a time-varying perspective on mindfulness and physical
TRANSCRIPT
The Pennsylvania State University
The Graduate School
College of Health and Human Development
A TIME-VARYING PERSPECTIVE ON MINDFULNESS AND PHYSICAL ACTIVITY
A Dissertation in
Kinesiology
by
Chih-Hsiang Yang
© 2017 Chih-Hsiang Yang
Submitted in Partial Fulfillment
of the Requirements
for the Degree of
Doctor of Philosophy
August 2017
ii
The dissertation of Chih-Hsiang Yang was reviewed and approved* by the following faculties:
David E. Conroy
Professor of Kinesiology and Human Development & Family Studies
Dissertation Advisor
Chair of Committee
Steriani Elavsky
Associate Professor of Kinesiology
Michael Blair Evans
Assistant Professor of Kinesiology
Lesley A. Ross
Associate Professor of Human Development and Family Studies
Stephen J. Piazza
Professor of Kinesiology and Physiology
Graduate Program Director of Kinesiology
*Signatures are on file in the graduate school
iii
Abstract
Physical activity and mindfulness training can each be health enhancing but limited
efforts have been made to integrate them in research or clinical practice. Combining physical
activity with mindfulness as a single intervention have potential to escalate the health effects.
Practicing mindfulness during physical activity interventions may also help people to maintain
their increased physical activity level, leading to a more sustainable intervention. The
disproportional attention on trait mindfulness but limited focus on state mindfulness in previous
studies signifies a main barrier that restricted the application for implementing mindfulness in
physical activity interventions. To overcome this main obstacle, three studies in this dissertation
were designed to address the barrier and advance understanding of the relation between physical
activity and mindfulness.
The first study involved a systematic review of peer-reviewed research articles in major
academic database and Google Scholar to synthesize and identify gaps in the mindfulness-
physical activity literature. Available evidence showed that physical activity and trait
mindfulness were positively related, but little has been known regarding the association between
physical activity and state mindfulness. Based on the lack of state mindfulness studies in the
current literature, a three-level mindfulness framework (global, contextual, and situational level)
was proposed to organize current research studies and available mindfulness self-report measures
within each mindfulness level. This hierarchical framework that differentiated the contextual and
temporal specificity of mindfulness is needed to bridge the gap in the literature.
The second study applied experience sampling methods to investigate the relations
between momentary time allocation in different daily activities/postures and well-being among
college students (N=158). Results from multilevel analysis suggested that college students’
iv
negative affect was associated with their daily activities/postures and mindfulness in the within-
person level. When students moved more or stood more compared to sitting in their daily life,
they reported lower levels of negative affect. Further, students’ situational mindfulness seemed
to moderate this within-person association between momentary activities/postures and negative
affect. When students were more mindful while moving, they experienced greater degrees of
reduction in negative affect momentarily.
The final study designed and evaluated an outdoor mindful walking program to determine
its feasibility, acceptability, sustainability and preliminary efficacy in reducing negative affect
among older adults. Community-dwelling older adults (N=27) attended a one-month, eight
session mindful walking program and completed multiple self-report measures before, during,
and after the program. Overall, participants perceived this outdoor mindful walking program to
be acceptable, engaging and appealing. After the program, most of them were still willing to
maintain and actually continued practicing mindful walking in their leisure time. Preliminary
efficacy of the program was also identified. After the mindful walking sessions, reductions in
negative affect were associated with increases in situational mindfulness among older adults.
Based on the promising results, future randomized controlled trials are warranted to test the
efficacy of mindful walking program among older adults.
Collectively, these studies highlight the value of studying mindfulness as a time-varying
construct in physical activity studies. Differentiating global mindfulness from context- or
situation-specific mindfulness not only broadens our scope in understanding the relation between
physical activity and mindfulness, but also provides a new avenue for future research. Each study
in the current dissertation made unique contributions to the physical activity and mindfulness
literature. First, this dissertation synthesized research evidence on the physical activity-
v
mindfulness association, identified the literature gap, and provided a useful framework for
further studies to close the gap. Second, this dissertation was the first experience sampling study
that identified the time-varying association between momentary physical activity, mindfulness,
and negative affect in daily life. Lastly, this dissertation designed an innovative and feasible
mindful walking program which may inform future dissemination for reducing negative affect in
older adults. In general, the within-person associations between physical activity and
mindfulness established in this dissertation provided valuable implications in facilitating and
developing effective behavioral intervention strategies to promote health and well-being in
different populations.
vi
Table of Contents
List of Tables ................................................................................................................................ vii
List of Figures .............................................................................................................................. viii
Acknowledgements ........................................................................................................................ ix
Chapter 1: Introduction ................................................................................................................... 1
References ................................................................................................................................... 8
Chapter 2: Mindfulness and Physical Activity: A Systematic Review and Hierarchical Model of
Mindfulness................................................................................................................................... 17
Methods ..................................................................................................................................... 21
Results ....................................................................................................................................... 21
Discussion ................................................................................................................................. 26
References ................................................................................................................................. 37
Chapter 3: Momentary Negative Affect is Lower During Mindful Movement than While Sitting:
An Experience Sampling Study .................................................................................................... 55
Abstract ..................................................................................................................................... 56
Methods ..................................................................................................................................... 62
Results ....................................................................................................................................... 68
Discussion ................................................................................................................................. 70
References ................................................................................................................................. 77
Chapter 4: Feasibility of an Outdoor Mindful Walking Program for Reducing Negative Affect in
Older Adults .................................................................................................................................. 94
Abstract ..................................................................................................................................... 95
Methods ................................................................................................................................... 100
Results ..................................................................................................................................... 106
Discussion ............................................................................................................................... 109
References ............................................................................................................................... 115
Chapter 5: Conclusions ............................................................................................................... 129
References ............................................................................................................................... 138
vii
List of Tables
Table 2.1. Description of the reviewed studies on mindfulness and physical activity….…….…46
Table 2.2. Current mindfulness questionnaires organized by their level in the proposed
hierarchical model……………...….…………………………………………………...…….….50
Table 3.1. Descriptive statistics, correlations, and intraclass correlation coefficients of subjective experiences, physical activity, and other variables of interest………….................………….....91 Table 3.2. Multilevel model coefficients for model predicting negative affect....………………92 Table 4.1. Overview of the eight walking sessions in the mindful walking program...………..124
Table 4.2. Contexts of the mindful walking sessions.............…………………...……………..125
Table 4.3. Correlation coefficient matrix of the pre-post walking session variables.……...…..126
Table 4.4. Result of multiple regression model examining associations between mindfulness
level and negative affective reactivity…………………………..……………….……..………127
viii
List of Figures
Figure 1.1. Conceptual framework of the proposed studies designed in the dissertation ...………15
Figure 2.1. The PRISMA flow chart for literature research ...…………………………………....53
Figure 3.1. Frequency of experience sampling responses at each time during the study period …89
Figure 3.2. Associations of momentary mindfulness and moving on negative affect …………....90
Figure 4.1. CONSORT flow diagram of mindful walking program………………...…………...123
ix
Acknowledgements
In my journey of pursuing the doctoral degree in Kinesiology, I have received tremendous support
from multiple individuals. My success is the product of their support and encouragement.
First and foremost, I would like to express my sincere gratitude to my advisor David E. Conroy for
providing me his excellent guidance and support throughout my graduate training over the past four years.
His mentorship is always thoughtful and patient. I am very fortunate to be his student and work with him.
His expertise and constructive feedback have inspired my work and prepared me to become a better
researcher. My deepest appreciation also goes out to Dr. Steriani Elavsky, Dr. Blair Evans, and Dr. Lesley
Ross for their kindness and precious time in serving on my dissertation committee. With their valuable
insights and feedback, the quality of my dissertation has elevated in all aspects.
I am forever grateful to my family, including my parents and my sisters Peggy and Carol, for their
consistent, unconditional support and love; and to my dear friends and colleagues both in Taiwan and
Penn State for their support and positive thoughts. I am also grateful to Jessie Fu for believing in me and
willing to walk with me in reaching the finish line of this marathon. Her warm consideration and
understanding has undoubtedly strengthened my ability to complete this challenging process.
Special thanks to my bachelor and master mentor Dr. Zhong, Sheng-Xiao, Dr. Sheue-Mei Lu, and
Principle Ching-Yuan Huang at Ta-Yeh Elementary School for their encouragement, ongoing support,
and valuable experiences they have shared with me. Thanks to all the great people in Happy Valley, to
those who were so gracious with their time and resources in helping with my study recruitment, and to
those who expressed their genuine attitude in participating my study. Without their commitment, there
would not be my dissertation.
Finally, I would also like to acknowledge the funding agents - the Studying Abroad Scholarship
from the Ministry of Education in Taiwan for supporting my graduate training, and the Dissertation
Research Endowment Funds from College of Health and Human Development at Penn State for
supporting my dissertation work. Without the financial resources, my work would not be possible.
1
Chapter 1: Introduction
2
The mind-body practice of mindful movement has become increasingly popular as a non-
pharmacological therapy to promoting health and well-being. This approach can be simply
described as combining features from both mindfulness meditation and bodily-based activities
into a particular form of practice (La Forge, 2016; Tang, Jiang, & Tang, 2017). Accumulating
research evidence has revealed the salutary impacts of mindful movement approach on a variety
of physical and mental health outcomes in both the clinical and general populations (Appling,
Scarvalone, MacDonald, McBeth, & Helzlsouer, 2012; Lee, Mancuso, & Charlson, 2004; Paul et
al., 2013; Schure, Christopher, & Christopher, 2008; Tang et al., 2017; Wells, Phillips, &
McCarthy, 2011). Despite the promising outcomes of mindful movement interventions, the
association between mindfulness and physical activity has not been fully studied.
Mindfulness is the ability to regulate one’s attention and awareness towards the present
moment experiences, and adopting an accepting, open-minded, and curious orientation towards
these experiences (Kabat-Zinn, 2011; Langer, 1992). Previous research has made a distinction
between trait and state modes of mindfulness to characterize their between-person and within-
person individual difference, respectively (Brown & Ryan, 2003; Thompson & Waltz, 2015).
Trait and state mindfulness are closely associated, but they are considered different constructs
theoretically and operationally (Bishop et al., 2004). The literature points to a profound effect of
mindfulness-based interventions on physical and mental health. These interventions are generally
designed to target people’s trait mindfulness, so the beneficial effects can be observed as
participants’ trait mindfulness increased (Greeson, 2009). Mindfulness-based interventions can
positively impact health behaviors including eating, sleeping, substance use, and cardiovascular
health (Gilbert & Waltz, 2010; Loucks et al., 2015). They have also consistently exerted
substantial efficacy in reducing negative affective states including stress, anxiety, and depression
3
(Davis & Hayes, 2011; Gotink et al., 2015; Grossman, Niemann, Schmidt, & Walach, 2004;
Keng, Smoski, & Robins, 2011; Sharma & Rush, 2014). These results have mostly focused
health behavior and well-being differences between more and less mindful people. Only a few
studies thus far explored the time-varying association between mindfulness and negative affect
(Snippe et al., 2016; Snippe, Nyklíček, Schroevers, & Bos, 2015).
Physical activity refers to any bodily movement that increases energy expenditure from
the contraction of skeletal muscle (Caspersen, Powell, & Christenson, 1985). Engaging in
moderate-to-vigorous physical activity can lower the risk for early death, heart disease, stroke,
type-2 diabetes, depression, and some cancers (Physical Activity Guidelines Advisory
Committee, 2008). Regular physical activity participation is also associated with better mental
health and less psychological illness in different populations (Biddle & Asare, 2011; Mammen &
Faulkner, 2013; Rebar et al., 2015; Rosenbaum, Tiedemann, Sherrington, Curtis, & Ward, 2014).
For improving well-being, recent reviews and meta-analyses have reported that physical activity
engagement, especially under moderate and vigorous intensities, may reduce different aspects of
negative affect including stress, anxiety, and depression. (Cooney, Dwan, & Mead, 2014; Ensari,
Greenlee, Motl, & Petruzzello, 2015; Schuch, Rocha, & Cadore, 2015; Stults-Kolehmainen &
Sinha, 2013). As with mindfulness research, the majority of these findings are based on between-
person differences, with fewer studies focusing on within-person associations between physical
activity and negative affective states (Dunton et al., 2014; Hyde, Conroy, Pincus, & Ram, 2011;
Liao, Shonkoff, & Dunton, 2015). Based on the well-established positive findings in both
physical activity and mindfulness interventions in improving health and well-being, it would be
interesting to investigate how mindfulness is related to physical activity, and whether there
4
would be potential synergistic effects from integrating these two factors in promoting health and
well-being.
