Objective: Theory highlights the role of emotion regulation (ER) and impulsivity in the development and maintenance of eating disorders. Although the associations between negative ER, impulsivity features, and eating disorder symptoms are well-documented, the role of positively-valanced ER difficulties remain unclear. To address this gap, we adopted a transbehavioral approach to examine how valence-specific urgency and emotion regulation difficulties individually and interactively relate to disordered eating behaviors. Method: Our sample consisted of 181 college students with heterogeneous symptom severity presentations. Participants completed self-report measures for (1) negative and positive ER difficulties, (2) negative and positive urgency, and (3) eating disorder behaviors. Results: Positive ER difficulties were positively associated with binge eating and fasting frequency at low levels of positive urgency. Additionally, negative ER difficulties were significantly associated with purging frequency at both low and high levels of negative urgency, but a stronger positive association was observed when negative urgency was low. Furthermore, negative ER difficulties were significantly associated with binge eating frequency at low levels of negative urgency. Conclusions: Contrary to our hypotheses, disordered eating behaviors were more strongly associated with emotion regulation difficulties at lower levels of urgency. These findings suggest that emotion regulation difficulties may represent a distinct pathway to disordered eating beyond urgency-related risk and highlight the importance of considering both emotion regulation and urgency in understanding eating disorder symptomatology.

INTRODUCTION:Basic psychological needs (BPN) include feelings of autonomy, competence, and relatedness. Both unsatisfied BPN and frustrated BPN have been linked to suicidal thoughts. However, the relationship between real-time BPN and suicidal thoughts remains unknown. This study utilized ecological momentary assessment (EMA) to explore how BPN relates to subsequent suicidal thoughts. METHODS:Undergraduate students (n = 460) completed baseline self-report measures of BPN frustration and satisfaction, then 6 daily EMA surveys with items assessing suicidal thoughts, frustrated BPN, and satisfied BPN. RESULTS:Four hundred and sixty students completed a total of 57,972 assessments during the study period. Multi-level regression models indicated that within-person frustrated competence (b = 0.02, 95% CI = 0.01-0.02, p < 0.001), frustrated relatedness (b = 0.02, 95% CI = 0.01-0.03, p < 0.001), satisfied autonomy (b = -0.01, 95% CI = -0.02 to -0.01, p < 0.001), BPN satisfied competence (b = -0.01, 95% CI = -0.01 to -0.00, p < 0.001), and BPN satisfied relatedness (b = -0.01, 95% CI = -0.01 to -0.00, p < 0.001) were significantly related to suicidal thoughts at the following timepoint. CONCLUSION:Real-time BPN (2/3 frustration subscales, all satisfaction subscales) are significantly associated with subsequent suicidal thoughts over short time periods. Further research is warranted to determine if these findings hold true among clinical populations and whether BPN are relevant treatment targets for individuals with suicidal thoughts.

BACKGROUND:Though greater positive psychological well-being (PPWB) is associated with both improved physical and mental health in irritable bowel syndrome (IBS), it has not yet been explored as a primary target of brain-gut behavior therapies (BGBTs). Accordingly, we developed a novel, 9-week, phone-delivered BGBT to cultivate PPWB in IBS, and examined its feasibility, acceptability, and preliminary effects in a randomized waitlist-controlled proof-of-concept trial. METHODS:Twenty-two adults with IBS meeting Rome IV criteria were randomized, stratified by gender and IBS subtype, to the intervention (n = 12) or waitlist-control (WLC; n = 10) groups. Participants completed specific positive psychology (PP) activities and phone sessions weekly with an interventionist. Intervention feasibility was assessed by the proportion of completed sessions, and acceptability by weekly ease/utility ratings. Exploratory psychological and health-related self-report measures were collected pre- and post-intervention. KEY RESULTS:Participants (N = 22; ages 19-79; 55% female) completed 85% of sessions, above our a priori feasibility threshold of 65%. The intervention was rated as easy to complete (mean = 7.2/10, 95% CI: [6.70, 7.75]) and subjectively helpful (mean = 7.6/10, 95% CI: [7.14, 8.01]). Of the 18 participants who completed the intervention, 11 (61%) no longer met criteria for IBS post-intervention. Compared to the WLC, the intervention led to promising but nonsignificant improvements in exploratory clinical outcomes including IBS symptom severity, IBS health-related quality of life, and resilience, with effect sizes ranging from 0.1 to 0.7. CONCLUSIONS AND INFERENCES:This 9-week, phone-delivered intervention targeting greater PPWB in IBS was feasible, well-accepted, and associated with promising improvements in key IBS-related outcomes, highlighting the need for further testing.

