery mode and self-compassion interact such that one method of delivery (group or individual) is better suited to women at low, moderate, or high self-compassion. This outcome is exploratory only and the researchers put forth no hypothesis.

Trial Design: This intervention was developed with the Consolidated Standards of Reporting Trials (CONSORT) guidelines (Schulz et al., 2010). This is a two-armed optimization trial with 1:1 randomization to be conducted in a single centre in Manitoba, Canada. Women at risk for CVD will be randomized to receive a combined physical activity behaviour change plus self-compassion intervention in small groups (intervention condition) or individually with a facilitator (control condition). The individual condition serves as a positive control against which the effectiveness of the group condition at increasing physical activity will be judged. The intervention will be delivered to both conditions via an institution-sponsored videoconferencing platform. Data will be collected at pre- and post-intervention using validated surveys completed online. The investigators often use this data collection approach.