In mindfulness-based interventions, the training on attention-regulation and the adoption
of an open, accepting orientation to mental and bodily experience are considered central
elements across different schools of thought (Hart, Ivtzan, & Hart, 2013). Considering the
critical role of self-regulation in sustaining people’s physical activity, training the regulation of
attention and awareness via mindfulness interventions may also play beneficial roles in
maintaining individual’s physical activity (Bandura, 2005; Buckley, Cohen, Kramer, McAuley,
& Mullen, 2014; de Bruin et al., 2012). In fact, one cross-sectional study has already identified
that people’s trait mindfulness level may amplify relations between intentions and physical
activity (Chatzisarantis & Hagger, 2007). Thus, prescribing mindfulness practice in physical
activity programs may provide additional intervention effect in increasing and sustaining
people’s physical activity level.
On the other hand, regular physical activity participation can also impact people’s
cognitive ability including attention and executive function (Best, Nagamatsu, & Liu-Ambrose,
2014; Kamijo & Takeda, 2010; Sofi et al., 2011). The improved attention and self-control from
physical activity are common outcomes from mindfulness practices, suggesting that physical
activity engagement may also facilitate people to be more mindful (Dickenson, Berkman, Arch,
& Lieberman, 2012; Jha, Krompinger, & Baime, 2007; Tang et al., 2007). Preliminary research
evidence supported this notion by showing that people who exercise more regularly and who can
meet their exercise goals tend to report higher levels of mindfulness (Ulmer, Stetson, & Salmon,
2010).
5
Although there are some studies focusing on how physical activity and mindfulness could
facilitate each other, these studies focus on linking trait mindfulness with physical activity, and
few studies have examined associations between state mindfulness and physical activity. Thus,
little is known about whether state mindfulness, or the mindfulness people experience at a given
moment in time, may also relate to physical activity or interact with physical activity
momentarily in predicting health outcomes. Based on the conceptualization that mindfulness is
more of a state than a trait mental construct, researchers should study mindfulness as a time-
varying state to unpack its relation with physical activity, health, and well-being (Bishop et al.,
2004).
To overcome this limitation in current literature, this dissertation comprises three studies
that advance understanding of how mindfulness and physical activity combine at the momentary
level to enhance health and well-being. Negative affect regulation was used as an indicator of
well-being for this work because negative affective experiences are prevalent in people’s daily
life across different populations (American Psychological Association, 2015). Excessive daily
negative affective experiences (i.e., feelings of stress, anxiety, depression) have been
documented as precursors to more severe, clinical-level mental disorders (Cohen, Janicki-
Deverts, & Miller, 2007; Watson, Clark, & Carey, 1988). Tackling these negative affective states
may prevent the onset of mental illness, and in turn, improve people’s health and well-being.
The conceptual model in Figure 1.1 illustrates the overall association of the main study
constructs. The solid arrows represent the established between-person association among the
constructs based on the literature. These associations are served as the background information
and are not the focus of the current dissertation. For example, intention could predict physical
activity and physical activity could further impact negative affect. However, negative affect
6
could in turn moderate intention-behavior relations. The dashed arrows represent the gaps in the
literature that have not been explored fully, especially from the within-person perspective. For
example, the within-person association between physical activity and mindfulness, or their
potential interaction in predicting negative affect, has not been addressed in depth thus far. Using
this model as a guide, three studies were conducted to address key gaps in the literature.
Chapter 2 reports a systematic literature review of evidence regarding the association
between trait or state mindfulness and physical activity. This review (a) synthesized current
strength of research evidence between both forms of mindfulness and physical activity, (b)
identified key gaps in the literature, and (c) proposed a hierarchical framework to organize
mindfulness at different levels of analysis to improve conceptual clarity and precision.
Chapter 3 reports results from a 14-day experience sampling study conducted to evaluate
among daily activities/postures, mindfulness and negative affect among college students. This
study (a) separated the time-varying and time-invariant components of daily activities/postures
and mindfulness that regulate negative affect in college students, and (b) established the potential
interaction effect of daily activities/postures and momentary mindfulness in moderating negative
affect. These findings provide a foundation for the development of mindful movement
interventions to improve well-being.
Chapter 4 presents the results from a study investigating the feasibility of an outdoor
mindfulness-based walking program implemented with healthy, community-dwelling older
adults. This study (a) evaluated whether an outdoor mindful walking program was feasible,
acceptable, and sustainable to older adults in the community, and (b) examined whether this
intervention showed promise for reducing negative affect among older adults.
7
These three studies fill important gaps in the literature on mindfulness and physical
activity. They address the need to disambiguate forms of state mindfulness in physical activity
research. They provide an example of how mindful movement can improve one indicator of
well-being. These results provide critical insights and generate new hypotheses to inform efforts
to integrate mindfulness and physical activity in ways that improve health and well-being.
8
References
American Psychological Association. (2015). Stress in America. Retrieved May 2, 2016,
from http://www.apa.org/news/press/releases/stress/2014/highlights.aspx
Appling, S. E., Scarvalone, S., MacDonald, R., McBeth, M., & Helzlsouer, K. J. (2012).
Fatigue in breast cancer survivors: The impact of a mind-body medicine intervention. Oncology
Nursing Forum, 39(3), 278–286. https://doi.org/10.1188/12.ONF.278-286
Bandura, A. (2005). The primacy of self-regulation in health promotion. Applied
Psychology, 54(2), 245–254. https://doi.org/10.1111/j.1464-0597.2005.00208.x
Best, J. R., Nagamatsu, L. S., & Liu-Ambrose, T. (2014). Improvements to executive
function during exercise training predict maintenance of physical activity over the following
year. Frontiers in Human Neuroscience, 8. https://doi.org/10.3389/fnhum.2014.00353
Biddle, S. J. H., & Asare, M. (2011). Physical activity and mental health in children and
adolescents: A review of reviews. British Journal of Sports Medicine, 45(11), 886–895.
https://doi.org/10.1136/bjsports-2011-090185
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., …
Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science
and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its
role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.
https://doi.org/10.1037/0022-3514.84.4.822
Buckley, J., Cohen, J. D., Kramer, A. F., McAuley, E., & Mullen, S. P. (2014). Cognitive
control in the self-regulation of physical activity and sedentary behavior. Frontiers in Human
Neuroscience, 8. https://doi.org/10.3389/fnhum.2014.00747
9
Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise,
and physical fitness: Definitions and distinctions for health-related research. Public Health
Reports, 100(2), 126–131.
Chatzisarantis, N. L. D., & Hagger, M. S. (2007). Mindfulness and the intention-behavior
relationship within the Theory of Planned Behavior. Personality and Social Psychology Bulletin,
33(5), 663-676. https://doi.org/10.1177/0146167206297401
Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease.
Journal of the American Medical Association, 298(14), 1685–1687.
https://doi.org/10.1001/jama.298.14.1685
Cooney, G., Dwan, K., & Mead, G. (2014). Exercise for depression. JAMA, 311(23),
2432–2433. https://doi.org/10.1001/jama.2014.4930
Davis, D. M., & Hayes, J. A. (2011). What are the benefits of mindfulness? A practice
review of psychotherapy-related research. Psychotherapy, 48(2), 198–208.
https://doi.org/10.1037/a0022062
de Bruin, M., Sheeran, P., Kok, G., Hiemstra, A., Prins, J. M., Hospers, H. J., & P, J.
(2012). Self-regulatory processes mediate the intention-behavior relation for adherence and
exercise behaviors. Health Psychology, 31(6), 695–703. https://doi.org/10.1037/a0027425
Dickenson, J., Berkman, E. T., Arch, J., & Lieberman, M. D. (2012). Neural correlates of
focused attention during a brief mindfulness induction. Social Cognitive and Affective
Neuroscience, 8(1), 40. https://doi.org/10.1093/scan/nss030
Dunton, G. F., Huh, J., Leventhal, A., Riggs, N., Spruijt-Metz, D., Pentz, M. A., &
Hedeker, D. (2014). Momentary assessment of affect, physical feeling states, and physical
activity in children. Health Psychology, 33(3), 255–263. https://doi.org/10.1037/a0032640
10
Ensari, I., Greenlee, T. A., Motl, R. W., & Petruzzello, S. J. (2015). Meta-analysis of
acute exercise effects on state anxiety: An update of randomized controlled trials over the past 25
years. Depression and Anxiety, 32(8), 624–634. https://doi.org/10.1002/da.22370
Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4),
227–234. https://doi.org/10.1007/s12671-010-0032-3
Goodwin, R. D. (2003). Association between physical activity and mental disorders
among adults in the United States. Preventive Medicine, 36(6), 698–703.
https://doi.org/10.1016/S0091-7435(03)00042-2
Gotink, R. A., Chu, P., Busschbach, J. J. V., Benson, H., Fricchione, G. L., & Hunink, M.
G. M. (2015). Standardised mindfulness-based interventions in healthcare: An overview of
systematic reviews and meta-analyses of RCTs. PLOS ONE, 10(4), e0124344.
https://doi.org/10.1371/journal.pone.0124344
Greeson, J. M. (2009). Mindfulness research update: 2008. Complementary Health
Practice Review, 14(1), 10–18. https://doi.org/10.1177/1533210108329862
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress
reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–
43. https://doi.org/10.1016/S0022-3999(03)00573-7
Hart, R., Ivtzan, I., & Hart, D. (2013). Mind the gap in mindfulness research: A
comparative account of the leading schools of thought. Review of General Psychology, 17(4),
453–466. https://doi.org/10.1037/a0035212
Hyde, A. L., Conroy, D. E., Pincus, A. L., & Ram, N. (2011). Unpacking the feel good
effect of free-time physical activity: between- and within-person associations with pleasant-
activated feeling states. Journal of Sport & Exercise Psychology, 33(6), 884–902.
11
Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies
subsystems of attention. Cognitive, Affective, & Behavioral Neuroscience, 7(2), 109–119.
https://doi.org/10.3758/CABN.7.2.109
Kabat-Zinn, J. (2011). Mindfulness for beginners: Reclaiming the present moment–and
your life. Sounds True.
Kamijo, K., & Takeda, Y. (2010). Regular physical activity improves executive function
during task switching in young adults. International Journal of Psychophysiology, 75(3), 304–
311. https://doi.org/10.1016/j.ijpsycho.2010.01.002
Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on
psychological health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041–
1056. https://doi.org/10.1016/j.cpr.2011.04.006
La Forge, R. (2016). Mind-body (mindful) exercise in practice. ACSM’s Health & Fitness
Journal, 20(4), 6–8.
Langer, E. J. (1992). Matters of mind: Mindfulness/mindlessness in perspective.
Consciousness and Cognition, 1(3), 289–305. https://doi.org/10.1016/1053-8100(92)90066-J
Lee, S. W., Mancuso, C. A., & Charlson, M. E. (2004). Prospective study of new
participants in a community-based mind-body training program. Journal of General Internal
Medicine, 19(7), 760–765. https://doi.org/10.1111/j.1525-1497.2004.30011.x
Liao, Y., Shonkoff, E. T., & Dunton, G. F. (2015). The acute relationships between
affect, physical feeling states, and physical activity in daily life: A review of current evidence.
Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.01975
Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G.,
Brewer, J. A., & Fulwiler, C. (2015). Mindfulness and cardiovascular disease risk: State of the
12
evidence, plausible mechanisms, and theoretical framework. Current Cardiology Reports,
17(12). https://doi.org/10.1007/s11886-015-0668-7
Mammen, G., & Faulkner, G. (2013). Physical activity and the prevention of depression:
A systematic review of prospective studies. American Journal of Preventive Medicine, 45(5),
649–657. https://doi.org/10.1016/j.amepre.2013.08.001
Paul, A., Cramer, H., Lauche, R., Altner, N., Langhorst, J., & Dobos, G. J. (2013). An
oncology mind-body medicine day care clinic: concept and case presentation. Integrative Cancer
Therapies, 12(6), 503–507. https://doi.org/10.1177/1534735412473639
Physical Activity Guidelines Advisory Committee. (2008). Physical activity guidelines
advisory committee report. Washington, DC: US Department of Health and Human Services,
2008, A1-H14.
Rebar, A. L., Stanton, R., Geard, D., Short, C., Duncan, M. J., & Vandelanotte, C.
(2015). A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-
clinical adult populations. Health Psychology Review, 9(3), 366–378.
https://doi.org/10.1080/17437199.2015.1022901
Rosenbaum, S., Tiedemann, A., Sherrington, C., Curtis, J., & Ward, P. B. (2014).
Physical activity interventions for people with mental illness: a systematic review and meta-
analysis. The Journal of Clinical Psychiatry, 75(9), 964–974.
https://doi.org/10.4088/JCP.13r08765
Schuch, F. B., Rocha, N., & Cadore, E. L. (2015). Progress in Physical activity and
Exercise and Affective and Anxiety Disorders: Translational Studies, Perspectives and Future
Directions. Frontiers Media SA.