Objective: Optimism is an important factor impacting health and human functioning. Originally conceptualized as a trait, increasing evidence indicates that optimism can change over time and could be an intervention target. Measures are needed that can capture changes in optimism. Design: In this secondary analysis, we compared the performance of a newly developed state measure, the State Optimism Measure (SOM), to the widely used trait measure, the Life Orientation Test-Revised (LOT-R), in detecting changes over time during a disruptive life event: the onset of the COVID-19 pandemic in the United States. Main Outcome Measures: Participants (n = 81) were nondaily smokers participating in a smoking cessation intervention, who completed the SOM and LOT-R before and after the initial COVID-19 outbreak. Results: Optimism declined from pre- to post-COVID-19 outbreak, as assessed by both scales (LOT-R: p=.0147,g(av)=0.23; SOM: p<.0001,g(av)=0.56). The change detected was greater when measured by the SOM (p<.0001). Changes in optimism were correlated with concurrent changes in perceived stress, positive affect, and negative affect. Conclusion: Our results suggest that the SOM has a greater sensitivity to detect within-person changes in optimism than the LOT-R and highlight the SOM's utility for longitudinal studies assessing changes in optimism.

Introduction: College years represent a period that is commonly marked by emotion dysregulation and related risky behaviors, including suicide. Despite evidence that the dysregulation of positive emotions plays a unique role in suicidal thoughts and behaviors (STBs), most extant research has only examined emotion dysregulation and STBs in the context of negative emotions. Clarifying the relationship between positive emotion dampening, a form of positive emotion dysregulation, and suicide risk among college students may inform assessment and treatment efforts. Methods: This cross-sectional study was conducted with a sample of 184 undergraduate students (Mage = 18.74, 61.5 % female) at a large state university. Participants completed a clinical diagnostic interview and a self-report measure of positive emotion dampening. Results: The results indicated that engaging in positive emotion dampening was significantly associated with current suicide risk (OR = 1.21, Z = 3.11, p = 0.002). Moreover, positive emotion dampening was significantly predictive of suicide risk severity (OR = 1.15, Z = 3.09, p = 0.002). Conclusion: The findings suggest that positive emotion dampening does play a role in suicide risk and severity among college students. The ways in which college-aged individuals experience positive emotions may have important implications for assessment and treatment of STBs.

Background: Peer support has been associated with improved health-related outcomes (e.g., psychological wellbeing and treatment adherence) among patients with serious, chronic conditions, including kidney disease. Yet, there is little existing research evaluating the effects of peer support programs on health outcomes among patients with kidney failure being treated with kidney replacement therapy. fMethods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a systematic review using five databases to assess the effects of peer support programs on healthrelated outcomes (e.g., physical symptoms, depression) among patients with kidney failure undergoing kidney replacement therapy. Results: Peer support in kidney failure was assessed across 12 studies (eight randomized controlled trials, one quasi-experimental controlled trial, and three single-arm trials) with 2893 patients. Three studies highlighted the links between peer support and improved patient engagement with care, while one found peer support did not significantly impact engagement. Three studies showed associations between peer support and improvements in psychological well-being. Four studies underscored the effects of peer support on self-efficacy and one on treatment adherence. Conclusions: Despite preliminary evidence of the positive associations between peer support and health-related outcomes among patients with kidney failure, peer support programs for this patient population remain poorly understood and underutilized. Further rigorous prospective and randomized studies are needed to evaluate how peer support can be optimized and incorporated into clinical care for this vulnerable patient population.

Objective: Psychological factors (e.g., depression, anxiety) are known to contribute to the development and maintenance of irritable bowel syndrome (IBS). Less is known, however, about the role of positive psychological well-being (PPWB) in IBS. Accordingly, we completed a systematic review of the literature examining relationships between PPWB and clinical characteristics in IBS. Method: A systematic review using search terms related to PPWB and IBS from inception through July 28, 2022, was completed. Quality was assessed with the NIH Quality Assessment Tool. A narrative synthesis of findings, rather than meta-analysis, was completed due to study heterogeneity.Results: 22 articles with a total of 4285 participants with IBS met inclusion criteria. Individuals with IBS had lower levels of PPWB (e.g., resilience, positive affect, self-efficacy, emotion regulation) compared to healthy populations, which in turn was associated with reduced physical and mental health and health-related quality of life (HRQoL). Limited exploration of potential biological mechanisms underlying these relationships has been described. Conclusions: PPWB is diminished in individuals with IBS compared to other populations, and greater PPWB is linked to superior physical, psychological, and HRQoL outcomes. Interventions to increase PPWB may have the potential to improve IBS-related outcomes. Registration: Prospective Register of Systematic Reviews CRD42022304767.