13
Schure, M. B., Christopher, J., & Christopher, S. (2008). Mind-body medicine and the art
of self-care: Teaching mindfulness to counseling students through yoga, meditation, and qigong.
Journal of Counseling and Development : JCD; Alexandria, 86(1), 47–56.
Sharma, M., & Rush, S. E. (2014). Mindfulness-based stress reduction as a stress
management intervention for healthy individuals: A systematic review. Journal of Evidence-
Based Complementary & Alternative Medicine, 19(4), 271–286.
https://doi.org/10.1177/2156587214543143
Snippe, E., Nyklíček, I., Schroevers, M. J., & Bos, E. H. (2015). The temporal order of
change in daily mindfulness and affect during mindfulness-based stress reduction. Journal of
Counseling Psychology, 62(2), 106–114. https://doi.org/10.1037/cou0000057
Snippe, E., Simons, C. J. P., Hartmann, J. A., Menne-Lothmann, C., Kramer, I., Booij, S.
H., … Wichers, M. (2016). Change in daily life behaviors and depression: Within-person and
between-person associations. Health Psychology, 35(5), 433–441.
https://doi.org/10.1037/hea0000312
Sofi, F., Valecchi, D., Bacci, D., Abbate, R., Gensini, G. F., Casini, A., & Macchi, C.
(2011). Physical activity and risk of cognitive decline: a meta-analysis of prospective studies.
Journal of Internal Medicine, 269(1), 107–117. https://doi.org/10.1111/j.1365-
2796.2010.02281.x
Stults-Kolehmainen, M. A., & Sinha, R. (2013). The effects of stress on physical activity
and exercise. Sports Medicine, 44(1), 81–121. https://doi.org/10.1007/s40279-013-0090-5
Tang, Y.-Y., Jiang, C., & Tang, R. (2017). How mind-body practice works—integration
or separation? Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.00866
14
Tang, Y.-Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., … Posner, M. I. (2007). Short-
term meditation training improves attention and self-regulation. Proceedings of the National
Academy of Sciences, 104(43), 17152–17156. https://doi.org/10.1073/pnas.0707678104
Thompson, B. L., & Waltz, J. (2015). Everyday mindfulness and mindfulness meditation:
Overlapping constructs or not? Personality and Individual Differences, 43(7), 1875–1885.
https://doi.org/10.1016/j.paid.2007.06.017
Ulmer, C. S., Stetson, B. A., & Salmon, P. G. (2010). Mindfulness and acceptance are
associated with exercise maintenance in YMCA exercisers. Behaviour Research and Therapy,
48(8), 805–809. https://doi.org/10.1016/j.brat.2010.04.009
Watson, D., Clark, L. A., & Carey, G. (1988). Positive and negative affectivity and their
relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97(3), 346–353.
https://doi.org/10.1037/0021-843X.97.3.346
Wells, R. E., Phillips, R. S., & McCarthy, E. P. (2011). Patterns of mind-body therapies
in adults with common neurological conditions. Neuroepidemiology, 36(1), 46–51.
https://doi.org/10.1159/000322949
15
Figure Caption
Figure 1.1. Conceptual framework of the proposed studies designed in the dissertation.
16
17
Chapter 2: Mindfulness and Physical Activity: A Systematic Review and Hierarchical
Model of Mindfulness
18
Abstract
Mindfulness has attracted recent interest for its potential to promote and sustain health
behaviors such as physical activity. It is conceptualized as an individual characteristic or mental
skill reflecting differences between people (trait) as well as differences within people across
contexts and time (state). Emerging empirical studies have investigated the association between
mindfulness and physical activity, but most have narrowly focused on trait mindfulness and not
examined state mindfulness as a time-varying construct. This paper reports a systematic review
of research on the association between mindfulness and physical activity. The available evidence
supported a positive association between trait mindfulness and physical activity and confirmed a
large gap in research on state mindfulness and physical activity. A three-level, hierarchical
framework – including global, contextual, and situational mindfulness – was proposed to
stimulate research on state mindfulness and physical activity by distinguishing between
momentary and context-specific levels of mindfulness. Available mindfulness measures
corresponding to each level of analysis were identified and reviewed to recommend
measurement options at each level. Finally, future research priorities were proposed based on the
three-level framework of mindfulness. These priorities include developing level-specific
mindfulness measurements based on a unifying conceptual model, conducting more longitudinal
and experimental studies that evaluate the dynamics of mindfulness, and translating emerging
evidence into interventions to promote physical activity and public health.
19
Mindfulness and Physical Activity: A Systematic Review and Hierarchical Model of
Mindfulness
Physical inactivity is the fourth leading risk factor for global mortality in both men and
women (Bull & Bauman, 2011; Lee et al., 2011). The annual worldwide health care burden of
physical-inactivity has been conservatively estimated to exceed $500 billion (Ding et al., 2016).
Despite the well-known benefits of physical activity, a substantial proportion of the population
fails to meet physical activity guidelines (Centers for Disease Control and Prevention, 2017).
Many who are motivated also fail to enact their intentions for physical activity (Rhodes & de
Bruijn, 2013). This inactivity problem involves environmental, policy, social, and intrapersonal
factors (Seefeldt, Malina, & Clark, 2012; Trost, Owen, Bauman, Sallis, & Brown, 2002).
Mindfulness, a form of heightened awareness and acceptance, is a modifiable intrapersonal
factor that has demonstrated a salutary influence on a variety of health behaviors including
eating, sleeping, and substance use (Greeson, 2009; Jordan, Wang, Donatoni, & Meier, 2014).
Mindfulness meditation has also been shown to improve immune function and lower
inflammatory disease risk (Creswell et al., 2016.; Davidson et al., 2003). Emerging evidence
suggests a positive association between mindfulness and overall cardiovascular health (Kennedy
& Resnick, 2015; Loucks, Britton, Howe, Eaton, & Buka, 2014). This systematic review
summarizes the available evidence on associations between mindfulness and physical activity,
identifies critical gaps in the literature, and proposes a framework to guide future research.
Mindfulness is conceived as modifiable because it can be trained and cultivated by
paying attention in a sustained and particular way (Kabat-Zinn, 2011). The two leading
contemporary schools of thought about mindfulness were advanced by Langer and Kabat-Zinn
(Hart, Ivtzan, & Hart, 2013). Langer considered mindfulness as both a state of conscious
20
awareness and a state of openness to novelty (Langer, 1992). Kabat-Zinn, on the other hand,
described mindfulness as a process of bringing a certain quality of attention to one’s moment-by-
moment experience. This process requires paying attention in a very particular way: on purpose,
in the present moment, and nonjudgmentally (Kabat-Zinn, 1990, 1994). Bishop et al. (2004) later
integrated these definitions and conceived mindfulness as both a state and a mental skill, as well
as a constellation of personality traits that contribute to mindful states. The trait and state
versions of mindfulness have historically been conceptualized as separate constructs theoretically
(Davidson, 2010; Thompson & Waltz, 2015).
Individuals are assumed to have a dispositional capacity (i.e., trait) for mindfulness
across contexts. Momentary levels (i.e., state) of mindfulness vary over time during specific
activities and situations, regardless of one’s level of trait mindfulness (Brown & Ryan, 2003).
The established trait and state mindfulness model corresponds to the contrast involving between-
and within-person variation (Curran & Bauer, 2011), respectively. It is important to consider
both sources of variation to understand fully how mindfulness is associated with physical
activity.
The present paper reports a systematic review of literature on mindfulness and physical
activity. First, the available evidence linking physical activity with both trait and state
mindfulness is summarized. Second, key gaps in that literature are identified. Third, a
hierarchical model is proposed to improve conceptual clarity and precision when defining and
measuring mindfulness in physical activity studies. Measures at each level of analysis are
reviewed to develop recommendations for harmonizing assessments. Finally, priorities for
further research are proposed to improve our understanding for how mindfulness can be
implemented as a strategy to promote physical activity.
21
Methods
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA; Moher, Liberati, Tetzlaff, Altman, & Group, 2009) as a guide, we searched the
PubMed, PsycINFO, and Web of Science (Science Citation Index and Social Science Citation
Index) databases and Google Scholar (limited to the first 1000 articles) to identify relevant
research on mindfulness and physical activity. Inclusion criteria for the targeted studies included:
(1) peer-reviewed publication, (2) full-text of article is available, (3) published in English, (4)
original research, (5) human subject research, and (6) quantitative data for both mindfulness and
physical activity. Title and abstract field search was conducted in April 2017 using the following
search terms: (exercise OR sport OR sports OR “leisure activity” OR “physical activities” OR
“leisure activities” OR “physical activity” OR “health behavior” OR “health behaviour” OR
“health behaviors” OR “health behaviours”) AND (mindful* OR mindfulness-based OR
meditation OR mind-body OR "acceptance-based" OR self-compassion OR yoga). Key words
such as leisure activity, health behavior, acceptance-based, self-compassion, or yoga were
included in the search term because of their relevance to physical activity or mindfulness.
Articles were excluded out if they did not explicitly assess both mindfulness and physical
activity levels. No limitations were specified for the starting date in the search, so the earliest
articles were identified automatically by each database or search engine.
Results
As seen in Figure 1.1, a total of 1515 articles were first generated from four sources
based on our search term and inclusion criteria. After removing duplicates and screening for
eligibility, 13 articles were included in the current review (Butryn, Forman, Hoffman, Shaw, &
22
Juarascio, 2011; Chatzisarantis & Hagger, 2007; Gilbert & Waltz, 2010; Kangasniemi,
Lappalainen, Kankaanpää, & Tammelin, 2014; Loucks et al., 2014; Mothes, Klaperski, Seelig,
Schmidt, & Fuchs, 2014; Murphy, Mermelstein, Edwards, & Gidycz, 2012; Roberts & Danoff-
Burg, 2010; Ruffault, Bernier, Juge, & Fournier, 2015; Salmoirago-Blotcher, Hunsinger,
Morgan, Fischer, & Carmody, 2013; Sheeran, 2002; Tsafou, De Ridder, van Ee, & Lacroix,
2015; Tsafou, Lacroix, Ee, Vinkers, & Ridder, 2016; Ulmer, Stetson, & Salmon, 2010). Table
2.1 summarizes key characteristics of these articles.
Samples. Across the 13 articles, a total of 3891 participants were included, with one article
including two studies with separate samples (Chatzisarantis & Hagger, 2007). The majority of
the studies included both female and male participants, except two studies that recruited only
female students (Butryn et al., 2011; Murphy et al., 2012) and one study that included only
young male adults (Mothes et al., 2014). All studies included participants who were age 18 or
older, but most of studies involved only undergraduates or middle-aged adults. Only three
studies included participants with a relatively wider age range (over 18 or between 18 to 65), but
the majority of the participants in these studies were middle-aged adults (Tsafou et al., 2015,
2016; Ulmer et al., 2010).
Study design. Nine of the 13 studies utilized cross-sectional study designs. One longitudinal
study observed undergraduate students’ levels of mindfulness and physical activity at the
beginning and the end of a 10-week semester (Murphy et al., 2012). Two randomized controlled
trials were conducted to identify whether exercise training could enhance mindfulness in middle-
age male adults (Mothes et al., 2014), and whether an Acceptance and Commitment Therapy
(ACT) with mindfulness components could increase physical activity in young female adults
(Butryn et al., 2011). Finally, one intervention study with a single group pre-post design was
23
conducted to test if an 8-week mindfulness-based stress reduction program (MBSR) increased
physical activity (Salmoirago-Blotcher, Hunsinger, Morgan, Fischer, & Carmody, 2013).
Mindfulness measures. Self-report measures were used to assess mindfulness in all studies. Six
different mindfulness scales were identified: the Five-Factor Mindfulness Questionnaire
(FFMQ; Baer et al., 2008), Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003),
Philadelphia Mindfulness Scale (PHLMS; Cardaciotto, Herbert, Forman, Moitra, & Farrow,
2008), Kentucky Inventory of Mindfulness Skills (KIMS; Baer, Smith, & Allen, 2004), Frieberg
Mindfulness Inventory (FMI; Walach, Buchheld, Buttenmüller, Kleinknecht, & Schmidt, 2006),
and Mindfulness in Physical Activity Questionnaire (MFPA; Tsafou et al., 2015). The MAAS
(used in eight studies including two with Dutch versions) and FFMQ (used in four studies) were
the most frequently used instruments to assess trait mindfulness. Three studies used more than
one mindfulness scale to assess both state and trait mindfulness. In one study, the MAAS and
FMI were used to assess the trait and the state mindfulness, respectively (Ulmer et al., 2010). In
the other two studies, MAAS and FFMQ were used to assess trait mindfulness, and the MFPA
was designed to measure mindfulness in the context of physical activities (Tsafou et al., 2015,
2016).
Physical activity measures. Measures for physical activity were more heterogeneous but 12 of
them used self-report measures. The International Physical Activity Questionnaire (IPAQ; Craig
et al., 2003) was the most common measure being applied in six studies. Other self-report
measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ; Godin &
Shephard, 1985) and the Physical Activity, Exercise, and Sport Questionnaire (Fuchs, Klaperski,
Gerber, & Seelig, 2015). Researchers used selected items from Rapid Assessment of Physical
Activity questionnaire (RAPA; Topolski et al., 2006), Youth Risk Behavior Surveillance System,
24
and the Weight and Lifestyle Inventory (WALI; Wadden & Foster, 2006) to assess weekly, daily
physical activity, and daily lifestyle activity. One study used the number of athletic center visits
as proxy for PA frequency (Butryn et al., 2011). Only one study utilized accelerometers to
measure physical activity (Kangasniemi et al., 2014). In addition to assessing physical activity
level, several studies also assessed PA habit strength, exercise maintenance, and satisfaction with
physical activity via self-report questionnaires (Chatzisarantis & Hagger, 2007; Tsafou et al.,
2015, 2016; Ulmer et al., 2010).
Trait mindfulness and physical activity
Cross-sectional studies largely indicated a positive association between trait mindfulness
and physical activity. Trait mindfulness was positively associated with higher frequency and
total volume of physical activity among college students (Gilbert & Waltz, 2010; Roberts &
Danoff-Burg, 2010; Tsafou et al., 2015, 2016). Trait mindfulness was also positively associated
with physical activity maintenance, achievement of exercise goals, physical activity enjoyment,
and satisfaction with physical activity (Loucks et al., 2014; Roberts & Danoff-Burg, 2010;
Tsafou et al., 2015; Ulmer et al., 2010). A positive association between mindfulness and device-
measured physical activity was observed in one study, suggesting that active people are more
mindful than less active people (Kangasniemi et al., 2014). One longitudinal study did not find a
significant association between trait mindfulness and frequency of leisure-time exercise at either
the beginning or end of a 10-week study period (Murphy et al., 2012).
A single-group intervention study revealed that the proportion of inactive participants
decreased after an eight-week MBSR program, and participants increased their overall strength
or flexibility (Salmoirago-Blotcher et al., 2013). The correlation between changes in trait
mindfulness scores was not significantly related to changes in physical activity in that study. The
25
strongest evidence for a positive association between trait mindfulness and physical activity
came from two randomized controlled trials. In the first trial, sedentary male employees were
randomly assigned to either 12-week aerobic exercise group, relaxation training group, or a
waitlist control group (Mothes et al., 2014). The aerobic exercise group increased trait
mindfulness, but the relaxation training and control groups did not increase in trait mindfulness.
In the second study, female students who completed Acceptance-Commitment Therapy sessions
in groups visited the athletic center more frequently over a five-week period than their peers in a
physical activity education group (Butryn et al., 2011). Associations were not reported between
changes in trait mindfulness and the frequency of athletic center visits from baseline through the
end of intervention and the one-month follow-up.
Trait mindfulness may also moderate relations between motivation and action. In one
cross-sectional study, intentions positively predicted physical activity for students who were
more, but not less, trait mindful. Additionally, those who acted more mindfully and less
habitually were more likely to sustain their physical activity intentions than those who acted less
mindfully and more habitually (Chatzisarantis & Hagger, 2007). Tsafou et al. (2015) later
replicated this finding by showing that trait mindfulness was only associated with physical
activity among people with weak physical activity habits. Another cross-sectional study
indicated that trait mindfulness moderated relations between intrinsic motivation and physical
activity. Compared to medium or lower levels of trait mindfulness, people with higher levels of
trait mindfulness had a stronger association between their intrinsic motivation and physical
activity (Ruffault et al., 2015).
State mindfulness and physical activity association
26
Two cross-sectional studies examined physical activity -specific state mindfulness and its
association with physical activity. In both, increased state mindfulness in physical activity
settings was associated with greater physical activity and this association was mediated by
satisfaction towards physical activity (Tsafou et al., 2015, 2016). The Tsafou (2016) study
further showed that both state mindfulness and satisfaction with physical activity mediated the
positive association between trait mindfulness and physical activity. Another cross-sectional
study revealed that YMCA exercisers who reported higher levels of state mindfulness had
stronger beliefs that they could successfully meet their exercise goals (Ulmer et al., 2010). On
the other hand, exercisers who reported missing one week of exercise sessions in the past year
had lower state mindfulness; however, the association between state mindfulness (as measured
by Frieberg Mindfulness Inventory) and physical activity was not clear. This result may be
partially explained by the fact that items from the Frieberg Mindfulness Inventory ask about
more advanced mindfulness experiences, and are considered inappropriate for people who are
not familiar with or have no experience with mindfulness practices (Bergomi, Tschacher, &
Kupper, 2012b). No study assessed momentary mindfulness level and its relation to physical
activity based on the current review.
Discussion
This review examined research on mindfulness and physical activity. Findings revealed
that samples have largely been limited to young and middle-aged adults. No studies to date
sampled younger (younger than 18 years) or older adult (older than 65 years) populations. Study
designs were typically cross-sectional with self-report measures of both mindfulness and
physical activity. Researchers used a variety of measures to assess mindfulness and physical
27
activity, with the MAAS and the IPAQ being the most popular option for mindfulness and
physical activity, respectively.
Previous research has examined both the direct association between mindfulness and
physical activity, and the role of mindfulness in moderating relations between motivational
processes and physical activity. All 13 studies included in this review assessed trait or
dispositional mindfulness, and 10 of them found significant positive associations between trait
mindfulness and physical activity. In contrast, only three studies assessed state mindfulness in
specific exercise or physical activity contexts, and two of them found that higher state
mindfulness could predict physical activity level (Tsafou et al., 2015, 2016). Collectively, the
evidence suggests that both trait and state mindfulness are associated with greater physical
activity. Also, trait mindfulness may help to bridge the intention-behavior gap for physical
activity, so interventions that cultivate mindfulness may be important component of programs to
address this persistent barrier to behavior change (Rhodes & Dickau, 2012; Sheeran, 2002).
In terms of the strength of the evidence, 11 out of the 13 studies used observational or
cross-sectional designs, so it is not possible to make strong statements about the existence or
direction of causal relations between mindfulness and physical activity in most of the reviewed
studies. Two studies applied experimental methods to test whether mindfulness impacted
physical activity or vice versa, but neither study included mixed gender samples which limited
their generalizability. It should also be noted that one of the randomized controlled trials
operationalized physical activity as the frequency of athletic center visits (Butryn et al., 2011).
This measure may not be sensitive to variability in the duration or intensity of physical activity in
that context, or to the frequency, duration or intensity of physical activity in other contexts.
Overall, based on the prevalence of cross-sectional designs and the limitations of the few
28
randomized controlled trials identified, it is not possible to draw strong causal inferences about
the direction of relations between mindfulness and physical activity.
Gap in state mindfulness and physical activity research
With respect to state mindfulness, no research was identified on relations between
momentary mindfulness levels and physical activity. There is a clear gap in our understanding of
how state mindfulness influences thoughts, feelings and actions associated with physical activity.
Generalizing findings about research on trait mindfulness to predict how mindfulness in a
particular context or at a particular moment will impact people’s behavior is risky. People
typically do not act, think or feel the same way in all contexts or even on all occasions within a
context (Fleeson, 2001). Likewise, mindfulness in a particular context may differ from
mindfulness in other contexts or even across occasions within that original context (Brown &
Ryan, 2003). State mindfulness experienced during physical activity may be similar to or
different from state mindfulness during activities that do not involve physical activity (or even
from one physical activity episode to another). In addition to context-specific mindfulness,
people can also experience different levels of state mindfulness from moment to moment in their
everyday life (Thompson & Waltz, 2015). Without disentangling contextual and temporal
variability in state mindfulness, it is not possible to draw clear conclusions about context- and
occasion-specific mindfulness experiences. This confound could present a barrier to
understanding relations between mindfulness and physical activity. As research on state
mindfulness and physical activity develops, it will be important to differentiate between context-
specific states and momentary states with a more refined framework.
The three-level hierarchical mindfulness framework
29
A hierarchical, three-level model can be applied to differentiate between forms of state
mindfulness based on the contextual- and temporal-specificity of the phenomenon. A similar
approach was applied profitably to advance research on intrinsic and extrinsic motivation in
sport and exercise (Vallerand, 1997, 2007a, 2007b). This hierarchical framework differentiates
three levels of mindfulness: global, contextual, and situational.
Global mindfulness represents a general disposition towards mindfulness across the
varied contexts and moments of daily life. In that sense, it represents a person’s default level of
mindfulness (all else being equal). It is similar to trait mindfulness in the two-component (trait-
state) model because it is relatively stable across time and circumstances. Contextual mindfulness
represents a person’s typical level of mindfulness within a specific life context (e.g., while
exercising). It represents a person’s default level of mindfulness at any point of time in a
particular context but may vary from one context to another. Situational mindfulness represents
the level of mindfulness that an individual experiences during a specific activity at a specific
moment. That is, situational mindfulness varies as a function of both context and time. These
three levels of mindfulness should be differentiated to capture the whole spectrum of
mindfulness as it relates to physical activity.
The major difference between the existing two-component model and the proposed
hierarchical framework of mindfulness is that the latter decomposes state mindfulness into
contextual and momentary components. This distinction reduces conceptual fuzziness and should
lead to improved assessments, less ambiguous evidence, and accelerated theory development. A
context-specific mindfulness construct is needed because some life contexts or activities may
elicit more mindfulness than others. For instance, people who feel more involved in the natural
environment have reported higher levels of trait mindfulness and well-being (Howell, Dopko,
30
Passmore, & Buro, 2011; Wolsko & Lindberg, 2013) Likewise, activities that direct people to the
internal incorporation of regulated breathing and focused attention, such as yoga, are believed to
evoke more mindfulness than other physical activities (La Forge, 1997). These observations
become specific, testable questions if contextual mindfulness is differentiated and assessed.
The hierarchical framework also postulates bidirectional relations across the three levels
(Vallerand, 1997, 2007a, 2007b). Top-down effects describe how mindfulness at more abstract
levels in the hierarchy can influence mindfulness at more specific levels (e.g., global mindfulness
influencing contextual mindfulness, or contextual mindfulness influencing situational
mindfulness). Bottom-up effects describe how mindfulness at more specific levels can
accumulate to influence more abstract levels over time (e.g., increases in situational mindfulness
within a context accumulating to increase corresponding contextual mindfulness). The Top-down
principle is consistent with Brown and Ryan’s (2003) study showing that people who had higher
global mindfulness were more likely to express higher situational mindfulness, when assessed by
both the trait and state versions of Mindful Attention and Awareness Scale. The Bottom-up
principle has also been partially supported in a longitudinal study showing that over time,
increases in global mindfulness level were positively predicted by their rates of change in
contextual mindfulness during meditation practice (Kiken, Garland, Bluth, Palsson, & Gaylord,
2015).
Organizing mindfulness measures within the three-level hierarchical framework
To realize the potential of this hierarchical framework, researchers need instruments to
measure mindfulness validly at each level. The majority of existing scales have been used to
assess individual differences in global mindfulness (Bergomi et al., 2012b; Sauer et al., 2012).
Only a few scales are available for measuring either contextual or situational mindfulness. Table
31
2.2 summaries the major measures used in contemporary research on mindfulness (including
research on mindfulness and physical activity) according to the three levels in the proposed
hierarchical framework of mindfulness.
The eight available global mindfulness measures in Table 2.2 generally demonstrate
acceptable validity and reliability (Baer, 2011). They differ in the presumed latent structure of
mindfulness, the target populations for which the measures were developed, and the scope of
meditation experience required to respond to the items (Sauer et al., 2012). These differences
present a challenge when comparing and replicating research findings (Bergomi, Tschacher, &
Kupper, 2012a; Bergomi et al., 2012b). The Mindful Attention Awareness Scale has been used
most frequently in research on physical activity, followed by the Five Facet Mindfulness
Questionnaire. The main difference between the two measures is that the former assesses a
unidimensional mindfulness structure, whereas the latter measures a multidimensional
mindfulness structure and thus requires more items and time to complete.
Measures of contextual mindfulness are more limited with only three options specific for
sport or physical activity contexts. Scores from the Mindfulness Inventory for Sport have
psychometric support from factor analysis and evidence of convergent validity with related
constructs (Thienot et al., 2014). The State Mindfulness Scale for physical activity is an
adaptation of the State Mindfulness Scale (Cox, Ullrich-French, & French, 2016; Tanay &
Bernstein, 2013). Scores from State Mindfulness Scale measure have demonstrated convergent
validity with scores from the Toronto Mindfulness Scale and showed mean score differences
between groups with and without yoga experience. To the best of our knowledge, the six-item
Mindfulness in Physical Activity scale (Tsafou, De Ridder, van Ee, & Lacroix, 2015) is the only
contextual mindfulness scale that has been used in more than one empirical study to measure
32
mindfulness in the physical activity context. Neither the validity nor the reliability evidence of
scores from this questionnaire were reported in those studies (Tsafou et al., 2015, 2016).