Physical activity promotes health and longevity after metabolic/bariatric surgery (MBS), but most patients do not meet recommended levels. The Gaining Optimism After weight Loss Surgery (GOALS) Project was a positive psychological intervention designed to address common emotional barriers to physical activity in patients who have recently undergone MBS (e.g., low confidence around exercise, internalized weight bias, fear of injury) and use motivational interviewing and standard behavior change techniques (e.g., self-monitoring) to increase physical activity. This single-arm proof-of-concept trial was designed to refine the intervention, test feasibility and acceptability, and explore pre-post changes in behavioral and psychological outcomes. Participants were 12 adults 6-12 months post-MBS (M age of 46, 58% female, 67% non-Hispanic white). GOALS was a 10-week telephone counseling program that introduced new positive psychological skills and physical activity topics each week. Participants tracked physical activity with a Fitbit and set weekly goals. Results showed that the intervention was feasible (85% of sessions completed) and acceptable (average participant ratings of session ease and utility above 8.0 on a 0-10 scale). There were medium-to-large effect size improvements in physical activity and psychological well-being (e.g., depressive symptoms). The GOALS intervention will next be tested in a pilot randomized controlled trial with longer-term follow-up to assess its effect more robustly.

BACKGROUND:Though a growing body of research suggests that greater positive psychological well-being in irritable bowel syndrome (IBS) may be protective, existing brain-gut behavior therapies primarily target negative psychological factors. Little is known about how positive psychological factors in IBS relate to IBS symptoms, health-related quality of life (HRQoL), or adherence to key health behaviors, such as physical activity and diet modification. Accordingly, per the ORBIT model of behavioral treatment development for chronic diseases, we explored potential connections between psychological constructs and IBS symptoms, health behavior engagement (physical activity and dietary modification), and HRQoL in a qualitative study to inform the development of a novel brain-gut behavior therapy.METHODS:Participants with IBS completed self-report assessments and semi-structured phone interviews about relationships between positive and negative psychological constructs, IBS symptoms, health behavior engagement, and HRQoL.KEY RESULTS:Participants (n = 23; 57% female) ranged in age from 25 to 79 (mean age = 54). IBS subtypes were similarly represented (IBS-diarrhea [n = 8], IBS-constipation [n = 7], and IBS-mixed [n = 8]). Participants described opposing relationships between positive and negative psychological constructs, IBS symptoms, health behavior engagement, and HRQoL, respectively, such that experiencing positive constructs largely mitigated IBS symptoms, boosted health behavior participation, and improved HRQoL, and negative constructs exacerbated symptoms, reduced health behavior participation, and worsened HRQoL.CONCLUSIONS AND INFERENCES:Participants with IBS linked greater positive psychological well-being to moderated IBS symptoms and better HRQoL and health behavior participation. An intervention to cultivate greater well-being may be a novel way to mitigate IBS symptoms, boost health behavior participation, and improve HRQoL in IBS.