Assessment options for situational mindfulness are also limited. None of the measures in
Table 2.2 have been used to assess situational mindfulness during physical activity or even while
contemplating physical activity. The Toronto Mindfulness Scale was designed to assess
mindfulness as a state that can vary across short periods of time; however, in practice, it has been
used exclusively to measure an individual's level of mindfulness during a formal meditation
session which requires participants to first sit quietly and pay attention to their breath for a short
period of time before responding. This scale has not been widely applied to assess situational
mindfulness in different settings (Feldman et al., 2006). The State-Mindful Attention and
Awareness Scale is a five-item scale derived from Mindful Attention and Awareness Scale which
assesses an individual’s mindfulness over a short period of time (Brown & Ryan, 2003). The
main limitation of this short scale is that it mainly samples individuals’ conscious awareness or
attention of mindfulness and lacks items for assessing physical and mental experiences that are
also central components of mindfulness. For example, it does not involve items measuring the
awareness of one’s emotional states, physical sensations, and passing thoughts (Tanay &
Bernstein, 2013). As a result, construct validity remains a concern when using the State-Mindful
Attention and Awareness Scale to assess situational mindfulness. Lastly, the State Mindfulness
Scale measures mindfulness during a specific time period (e.g., the preceding 15 minutes) and in
a particular context (e.g., meditation or other types of activities). Strong evidence exists for the
construct and incremental predictive validity of scores from this scale. It has been rigorously
tested in its developmental phase and corresponds well with the concept of situational
mindfulness (Tanay & Bernstein, 2013). Despite the superiority of this tool relative to other
33
options, it has not yet been used widely in research on mindfulness generally or in research on
mindfulness and physical activity specifically.
In sum, the majority of mindfulness measures were designed to assess global
mindfulness, and approximately half of these measures have been applied in research on physical
activity. Fewer scales with known psychometric properties are available for assessing situational
or contextual mindfulness, and these measures have rarely been used in physical activity
research. Based on the brief summary of the mindfulness measures, the best available choices for
measuring global, contextual and situational mindfulness in physical activity research (at the
present time) are likely to be the Mindful Attention and Awareness Scale, State Mindfulness
Scale-PA, and State Mindfulness Scale, respectively. The Mindful Attention and Awareness Scale
is by far the most frequently used measure in physical activity research as well as the most
accepted and broadly-applied global mindfulness measure (Sauer et al., 2012). Further, State
Mindfulness Scale-PA is derived from the State Mindfulness Scale and shares a common
underlying conceptual model. The shared conceptual model underlying these measures will
facilitate meaningful inferences about mindfulness and physical activity relations between the
contextual and situational levels. Scores from these three instruments are all well-validated and
compatible with unidimensional definitions of mindfulness.
Harmonizing future measures based on conceptual and structural consistency would
facilitate comparisons across levels of analysis in research on physical activity. No single
measure is capable of capturing all three levels of mindfulness. The three-level framework
described above can be applied to develop precise hypotheses, select measures, and refine
theories about the role of mindfulness in physical activity promotion.
Future directions
34
This review suggested several priorities for future research on mindfulness and physical
activity. First, the bulk of this evidence derives from research on global mindfulness and uses
cross-sectional research designs. Future work should emphasize the contextual and situational
levels of mindfulness to fill an identified gap and determine whether conclusions about a positive
association between global (trait) mindfulness and physical activity generalize to the contextual
and situational levels. Future work should also investigate whether contextual and situational
mindfulness can bridge the intention-behavior gap that has also been revealed as a within-person
phenomenon (Conroy, Elavsky, Doerksen, & Maher, 2013; Conroy, Elavsky, Hyde, & Doerksen,
2011; Maher, Dzubur, Huh, Intille, & Dunton, 2016). To conduct this work, it would be valuable
to develop parallel measures for assessing mindfulness at each level of analysis. This work will
also benefit from study designs and measures that are capable of capturing both the time-varying
nature of situational mindfulness and the context-dependent nature of contextual mindfulness.
Ecological momentary assessment is an optimal approach that has been suggested to obtain
mindfulness or physical activity in daily settings (Davidson & Kaszniak, 2015; Robbins, Kubiak,
& Mostofsky, 2014), and should be applied more in future research to test the real-time
association between mindfulness and physical activity. Sampling mindfulness during a variety of
activities or settings will also be useful for addressing the confounding of mindfulness practices
with a specific type of activity (i.e., yoga, walking).
Experimental evidence is needed to draw causal inferences about mindfulness and
physical activity. The associations between mindfulness and physical activity reported here were
based on college student and mid-age adult populations, and predominately use self-report
measurements. Future experimental studies should target understudied populations (e.g.,
adolescents, older adults), and include objective measures of mindfulness (i.e., cognitive and
35
attentional tasks) and device-based measures of physical activity (i.e., accelerometers). As this
literature develops, researchers will need to investigate questions about dose-response
association, the best modes of mindfulness practice, and the potential mechanism and moderators
in mindfulness and physical activity.
The population-level inactivity problem also involves prolonged sedentary behavior (i.e.,
excessive sitting time). Relations between mindfulness and sedentary behavior have not been
investigated to date. Sedentary behavior has a habitual component but it also varies within
people over time and is negatively associated with fluctuations in intentions to limit sedentary
time (Conroy, Maher, Elavsky, Hyde, & Doerksen, 2013). The ability to be more aware of
thoughts, emotions and physical sensations in a given moment, which is a key characteristic of
mindfulness, may be a potential strategy for helping people to disengage from habitual behavior
patterns in different contexts and situations.
Conclusion
This review synthesized current evidence addressing the positive association between
mindfulness and physical activity, and proposed a hierarchical model to disambiguate mindful
states in future research. A similar hierarchical framework has been applied profitably to
organize research on intrinsic and extrinsic motivation (Vallerand, 2007a). Existing measures
corresponding to each level of mindfulness were summarized, and best-in-class measures of
mindfulness at each level were identified. Harmonizing measures in future research would
facilitate comparisons of research findings and accelerate understanding of relations between
mindfulness and physical activity.
The organizing hierarchical framework outlined in this review will also generate new
hypotheses that can inform intervention development. Of particular interest is the potential for
36
contextual and situational mindfulness to serve as self-regulatory tools for shielding motivation
and reducing interference from factors that often derail physical activity. If this potential is borne
out, mindfulness training may be a powerful tool for promoting physical activity and improving
public health.
37
References
Baer, R. A. (2011). Measuring mindfulness. Contemporary Buddhism, 12(1), 241–261.
https://doi.org/10.1080/14639947.2011.564842
Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-
report The Kentucky Inventory of Mindfulness Skills. Assessment, 11(3), 191–206.
https://doi.org/10.1177/1073191104268029
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., … Williams,
J. M. G. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating
and nonmeditating samples. Assessment, 15(3), 329–342.
https://doi.org/10.1177/1073191107313003
Bergomi, C., Tschacher, W., & Kupper, Z. (2012a). Measuring mindfulness: First steps
towards the development of a comprehensive mindfulness scale. Mindfulness, 4(1), 18–32.
https://doi.org/10.1007/s12671-012-0102-9
Bergomi, C., Tschacher, W., & Kupper, Z. (2012b). The assessment of mindfulness with
self-report measures: Existing scales and open issues. Mindfulness, 4(3), 191–202.
https://doi.org/10.1007/s12671-012-0110-9
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., …
Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science
and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its
role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.
https://doi.org/10.1037/0022-3514.84.4.822
38
Bull, F. C., & Bauman, A. E. (2011). Physical inactivity: the “Cinderella” risk factor for
noncommunicable disease prevention. Journal of Health Communication, 16 Suppl 2, 13–26.
https://doi.org/10.1080/10810730.2011.601226
Butryn, M. L., Forman, E., Hoffman, K., Shaw, J., & Juarascio, A. (2011). A pilot study
of Acceptance and Commitment Therapy for promotion of physical activity. Journal of Physical
Activity and Health, 8(4), 516–522. https://doi.org/10.1123/jpah.8.4.516
Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The
assessment of present-moment awareness and acceptance The Philadelphia Mindfulness Scale.
Assessment, 15(2), 204–223. https://doi.org/10.1177/1073191107311467
Centers for Disease Control and Prevention. (2017). Facts about Physical Activity.
Retrieved May 16, 2017, from https://www.cdc.gov/physicalactivity/data/facts.htm
Chatzisarantis, N. L. D., & Hagger, M. S. (2007). Mindfulness and the intention-behavior
relationship within the Theory of Planned Behavior. Personality and Social Psychology Bulletin.
https://doi.org/10.1177/0146167206297401
Conroy, D. E., Elavsky, S., Doerksen, S. E., & Maher, J. P. (2013). A daily process
analysis of intentions and physical activity in college students. Journal of Sport & Exercise
Psychology, 35(5), 493–502.
Conroy, D. E., Elavsky, S., Hyde, A. L., & Doerksen, S. E. (2011). The dynamic nature
of physical activity intentions: A within-person perspective on intention-behavior coupling.
Journal of Sport and Exercise Psychology, 33(6), 807–827. https://doi.org/10.1123/jsep.33.6.807
Conroy, D. E., Maher, J. P., Elavsky, S., Hyde, A. L., & Doerksen, S. E. (2013).
Sedentary behavior as a daily process regulated by habits and intentions. Health Psychology,
32(11), 1149–1157. https://doi.org/10.1037/a0031629
39
Cox, A. E., Ullrich-French, S., & French, B. F. (2016). Validity evidence for the State
Mindfulness Scale for Physical Activity. Measurement in Physical Education and Exercise
Science, 20(1), 38–49. https://doi.org/10.1080/1091367X.2015.1089404
Craig, C. L., Marshall, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L., Ainsworth, B.
E., … Oja, P. (2003). International Physical Activity Questionnaire: 12-country reliability and
validity. Medicine & Science in Sports & Exercise, 35(8), 1381–1395.
https://doi.org/10.1249/01.MSS.0000078924.61453.FB
Creswell, J. D., Taren, A. A., Lindsay, E. K., Greco, C. M., Gianaros, P. J., Fairgrieve,
A., … Ferris, J. L. (2016). Alterations in resting state functional connectivity link mindfulness
meditation with reduced interleukin-6: a randomized controlled trial. Biological Psychiatry.
https://doi.org/10.1016/j.biopsych.2016.01.008
Curran, P. J., & Bauer, D. J. (2011). The disaggregation of within-person and between-
person effects in longitudinal models of change. Annual Review of Psychology, 62, 583–619.
https://doi.org/10.1146/annurev.psych.093008.100356
Davidson, R. J. (2010). Empirical explorations of mindfulness: Conceptual and
methodological conundrums. Emotion, 10(1), 8–11. https://doi.org/10.1037/a0018480
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli,
S. F., … Sheridan, J. F. (2003). Alterations in brain and immune function produced by
mindfulness meditation: Psychosomatic Medicine, 65(4), 564–570.
https://doi.org/10.1097/01.PSY.0000077505.67574.E3
Davidson, R. J., & Kaszniak, A. W. (2015). Conceptual and methodological issues in
research on mindfulness and meditation. American Psychologist, 70(7), 581–592.
https://doi.org/10.1037/a0039512
40
Ding, D., Lawson, K. D., Kolbe-Alexander, T. L., Finkelstein, E. A., Katzmarzyk, P. T.,
van Mechelen, W., & Pratt, M. (2016). The economic burden of physical inactivity: a global
analysis of major non-communicable diseases. The Lancet. https://doi.org/10.1016/S0140-
6736(16)30383-X
Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J.-P. (2006). Mindfulness
and emotion regulation: The development and initial validation of the Cognitive and Affective
Mindfulness Scale-Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment,
29(3), 177–190. https://doi.org/10.1007/s10862-006-9035-8
Fleeson. (2001). Toward a structure- and process-integrated view of personality: traits as
density distribution of states. Journal of Personality and Social Psychology, 80(6), 1011–1027.
Fuchs, R., Klaperski, S., Gerber, M., & Seelig, H. (2015). Messung der bewegungs- und
sportaktivität mit dem BSA-Fragebogen: Eine methodische zwischenbilanz. Zeitschrift für
Gesundheitspsychologie, 23(2), 60–76. https://doi.org/10.1026/0943-8149/a000137
Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4),
227–234. https://doi.org/10.1007/s12671-010-0032-3
Godin, G., & Shephard, R. J. (1985). A simple method to assess exercise behavior in the
community. Canadian Journal of Applied Sport Sciences. Journal Canadien Des Sciences
Appliquées Au Sport, 10(3), 141–146.
Greeson, J. M. (2009). Mindfulness research update: 2008. Complementary Health
Practice Review, 14(1), 10–18. https://doi.org/10.1177/1533210108329862
Hart, R., Ivtzan, I., & Hart, D. (2013). Mind the gap in mindfulness research: A
comparative account of the leading schools of thought. Review of General Psychology, 17(4),
453–466. https://doi.org/10.1037/a0035212
41
Hewett, Z. L., Ransdell, L. B., Gao, Y., Petlichkoff, L. M., & Lucas, S. (2011). An
examination of the effectiveness of an 8-week Bikram yoga program on mindfulness, perceived
Stress, and physical fitness. Journal of Exercise Science & Fitness, 9(2), 87–92.
https://doi.org/10.1016/S1728-869X(12)60003-3
Howell, A. J., Dopko, R. L., Passmore, H.-A., & Buro, K. (2011). Nature connectedness:
Associations with well-being and mindfulness. Personality and Individual Differences, 51(2),
166–171. https://doi.org/10.1016/j.paid.2011.03.037
Jordan, C. H., Wang, W., Donatoni, L., & Meier, B. P. (2014). Mindful eating: Trait and
state mindfulness predict healthier eating behavior. Personality and Individual Differences,
68(1), 107–111. https://doi.org/10.1016/j.paid.2014.04.013
Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and
Mind to Face Stress, Pain, and Illness (15 Abr Anv edition). New York: Bantam Doubleday Dell
Publishing.
Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in
Everyday Life. New York: Hyperion.
Kabat-Zinn, J. (2011). Mindfulness for beginners: Reclaiming the present moment–and
your life. Boulder: Sounds True.
Kangasniemi, A., Lappalainen, R., Kankaanpää, A., & Tammelin, T. (2014). Mindfulness
skills, psychological flexibility, and psychological symptoms among physically less active and
active adults. Mental Health and Physical Activity, 7(3), 121–127.
https://doi.org/10.1016/j.mhpa.2014.06.005
Kennedy, A. B., & Resnick, P. B. (2015). Mindfulness and physical activity. American
Journal of Lifestyle Medicine, 9(3), 221–223. https://doi.org/10.1177/1559827614564546
42
Kiken, L. G., Garland, E. L., Bluth, K., Palsson, O. S., & Gaylord, S. A. (2015). From a
state to a trait: Trajectories of state mindfulness in meditation during intervention predict
changes in trait mindfulness. Personality and Individual Differences.
https://doi.org/10.1016/j.paid.2014.12.044
La Forge, R. (1997). Mind-body fitness: Encouraging prospects for primary and
secondary prevention. The Journal of Cardiovascular Nursing, 11(3), 53–65.
https://doi.org/10.1097/00005082-199704000-00006
Langer, E. J. (1992). Matters of mind: Mindfulness/mindlessness in perspective.
Consciousness and Cognition, 1(3), 289–305. https://doi.org/10.1016/1053-8100(92)90066-J
Lee, D.-C., Sui, X., Ortega, F. B., Kim, Y.-S., Church, T. S., Winett, R. A., … Blair, S.
N. (2011). Comparisons of leisure-time physical activity and cardiorespiratory fitness as
predictors of all-cause mortality in men and women. British Journal of Sports Medicine, 45(6),
504–510. https://doi.org/10.1136/bjsm.2009.066209
Loucks, E. B., Britton, W. B., Howe, C. J., Eaton, C. B., & Buka, S. L. (2014). Positive
associations of dispositional mindfulness with cardiovascular health: the New England Family
Study. International Journal of Behavioral Medicine, 1–11. https://doi.org/10.1007/s12529-014-
9448-9
Maher, J. P., Dzubur, E., Huh, J., Intille, S., & Dunton, G. F. (2016). Within-day time-
varying associations between behavioral cognitions and physical activity in adults. Journal of
Sport and Exercise Psychology, 38(4), 423–434. https://doi.org/10.1123/jsep.2016-0058
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, T. P. (2009). Preferred
reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS
Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
43
Mothes, H., Klaperski, S., Seelig, H., Schmidt, S., & Fuchs, R. (2014). Regular aerobic
exercise increases dispositional mindfulness in men: A randomized controlled trial. Mental
Health and Physical Activity, 7(2), 111–119. https://doi.org/10.1016/j.mhpa.2014.02.003
Murphy, M. J., Mermelstein, L. C., Edwards, K. M., & Gidycz, C. A. (2012). The
benefits of dispositional mindfulness in physical health: A longitudinal study of female college
students. Journal of American College Health, 60(5), 341–348.
https://doi.org/10.1080/07448481.2011.629260
Patrick, D. L., Williams, B., Walwick, J., & Patrick, M. B. (2006). The rapid assessment
of physical activity (RAPA) among older adults. Retrieved from
https://pdfs.semanticscholar.org/49e8/6eb094fdda1c12d9ff5a03e70880ac26f4fc.pdf
Rhodes, R. E., & de Bruijn, G.-J. (2013). What predicts intention-behavior discordance?
A review of the action control framework. Exercise and Sport Sciences Reviews, 41(4), 201–207.
Rhodes, R. E., & Dickau, L. (2012). Experimental evidence for the intention–behavior
relationship in the physical activity domain: A meta-analysis. Health Psychology, 31(6), 724–
727. https://doi.org/10.1037/a0027290
Robbins, M. L., Kubiak, T., & Mostofsky, D. I. (2014). Ecological monetary assessment
in behavioral medicine: research and practice. The Handbook of Behavioral Medicine, 46.
Retrieved from http://observelab.ucr.edu/wp-content/uploads/2014/09/Robbins-Kubiak-2014-
EMA-chapter.pdf
Roberts, & Danoff-Burg. (2010). Mindfulness and health behaviors: Is paying attention
good for you? Journal of American College Health, 59(3), 165–173.
https://doi.org/10.1080/07448481.2010.484452
44
Ruffault, A., Bernier, M., Juge, N., & Fournier, J. F. (2015). Mindfulness may moderate
the relationship between intrinsic motivation and physical activity: A cross-sectional study.
Mindfulness, 7(2), 445–452. https://doi.org/10.1007/s12671-015-0467-7
Salmoirago-Blotcher, E., Hunsinger, M., Morgan, L., Fischer, D., & Carmody, J. (2013).
Mindfulness-based stress reduction and change in health-related behaviors. Journal of Evidence-
Based Complementary & Alternative Medicine, 2156587213488600.
https://doi.org/10.1177/2156587213488600
Sauer, S., Walach, H., Schmidt, S., Hinterberger, T., Lynch, S., Büssing, A., & Kohls, N.
(2012). Assessment of mindfulness: Review on state of the art. Mindfulness, 4(1), 3–17.
https://doi.org/10.1007/s12671-012-0122-5
Seefeldt, V., Malina, R. M., & Clark, M. A. (2012). Factors affecting levels of physical
activity in adults. Sports Medicine, 32(3), 143–168. https://doi.org/10.2165/00007256-
200232030-00001
Sheeran, P. (2002). Intention-behavior relations: A conceptual and empirical review.
European Review of Social Psychology, 12(1), 1–36.
https://doi.org/10.1080/14792772143000003
Tanay, G., & Bernstein, A. (2013). State Mindfulness Scale (SMS): Development and
initial validation. Psychological Assessment, 25(4), 1286–1299.
https://doi.org/10.1037/a0034044
Thienot, E., Jackson, B., Dimmock, J., Grove, J. R., Bernier, M., & Fournier, J. F. (2014).
Development and preliminary validation of the Mindfulness Inventory for Sport. Psychology of
Sport and Exercise, 15(1), 72–80. https://doi.org/10.1016/j.psychsport.2013.10.003
45
Thompson, B. L., & Waltz, J. (2015). Everyday mindfulness and mindfulness meditation:
Overlapping constructs or not? Personality and Individual Differences, 43(7), 1875–1885.
https://doi.org/10.1016/j.paid.2007.06.017
Trost, S. G., Owen, N., Bauman, A. E., Sallis, J. F., & Brown, W. (2002). Correlates of
adults’ participation in physical activity: review and update. Medicine and Science in Sports and
Exercise, 34(12), 1996–2001. https://doi.org/10.1249/01.MSS.0000038974.76900.92
Tsafou, K.-E., De Ridder, D. T., van Ee, R., & Lacroix, J. P. (2015). Mindfulness and
satisfaction in physical activity: A cross-sectional study in the Dutch population. Journal of
Health Psychology. https://doi.org/10.1177/1359105314567207
Tsafou, K.-E., Lacroix, J. P., Ee, R. van, Vinkers, C. D., & Ridder, D. T. D. (2016). The
relation of trait and state mindfulness with satisfaction and physical activity: A cross-sectional
study in 305 Dutch participants. Journal of Health Psychology, 1359105315624748.
https://doi.org/10.1177/1359105315624748
Ulmer, C. S., Stetson, B. A., & Salmon, P. G. (2010). Mindfulness and acceptance are
associated with exercise maintenance in YMCA exercisers. Behaviour Research and Therapy,
48(8), 805–809. https://doi.org/10.1016/j.brat.2010.04.009
Vallerand, R. J. (1997). Toward a hierarchical model of intrinsic and extrinsic
motivation. In Advances in experimental social psychology, Vol. 29 (pp. 271–360). San Diego,
CA, US: Academic Press.
Vallerand, R. J. (2007a). A hierarchical model of intrinsic and extrinsic motivation for
sport and physical activity. In M. S. Hagger & N. L. D. Chatzisarantis (Eds.), Intrinsic
motivation and self-determination in exercise and sport (pp. 255–363). Champaign, IL, US:
Human Kinetics.
46
Vallerand, R. J. (2007b). Intrinsic and extrinsic motivation in sport and physical activity:
A review and a look at the future. In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of Sport
Psychology (pp. 59–83). John Wiley & Sons, Inc. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1002/9781118270011.ch3/summary
Wadden, T. A., & Foster, G. D. (2006). Weight and Lifestyle Inventory (WALI). Obesity,
14(S3), 99S–118S. https://doi.org/10.1038/oby.2006.289
Walach, H., Buchheld, N., Buttenmüller, V., Kleinknecht, N., & Schmidt, S. (2006).
Measuring mindfulness—the Freiburg Mindfulness Inventory (FMI). Personality and Individual
Differences, 40(8), 1543–1555. https://doi.org/10.1016/j.paid.2005.11.025
Wolsko, C., & Lindberg, K. (2013). Experiencing connection with nature: The matrix of
psychological well-being, mindfulness, and outdoor recreation. Ecopsychology, 5(2), 80–91.
https://doi.org/10.1089/eco.2013.0008
47
Table 2.1. Description of the reviewed studies on mindfulness and physical activity
Article Participants
and design
Measure of
mindfulness
Measure of physical
activity or exercise
Main findings in mindfulness and
physical activity
Roberts, K. C., &
Danoff-Burg, S. (2010).
553 undergraduate
students;
Cross-sectional
The Five-Factor
Mindfulness
Questionnaire
(FFMQ)
Selected items from
Youth Risk Behavior
Surveillance System
and
Weight and Lifestyle
Inventory
Mindfulness was positively associated
with:
1. Perceived daily physical activity
level
2. Enjoyment of physical activity
3. Number of days reported to be
physically active in the past week
Gilbert, D., & Waltz, J.
(2010).
269 undergraduate
students;
Cross-sectional
FFMQ International
Physical Activity
Questionnaire
(IPAQ)
1. The Observe subscale of FFMQ
predicted MPA and VPA in male.
2. The Describe subscale predicted
MPA, and the Act with Awareness
subscale predicted VPA in female.
Loucks, E. B., Britton,
W. B., Howe, C. J.,
Eaton, C. B., & Buka, S.
L. (2014).
382
adults with mean
age 47; Cross-
sectional
Mindful Attention
and Awareness
Scale (MAAS)
IPAQ short form High levels of mindfulness related to
high levels of physical activity level.
Murphy, M. J.,
Mermelstein, L. C.,
Edwards, K. M., &
Gidycz, C. A. (2012).
441
Female college
students;
Cross-sectional
MAAS
Godin leisure-time
exercise
questionnaire
(GLTEQ)
1. Higher mindfulness level related to
healthier eating practices, better
quality of sleep, and better physical
health.
2. Time1 Frequency of exercise was
not significantly related to
mindfulness in Time 1 and Time 2.
48
Chatzisarantis, N. L., &
Hagger, M. S. (2007).
226
undergraduate
students;
Cross-sectional
MAAS
GLTEQ
Self-Report Habit
Index (SRHI):
1. Mindfulness moderated the
intention-behavior relationship for
physical activity.
2. Intentions predicted physical
activity for more mindful
participants only.
3. More mindful and not habitual
participants are more likely to act on
their intentions compared to habitual
and not mindful participants.
Ruffault, A., Bernier, M.,
Juge, N., & Fournier, J.