Metabolic/bariatric surgery (MBS) is the most effective treatment available for severe obesity, but weight regain is common, increasing risk for cardiometabolic disease. Physical activity (PA) reduces these risks and aids with weight loss maintenance; however, over 90% of adults after MBS do not achieve at least 150 minutes/week of moderate-to-vigorous physical activity (MVPA) when measured objectively. Negative emotional associations with PA are common in this population (e.g., physical pain or injury, weight stigma). Positive psychological interventions are simple exercises shown to increase psychological well-being. The Gaining Optimism After weight Loss Surgery (GOALS) Project aims to target the emotional barriers to PA in adults with recent MBS using a positive psychological approach combined with motivational interviewing and goal-setting for PA. We tested feasibility, acceptability, and pre-post change in PA and psychological, behavioral, and physiological outcomes in a single-arm proof-of-concept trial to refine GOALS and prepare for a future RCT. GOALS included 10 weekly phone calls plus a written manual and a Fitbit to track PA. Each session included a positive psychology exercise, a PA-related topic, and setting a weekly PA goal. Participants were adults with MBS in the past 6-12 months who reported low physical activity. Primary outcomes were feasibility (session completion rates) and acceptability (participant ratings of session ease and utility). Pre-post assessments included physical activity measured with Actigraph GT3X-BT, a 6-minute walk test, BMI, percent body fat and waist circumference, and self-report measures of depression, anxiety, optimism, internalized weight bias, attitudes around physical activity, and post-MBS behavioral adherence. Mixed effects regression models with a random intercept measured change in outcomes including participants with missing data. Effect sizes (Cohen’s d) estimated magnitude of change given low study power. We enrolled 12 participants (58% female, M age 46 years, 67% non-Hispanic white). They completed 8.5/10 intervention sessions on average and gave high ratings ( M between 8.3 and 8.8/10) of ease and utility. There were increases in MVPA equivalent to an additional 17 minutes/day (d=0.61, p=0.09), 6-minute walk test distance (d=1.06, p=0.01) and reductions in BMI (d=0.81, p=0.04), depression (d=1.22, p<0.01), anxiety (d=0.51, p=0.16), and internalized weight bias (d=0.98, p=0.03), and increases in post-MBS adherence (d=1.44, p<0.01). The GOALS intervention demonstrated feasibility, acceptability, and pre-post improvements in PA and psychological well-being in a small proof-of-concept trial. The intervention is now being tested in a pilot RCT compared to a PA education control. If it continues to show similar effects, the intervention could be integrated into post-MBS clinical care to improve outcomes.

Positive psychology (PP) interventions utilize short tasks (e.g., using personal strengths,) to cultivate well-being, and they may increase cardiac health behaviors. Text message interventions (TMIs) may represent a novel, accessible means to deliver a personalized, PP-based program to promote health behavior engagement. Accordingly, we developed Text4Health, a 12-week, adaptive, PP-based TMI, which delivers specific text messages to individuals in response to their ratings of prior messages, to promote health in persons at elevated cardiac risk. In this manuscript, we describe the design, conduct, and process-related results of a controlled pilot trial of the Text4Health program, compared to enhanced usual care, among 60 patients with multiple cardiac risk conditions and suboptimal adherence to diet and exercise. The primary aim of this study is to assess the feasibility and acceptability of the adaptive TMI. As a key secondary analysis, we are comparing between-group differences in health-related outcomes at 12 and 24 weeks. Study procedures have been successfully completed for all 60 participants. Study participants reported the intervention as useful (mean rating 7.5 [SD 1.7] out of 10) and low burden (mean rating of burden 1.5/10 [SD 2.1]). In exit interviews, they reported enjoying the different types of text messages and provided suggestions for further intervention refinement. If subsequent analysis of the intervention shows potential benefit on clinically relevant outcomes, the next step will be to test it in a larger randomized trial powered to detect changes in health behaviors and other patient-centered outcomes. Trial registration : The study was registered at ClinicalTrials.gov, on May 11, 2020, after IRB approval but prior to the initiation of recruitment. The registration number is NCT04382521, https://clinicaltrials.gov/ct2/show/NCT04382521

Background/Objectives: This pilot randomized controlled trial aimed to help people with metabolic syndrome increase physical activity and well-being. Intervening on lifestyle behaviors such as physical activity, can improve metabolic syndrome outcomes. Methods: Primary care patients with metabolic syndrome were recruited from clinics across our hospital system. Eligibility criteria were: <150 minutes/week of moderate-vigorous physical activity (MVPA), having ≥2 of 5 metabolic syndrome criteria, and not having cardiovascular disease or diabetes, as this was a prevention study. The multilevel intervention (MAPP) included 8-weekly 60-minute group sessions, physical activity self-monitoring/goal setting using Fitbits, physical activity/motivational interviewing (MI) topics, positive psychology (PP) topics, a weekly group walk prior to COVID, and neighborhood walkability assessments. Participants were randomized to an immediate or waitlist control group. They wore an Actigraph GT3X+ accelerometer for one week before beginning and after the last session (8-weeks). We obtained pre-post weight measurements. Mean baseline to 8-week individual difference results were compared between groups using t-tests with unequal variances. Results: Sixty-four participants enrolled, with 32 randomized to each arm; 51 provided complete follow-up data, and 63% (10/16) of the groups were conducted virtually (post-COVID). Most (92%; 59/64) were non-Hispanic White, 69% (44/64) were female, and mean age was 60. Average daily physical activity did not increase significantly by objective measures. The estimated change in mean difference for sedentary time decreased for the intervention group compared to the control group by 46.8 minutes/day (CI: -47.5-141.1; d= 0.28). Light physical activity increased by an average of 21.0 minutes/day (CI: -13.9-55.9; d= 0.34), steps/day increased by 376.6 (CI: -949.6-1702.9; d =0.16), and moderate-vigorous physical activity increased by 4.1 minutes/day (CI: -4.5-12.8; d=0.27). The estimated change in mean weight was significant: 8.4 pounds lost for the intervention group compared to the control group (CI: -13.5-3.2; p =.002; d =0.92). Discussion: This 8-week randomized controlled trial of a multilevel physical activity PP-MI intervention was associated with small to medium effect sizes for changes in physical activity, and a significant decrease in weight, despite weight not being an intervention target. Changes of this magnitude are associated with reduced cardiovascular disease risk and mortality. These findings are all in expected directions, producing signals even amidst different modalities and COVID-19-related disruptions. We plan to test this in a larger efficacy trial with broader reach and implementation.