F. (2016).
280 adults age
between
18 and 37;
Cross-sectional
MAAS
IPAQ
Higher mindfulness level was related to
improved intrinsic motivation and
physical activity level.
Mothes, H., Klaperski,
S., Seelig, H., Schmidt,
S., & Fuchs, R. (2014).
143 sedentary
male adults;
Cross-sectional
MAAS
Physical Activity,
Exercise, and Sport
Questionnaire
Mindfulness increases in the aerobic
exercise group but not in the relaxation
or the control group.
Butryn, M. L., Forman,
E., Hoffman, K., Shaw,
J., & Juarascio, A.
(2011).
54 female college
students:
RCT:
Education group
(n = 19)
Acceptance and
Commitment
Therapy (ACT)
group (n = 35)
The Philadelphia
Mindfulness
Scale (PHLMS)
Athletic Center
Visits
ACT group significantly increased
physical activity level compared to the
education participants.
49
Salmoirago-Blotcher, E.,
Hunsinger, M., Morgan,
L., Fischer, D., &
Carmody, J. (2013).
174 adults with
mean age 47, and
psychological
symptom; Single
group pre–post
intervention
FFMQ Health Behaviors
Questionnaire:
selected items from
the Rapid
Assessment of
Physical Activity
questionnaire
(RAPA)
After completing the mindfulness based
stress reduction program, participants
showed:
1. Significant improvements in dietary
behaviors and sleep quality
2. Partial improvements in inactivity
level
Kangasniemi, A.,
Lappalainen, R.,
Kankaanpää, A., &
Tammelin, T. (2014).
108
Finnish adults. (58
physically less
active and 50
physically active);
Cross-sectional
Kentucky
Inventory of
Mindfulness Skills
(KIMS)
ActiGraph-GT1M
accelerometer
1. Mindfulness was positively
associated with MVPA time.
2. Compared to less active
participants, active individuals had
higher mindfulness level and less
psychological symptoms.
Ulmer, C. S., Stetson, B.
A., & Salmon, P. G.
(2010).
266
YMCA exercisers
with age 18 or
older; Cross-
sectional
Frieberg
Mindfulness
Inventory (FMI):
used to measure
state mindfulness
in this study
MAAS
Exercise
Maintenance
Questionnaire
IPAQ
Trait mindfulness:
1. Higher levels of mindfulness and
acceptance, and lower levels of
suppression were found in
participants who were more
successful at maintaining exercise,
who exercising more regularly, and
who were more successful in
meeting their exercise goals.
2. Lower levels of acceptance and
mindfulness were found in
participants who missed two
consecutive weeks of exercise over
the previous year.
State mindfulness:
1. Higher levels of acceptance and
mindfulness were found in
50
participants who were more
successful in meeting their exercise
goals
2. Higher levels of acceptance and
lower levels of mindfulness were
found in participants who missed 1
week of exercise over the previous
year.
Tsafou, K. E., De Ridder,
D. T., van Ee, R., &
Lacroix, J. P. (2015).
398
Dutch speaking
adults age between
18 to 65; Cross-
sectional
The Dutch version
MAAS
Mindfulness in
Physical Activity
(MFPA)
IPAQ short form
SRHI
Satisfaction with
physical activity
questionnaire
1. Both satisfaction with physical
activity and mindfulness predicted
physical activity level.
2. Satisfaction with physical activity
significant mediate the relationship
between mindfulness and physical
activity.
3. Mindfulness affects physical
activity only when habitual physical
activity is weak.
4. Mindfulness and habit, and their
interaction were significant in
predicting satisfaction with physical
activity.
Tsafou, K.-E., Lacroix, J.
P., Ee, R. van, Vinkers,
C. D., & Ridder, D. T. D.
(2016).
305 Dutch
speaking adults
age between 18 to
65; Cross-sectional
The Dutch version
MAAS
MFPA
FFMQ
IPAQ short form
Satisfaction with
physical activity
questionnaire
1. Satisfaction with physical activity
mediated the positive association
between mindfulness in physical
activity and physical activity level.
2. Trait mindfulness level was
positively associated with physical
activity level through physical
activity mindfulness and satisfaction
with physical activity.
51
Table 2. Current mindfulness questionnaires organized by their level in the proposed hierarchical framework
Measurements in each level Scores and structure Total
items
Used in
PA
researchc
Global Mindfulness Measures
Freiburg Mindfulness Inventory (FMI; Walach, Buchheld, Buttenmüller,
Kleinknecht, & Schmidt, 2006)
Unidimensional 30/14a Yes
Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003) Unidimensional 15 Yes
Cognitive and Affective Mindfulness Scale-Revised
(CAMS-R; Feldman et al., 2006)
Unidimensional 12 No
Southampton Mindfulness Questionnaire (SMQ; Chadwick et al., 2008) Unidimensional 16 No
Kentucky Inventory of Mindfulness Scale
(KIMS; Baer, Smith, & Allen, 2004)
Four factors:
(1) Observing
(2) Describing
(3) Acting with awareness
(4) Accepting without judgment
39 Yes
Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2008) Five factors:
(1) Nonreact
(2) Observe
(3) Act aware
(4) Describe
(5) Nonjudge
39 Yes
Philadelphia Mindfulness Scale (PHLMS; Cardaciotto, Herbert, Forman,
Moitra, & Farrow, 2008)
Two factors:
(1) Present-moment
(2) Awareness and acceptance
20 Yes
52
Trait Toronto Mindfulness Scale (Trait-TMS; Davis, Lau, & Cairns, 2009) Two factors:
(1) Decentering
(2) Curiosity
13 No
Contextual Mindfulness Measures
Mindfulness in Physical Activity Questionnaire
(MFPA; Tsafou et al., 2015)
Unidimensional 6 Yes
Mindfulness Inventory for Sport (MIS; Thienot et al., 2014) Three factors:
(1) Awareness
(2) Nonjudgmental attitude
(3) Refocusing
15 No
State Mindfulness Scale for Physical Activity (SMS-PA; Cox et al., 2016) Unidimensional mindfulness with
two main dimensions:
(1) state mind
(2) state body
12 No
Situational Mindfulness Measures
State Mindful Attention Awareness Scale
(State-MAAS; Brown & Ryan, 2003)
Unidimensional 5b No
Toronto Mindfulness Scale (TMS; Lau et al., 2006) Two factors:
(1) Decentering
(2) Curiosity
13 No
State Mindfulness Scale (SMS; Tanay & Bernstein, 2013) Unidimensional mindfulness with
two main dimensions:
(1) mindfulness of mind
(2) mindfulness of body
21 No
Note: a Long and short forms of this measure exist. b Adapted from the MAAS. C Not including studies aim at validating the measure.
53
Figure Caption
Figure 2.1. The PRISMA flow chart for literature research on mindfulness and physical activity.
54
Data Base Searching in PubMed,
PsycINFO and Web of Science
(n = 1310)
Data Base Searching in PubMed,
PsycINFO and Web of Science
(n = 1310)
Scr
eenin
g f
or
Eli
gib
ilit
y
Incl
uded
L
iter
ature
Iden
tifi
cati
on
Manual Searching in Google
Scholar search engine
(n = 205)
Manual Searching in Google Scholar
search engine
(n = 205)
All records after duplicates removed
(n = 632)
All records after duplicates removed
(n = 632)
Title and abstract screening
(n = 225)
Title and abstract screening
(n = 225)
Excluded articles that
did not explicitly
include both physical
activity and
mindfulness
component
(n = 407)
Excluded articles that
did not explicitly
include both physical
activity and
mindfulness
component
(n = 407)
Full-text screening
(n = 16)
Full-text screening
(n = 16)
Excluded articles that
did not provide
quantitative data for
both physical activity
and mindfulness
(n = 209)
Excluded articles that
did not provide
qualitative data for
both physical activity
and mindfulness
(n = 209)
Final articles included in qualitative
synthesis (n =13)
Final articles included in qualitative
synthesis (n =13)
Excluded articles
(n = 678)
Excluded articles
(n = 678)
Excluded articles that
did not test
association between
physical activity and
mindfulness
(n = 3)
Excluded articles that
did not test
association between
physical activity and
mindfulness
(n = 3)
55
Chapter 3: Momentary Negative Affect is Lower During Mindful Movement than While
Sitting: An Experience Sampling Study
56
Abstract
Physical activity and mindfulness can decrease many aspects of negative affect (e.g.,
stress, anxiety, depression). It is unclear whether mindfulness during various activity behaviors
or postures (e.g., standing, moving, sitting) influences the associations between those
behaviors/postures and negative affect. This study tested whether contextual or situational
mindfulness moderated associations between (1) usual behavioral/postural patterns and negative
affect, or (2) momentary behaviors/postures and negative affect. A 14-day experience sampling
study was conducted to assess college students’ momentary behaviors/postures and subjective
experiences using a smartphone application. When students moved (versus sitting), their
momentary negative affect was lower if they were more mindful than usual (controlling for the
perceived autonomy of their behavior and other temporal variables at that moment). These
results extend prior work showing that negative affective states can be reduced by mindfulness
and physical activity to the momentary level. Integrating mindfulness practices with physical
activity may lead to greater mental health benefits and this hypothesis should be tested in
experimental research.
57
Momentary Negative Affect is Lower During Mindful Movement than While Sitting:
An Experience Sampling Study
Regular physical activity participation has been associated with better mental health and
less intense psychological symptoms in both clinical and non-clinical populations (Biddle &
Asare, 2011; Mammen & Faulkner, 2013; Rebar et al., 2015; Rosenbaum, Tiedemann,
Sherrington, Curtis, & Ward, 2014). Similarly, mindfulness-based interventions that enhance
people’s awareness and acceptance of their bodily and emotional responses have consistently
reduced negative affect (Davis & Hayes, 2011; Gotink et al., 2015; Grossman, Niemann,
Schmidt, & Walach, 2004; Keng, Smoski, & Robins, 2011; Sharma & Rush, 2014). Little is
known about whether people’s mindfulness during everyday activity behaviors or postures
influences the intensity of negative affective experiences. This study investigated whether usual
or momentary mindfulness levels moderated associations between activity behaviors/postures
and negative affect.
Negative affect refers to individuals’ subjective experiences of displeasure (Ekkekakis &
Petruzzello, 2002). Examples of negative affective states include feeling sad, anxious, stressed,
and depressed (Harmon-Jones, Harmon-Jones, Amodio, & Gable, 2011; Posner, Russell, &
Peterson, 2005). Young adults, especially the college student population, consistently experience
negative affect in their daily life. For instance, young adults’ stress level was well above the
average stress level among all generations of US adults (APA, 2015). The American College
Health Association (ACHA) similarly revealed that more than half of the college student
population experienced negative affective states including overwhelming anxiety (57.7%),
sadness (63.5%), or mental exhaustion (81.6%) at least once a year. College students further
reported that stress and anxiety were the top two factors impacting their academic performance
58
(ACHA, 2015), and these negative states have impaired academic performance, self-esteem and
overall health status (Fogle & Pettijohn, 2013; Hudd et al., 2000; Zajacova, Lynch, &
Espenshade, 2005). Negative affect is consistently associated with lower levels of physical
activity and mindfulness; however, most of this work has focused on characterizing differences
between people (Conn, 2010; Davis & Hayes, 2011; Ensari, Greenlee, Motl, & Petruzzello,
2015; Keng et al., 2011; Rebar et al., 2015; Sharma & Rush, 2014; Stathopoulou, Powers, Berry,
Smits, & Otto, 2006). Less is known about the role of daily activity behaviors and postures or
how mindfulness interacts with those behaviors/postures in regulating momentary affective
states.
Physical activity refers to any bodily movement that increases energy expenditure above
a basal level due to the contraction of skeletal muscle (Caspersen, Powell, & Christenson, 1985).
Physical activity, especially under moderate and vigorous intensities, can reduce negative
affective states, including stress, anxiety, and depression. This negative association has been
found in research with different designs such as cross-sectional studies, prospective studies, and
randomized controlled trials (Cooney, Dwan, & Mead, 2014; Ensari et al., 2015; Schuch, Rocha,
& Cadore, 2015; Stults-Kolehmainen & Sinha, 2013). Less is known about how bodily postures
that do not involve locomotion (i.e., sitting, standing) or light intensity physical activities can
impact negative affect and the available results have been quite heterogeneous. One review
focusing on the proximal association of daily physical activity with subsequent affective
responses produced mixed and inconclusive findings. Some studies found negative or non-
significant associations between daily physical activity and subsequent negative affective
responses (Liao, Shonkoff, & Dunton, 2015). Some of this heterogeneity may be due to variation
in people’s mental states during their daily activities, such as their mindfulness levels.