Social support is essential to the recovery of patients who have undergone hematopoietic stem cell transplantation (HSCT). We undertook a qualitative study to explore the specific sources and benefits of social support as experienced by HSCT recipients, as well as their unmet social support needs. We conducted semistructured interviews with 25 HSCT recipients recruited from the Dana Farber Cancer Institute's HSCT database. The interviews explored the sources of support that patients receive, the type of assistance social support networks provide to patients, and unmet needs of social support. Interviews were audio-recorded, transcribed, and coded using Dedoose software. The median age of participants was 63 years (range, 22 to 73 years), and 13 (52%) were female, 20 (80%) were white, and 9 (36%) had been diagnosed with acute myelogenous leukemia. Participants reported receiving a majority of support from immediate family and close friends, with the primary benefits of social support including help with essential daily tasks and household chores, and receipt of emotional support. Participants reported occasional support from other patients but highlighted a desire for increased connection with patients who have undergone the same treatment. Participants also communicated a desire for more guidance on how to optimize the support they do receive and the need for more educational resources for caregivers and supporters to enhance understanding of the HSCT process and lessen patient burden. Participants reported relying on support from their family, friends, and other social connections for essential aspects of their recovery and daily living following HSCT. Although there are many benefits from these relationships, patients emphasized the need for more guidance and resources to facilitate post-transplantation aid and support.

Background Physical activity during midlife (ages 45-64) plays a major role in the prevention of chronic and serious medical conditions. Unfortunately, many midlife adults struggle to be physically active in the setting of low levels of psychological well-being and the management of multiple confluent sources of stress. Effective, scalable, midlife-specific interventions are needed to promote physical activity and prevent the development of chronic medical conditions.Objectives In an initial proof-of-concept trial, we assessed the feasibility and acceptability of a new, midlife-adapted, phone- and text message-based intervention using positive psychology (PP) skill-building and motivational interviewing (MI) techniques. We secondarily analyzed post-intervention changes in accelerometer-measured physical activity and self-reported outcomes.Methods The PP-MI intervention included six weekly phone sessions with a study trainer, with completion of PP activities and physical activity goals between calls, and in the subsequent six weeks briefer phone check-ins were conducted. Text messages over the 12-week intervention period were utilized to support participants and identify barriers to goal completion. Feasibility (session completion rates) and acceptability (participant ratings of intervention ease and utility) were assessed via descriptive statistics, and pre-post improvements in psychological, functional, and physical activity outcomes at 12 weeks were examined via mixed effects regression models.Results Twelve midlife adults with low baseline physical activity enrolled in the single-arm trial. Overall, 76.8% of all possible sessions were completed by participants, and mean ratings of weekly phone sessions were 8.9/10 (SD 1.6), exceeding our a priori thresholds for feasibility and acceptability. Participants demonstrated generally medium to large effect size magnitude improvements in accelerometer-measured physical activity, psychological outcomes, and function.Conclusions A novel, midlife-specific phone- and text-based PP-MI intervention was feasible and had promising effects on physical activity and other clinically relevant outcomes, supporting next-step testing of this program via a randomized controlled trial.

Background Physical activity levels after bariatric surgery are usually low, despite the significant protective health benefits of physical activity in this population. Positive psychological well-being is associated with improved adherence to health behaviors, but bariatric surgery patients often have negative associations with physical activity that prevent sustained engagement. Objective The Gaining Optimism After weight Loss Surgery (GOALS) pilot randomized controlled trial is aimed at testing a novel intervention to increase physical activity after bariatric surgery, which incorporates positive psychological skill-building with motivational interviewing and goal-setting. Methods The GOALS trial is a 2-arm, 24-week pilot randomized controlled trial that aims to enroll 58 adults who report less than 200 minutes per week of moderate to vigorous physical activity and a desire to become more active 6-12 months after bariatric surgery. GOALS is testing the feasibility, acceptability, and preliminary efficacy of a positive psychology–motivational interviewing telephone intervention targeting to increase physical activity and associated positive affect. Intervention components include positive psychology, goal-setting, self-monitoring via provided Fitbits, and motivational interviewing to overcome barriers and increase motivation. The intervention is compared to a physical activity education control that includes mailings with psychoeducation around physical activity and provision of a Fitbit. The primary outcomes of the pilot trial are feasibility and acceptability, measured as session completion rates and participant ratings of ease and helpfulness of each session. The main secondary outcome is change in accelerometer-measured moderate to vigorous physical activity post intervention and at 24-week follow-up. Additional outcomes include changes in attitudes related to physical activity, psychological well-being, and physical health measures. Results This multiphase project was funded in 2020 and institutional review board approval was obtained for the proposed trial in 2021. Recruitment for the randomized controlled trial began in July 2022. Upon completion of the pilot trial, we will examine the feasibility, acceptability, and preliminary efficacy of the intervention. Conclusions Although bariatric surgery is the most effective treatment available for severe obesity, weight regain occurs, often in the context of low psychological well-being. Many individuals would benefit from learning strategies to increase positive psychological well-being after bariatric surgery, which could help them maintain lifestyle changes. Positive psychology is a novel approach to improve adherence by increasing positive associations with health behaviors including physical activity. The GOALS pilot trial will determine whether this type of intervention is feasible and acceptable to this population and will provide a foundation for a future full-scale randomized controlled efficacy trial. Trial Registration ClinicalTrials.gov NCT04868032; https://clinicaltrials.gov/ct2/show/NCT04868032 International Registered Report Identifier (IRRID) PRR1-10.2196/39856

Positive Psychological (PP) constructs (e.g., optimism and gratitude) may impact the adherence to healthy behaviors, including diet, though prior studies have shown mixed findings. This qualitative study explored the relationships between PP constructs and dietary behaviors among 21 adults with metabolic syndrome through semi-structured interviews. Directed content analysis led to five themes: eating healthfully leads to PP constructs, PP constructs lead to eating healthfully, eating healthfully prevents negative emotions, healthy behaviors associated with diet, and an upward healthy spiral. Given the close relationship between PP constructs and diet, these may be targeted to improve diet in risk populations through interventions that promote well-being.

ABSTRACT Background: Physical activity is critical for preventing and treating Type 2 diabetes (T2D). It is important to identify different profiles of physical activity change among those participating in behavioral interventions to optimize intervention-person fit. Methods: This study analyzes longitudinal trajectories of change in moderate-to-vigorous physical activity (MVPA) in a positive psychology (PP) and motivational interviewing (MI) intervention for T2D, using latent growth curve modeling (LGCM). Objective measures of MVPA were collected using accelerometers at three time points: pre-intervention, immediately post-intervention, and eight weeks post-intervention. LGCM analyses identified subpopulations of participants who responded similarly to the intervention and examined if sociodemographic, medical and psychosocial characteristics were associated with MVPA trajectories. Results: Analyses included 47 participants with complete follow-ups: 49% male, 81% non-Hispanic white, average age 66.1 (SD = 10.1). Overall, 36% of the participants increased MVPA while 57% did not. LGCM identified three profiles with distinct MVPA trajectories. Profile 1 (‘Started Low, No Change’; 65.8% of participants) with a starting mean of 4.54 min of MVPA/day and decreased by −3.36 min. Profile 2 (‘Moderate-High Start, Minimal Change,’ 27.4% of participants) and had a starting mean of 22.86 min/day of MVPA with an average increase of 1.03 min. Profile 3 (‘Moderate Start, Ended High’; 6.8% of participants), had a starting mean of 7.33 min MVPA/day, and increased by 28.4 min. Being male, younger, having fewer medical and psychiatric comorbidities were associated with increases in MVPA. Conclusions: This secondary analysis detected three distinct physical activity profiles during and after a PP-MI intervention. Future interventions can target individuals with characteristics that showed the greatest benefit and add additional supports to people in groups that did not increase physical activity as much. These findings show a need for targeted and sustained behavior change strategies during and after physical activity interventions. Trial registration: ClinicalTrials.gov; identifier: NCT03001999.