59
Mindfulness is a form of heightened attention and awareness (Kabat-Zinn, 1994). It has
been identified as either a trait that varies between people or a state that changes within people
over time and contexts (Davidson, 2010; Thompson & Waltz, 2015). Based on different temporal
specificities, trait mindfulness can be conceptualized as the global level of mindfulness that is
relatively stable across time, whereas state mindfulness can be conceptualized as either the
contextual or the situational mindfulness that varies within different contexts and situations
(Bishop et al., 2004). This three level framework can enhance conceptual clarity and precision in
studying mindfulness, and is similar to what has been used to organize research on intrinsic and
extrinsic motivation (Vallerand, 2007; see Chapter 2).
In the past few decades, mindfulness practice has become a popular strategy widely
implemented in stress management interventions (Kabat-Zinn & Hanh, 2009; Praissman, 2008).
College students who participated in mindfulness-based stress reduction programs have
consistently decreased negative affect as indicated by lower levels of stress, anxiety, and
depression (Beddoe & Murphy, 2004; Jain et al., 2007; Moscaritolo, 2009; Schure, Christopher,
& Christopher, 2008; Shapiro, Oman, Thoresen, Plante, & Flinders, 2008). Aside from the
majority of the intervention studies that aim to enhance global mindfulness, simply elevating an
individual’s situational mindfulness at a particular time may improve affective valence. Bishop
et al. (2004) describe the state (situational) form of mindfulness as an active self-regulation of
one’s awareness and attention to the experience in the present moment, which indicates that
people could be relatively more mindful in any given moment without extra training in
mindfulness or meditation. Previous experience sampling research showed college students’
situational mindfulness level was negatively associated with momentary negative affect in terms
of both intensity and frequency over a few weeks (Brown & Ryan, 2003). The present study was
60
designed to investigate whether situational mindfulness can moderate associations between a
person’s activity or posture and their negative affective state.
The interaction hypothesis between mindfulness and physical activity in reducing
negative affect has not been explored in depth, and the available findings particularly came from
studies comparing between-person differences. In one systematic review including only
randomized controlled trials, researchers seek to compare the relative efficacy of reducing
depression between mindfulness-based exercise including yoga, tai chi, and qigong training and
other exercise interventions. They concluded that both interventions were effective in reducing
depression symptoms or levels in the short term (Tsang, Chan, & Cheung, 2008). Findings about
differences between mindful and non-mindful exercises were inconclusive due to methodological
limitations and insufficient sample sizes in most of the reviewed studies. Older breast cancer
survivors who participated in mindful dancing increased their quality of life through reduction of
recurrence fear and improvement of global mindfulness attitude compared to cancer survivors in
the control group (Crane-Okada et al., 2012). In another study, psychologically-distressed
patients who engaged in a mindful walking programs significantly decreased their stress
symptoms and increased quality of life compared to the waitlist control group (Teut et al., 2013).
To the best of our knowledge, only one study used experience sampling methods to study the
differences in momentary negative affect between more and less mindful activity. In this study,
mindful walking was carried out by adults with mindfulness training experiences (most of whom
had history of depression). Mindful walking significantly reduced negative affect compared to
the same duration of daily normal activities (Gotink et al., 2016).
These studies provide preliminary evidence for integrating mindfulness and physical
activity to reduce negative affect, but none explicitly examined the interaction between
61
momentary mindfulness and activity behaviors or postures. These studies also targeted patients
in clinical settings exclusively and no studies focused on college students population that
experience high levels of negative affect.
The Present Study
The present study was designed to evaluate whether momentary mindfulness levels
moderated associations between physical activity and negative affect. A second goal of this study
was to deepen understanding of the specific activity behaviors or postures that are most
associated with negative affect so we assessed a variety of activity intensities and postures that
are common across contexts of daily life (i.e., sitting, standing, moving). Based on the premise
that affect, daily activity behaviors/posture, mindfulness, and negative affect are all time-varying
phenomena, experience sampling methods were used to distinguish variance that differentiated
between people from variance that differentiated between moments nested within people
(Dunton, 2017). The primary within-person hypotheses in the current study were that (1)
momentary activity-negative affect relations would be stronger when participants were more
mindful than usual, and (2) negative affect would be lower when participants were moving
(relative to sitting). The primary between-person hypothesis in the current study was that once
the within-person associations were controlled, there would be no significant associations
between students’ usual daily activity, usual (global) mindfulness and negative affect.
Given the observational nature of these data, statistical controls were included for age,
gender, response time, day of the week, time in study, perceived autonomy, and lagged negative
affective state. These covariates were selected because they can each impact negative affect. For
example, stress perception or reactivity differ by age, gender, and the temporal contexts within a
day or week (APA, 2011; Jorm et al., 2005; Ragsdale, Beehr, Grebner, & Han, 2011; Rudolph &
62
Hammen, 1999). As the time in study increases, or as the prompts accumulated throughout the
day, participants may feel irritated and become more anxious as they receive frequent
unpredictable prompts (Beute, de Kort, & IJsselsteijn, 2016). Additionally, many college
students’ activities or postures are obligatory (e.g., due to norms for sitting in classrooms), so
perceived autonomy was assessed to control its influence on stress, anxiety or mental health
(Deci & Ryan, 2008; Ng et al., 2012). A single-lagged negative affect term also included to
adjust for any carry-over influence (Towbes & Cohen, 1996).
Methods
Participants and Procedures
University students enrolled in an undergraduate course (N= 161) participated in this
study as part of the course requirements. Three participants were excluded from analysis because
their data was too sparse (M = 13 responses out of 112 prompts). The remaining 158 participants
were predominantly female (58%), not Hispanic (91%) and White (82%) with a mean age of
20.0 years (SD = 1.26).
The institutional review board approved the study protocol and participants provided
informed consent at an initial lab session. Small groups of up to five participants met with the
researcher to download and install the Personal Analytics Companion Application (Paco;
https://www.pacoapp.com/) onto their smartphones (16% iOS, 84% Android). Following
installation, the researcher helped each participant complete a practice experience sampling
survey on Paco, and set a personalized 12-hour window for experience sampling prompts. The
default time block for receiving the notifications was within 8AM to 8PM, but participants could
adjust this time window based on their schedule.
63
Participants then completed an online questionnaire about their demographic
characteristics (e.g., age, gender). For the next 14 days, participants completed up to eight
randomly-delivered questionnaires from Paco each day during their waking time. There were a
minimum one-hour interval between prompts and a five-minute time window for responding.
Following each prompt, students reported their activity behavior/posture and rated their negative
affect and mindfulness at the moment they were prompted. Participants on average spent less
than one minute to response to each prompt. The researcher deactivated all participants’ accounts
from receiving the daily prompts from Paco after the two-week study period, and participants
were free to uninstall the app from their smartphones. All data were collected between late
October and mid-November 2015.
Measures
Demographics. Age, gender and ethnicity were self-reported.
Daily activity / postures. Momentary activity behaviors/postures were assessed using a
single item, “What were you doing when the signal went off?” Response options included sitting,
standing, moving, or sleeping. Sleep was rarely reported (5%) so these entries were excluded
from the data analysis. Dummy variables were created for standing and moving (0 = not selected,
1 = selected) with sitting serving as the reference category.
Negative affect. Three items were used to measure perceived stress (“During this
activity, I felt stressed”), anxiety (“During this activity, I felt anxious”), and affective valence
(“Please rate how you felt in general during this activity”). Participants responded to the stress
and anxiety items on a scale ranging from 0 (not at all) to 4 (extremely) and to the negative
valence item on a reverse-coded scale ranging from 0 (very bad) to 4 (very good). These items
were slightly modified from the “Emotional Distress - Anxiety”, “Distress - Depression”, and
64
“Positive Affect” short form measures in the Patient Reported Outcomes Measurement
Information System (PROMIS; Pilkonis et al., 2011; Schalet et al., 2016) to accommodate the
frequent momentary assessments required in an experience sampling design. Responses between
the stress, anxiety and the valence items were moderately to highly correlated (r ranged from
0.35 to 0.74 across observations and people and from 0.25 to 0.50 across participants), and the
three items were internally consistent as a whole (coefficient was 0.64 across observations and
0.76 across participants). Initial analyses were run on responses to each item individually and
results were consistent, so the three items were aggregated into a composite index of negative
affect for the analyses reported in the current study.
Mindfulness. Momentary mindfulness was assessed using two items from the State
Mindfulness Scale (SMS; Tanay & Bernstein, 2013). This measure was developed to assess
situational mindfulness (i.e., mindfulness during a specific time period and particular context,
such as during academic or other activities). Items were selected based on their factor loadings to
include the items whose responses were most closely associated with latent scores for
mindfulness of mind (“During this activity, I noticed pleasant and unpleasant emotions”) and
body (“During this activity, I noticed physical sensations come and go”). Participants indicated
their perceived situational mindfulness level on a scale ranging from 1 (not at all) to 5 (very
well). Based on the strong correlation (Spearman-Brown ρ=0.55 across observations and people;
ρ = 0.76 across people), the two items were combined to represent situational mindfulness.
Autonomy. One item modified from the Situational Motivation Scale (SIMS; Guay,
Vallerand, & Blanchard, 2000), was used to assess participant’s momentary perceptions of
autonomy: “I was engaging in this activity because I want to, not because I have to.” Participants
rated their momentary perceived autonomy on a scale ranging from 0 (do not agree at all) to 4
65
(strongly agree). Higher scores indicated that the person experienced greater relative autonomy
for the activity.
Temporal context. The temporal context of responses was recorded automatically by the
Paco app in the form of time and date stamps for each experience sample. To accommodate
college students’ schedules which can run past midnight, the time of day was expressed as
minutes since 4am (as opposed to using midnight; see Rives, 2007). Dummy variables were
created to represent the day of week and Saturday served as the reference category because it
coincided with the lowest mean negative affect scores.
Data Preparation and Analysis
Momentary variables were transformed to separate variance at the between- and within-
person levels (Bolger, Davis, & Rafaeli, 2003; Schwartz & Stone, 1998). First, each person’s
usual level of a variable was calculated as their intraindividual mean (imean) score. This data
preparation approach was equivalent to cluster-mean centering method described by Enders and
Tofighi (2007) for multilevel model analysis. Next, each momentary response was person mean
centered by subtracting each individual score from the corresponding person-level mean score.
The resulting difference score represented the deviation of a person’s activities or experiences
around their mean levels at a given time. For instance, participant i’s usual level of mindfulness
(Usual Mindfulnessi) was calculated as the imean of his/her momentary responses to mindfulness
items across the 2 weeks, and each participant’s momentary levels of mindfulness (Momentary
Mindfulnessit) were calculated by subtracting the scores at each occasion t from his or her imean.
Usual Mindfulnessi scores across the 2 weeks differentiate the more or less mindful people in
general (between-person differences), whereas Momentary Mindfulnessit scores represent
momentary deviations from usual mindfulness levels (within-person differences).
66
Negative affect scores were not over dispersed (kurtosis = 0.21)) but negatively skewed
(skewness = 0.93), so scores were transformed using the Box-Cox method (optimal λ = 0.39;
transformed skew = -0.57; Box & Cox, 1964; Osborne, 2010). This transformed score was used
in all analyses. The distributions of momentary mindfulness (skewness = 0.08; kurtosis = -0.75)
and perceived autonomy (skewness = -0.61; kurtosis = -0.78) ratings were not over skewed or
dispersed so the original score metric was retained.
Due to the nested structure of the data (moments nested within people), multilevel models
(MLM) were used to examine the between- and within-person associations between their
momentary activities and negative affect. Models were estimated using R 3.2.2 (R Core Team,
2013) with the nlme package (Pinheiro, Bates, DebRoy, Sarkar, & R Core Team, 2016). Missing
values (6%) were excluded from the analysis. Predictors in the multilevel models were
categorized into three different sources: the between-person factors, the within-person factors,
and the interactions between within-person factors. The within-person interactions were selected
by all the combinations between mindfulness and the activities (standing and moving).
Consistent with standard multilevel modeling practice, the intraclass correlation
coefficients (ICC) and the pseudo-R2 were calculated. The former index estimates the proportion
of total variance (between- and within-person) that can be attributed to between-person
differences (Kreft, Kreft, & Leeuw, 1998). The latter index represents the proportion of total
variability explained by a set of predictors. The pseudo-R2 is also considered as an effect size
estimation of the model (Nakagawa & Schielzeth, 2013).
Model specification. The final multilevel model in predicting negative affect is presented
below:
67
Level-1: Negative affectit = β0i + β1i (Response timeit) + β2i (Day in studyit) + β3i
(Mondayit) + β4i (Tuesdayit) + β5i (Wednesdayit) + β6i (Thursdayit) + β7i
(Fridayit) + β8i (Sundayit) + β9i (Deviations from usual standingit) + β10i
(Deviations from usual movingit) + β11i (Momentary autonomyit) + β12i
(Momentary mindfulnessit) + β13i (Prior negative affectit) +
β14i (Deviations from usual standingit x Momentary mindfulnessit) +
β15i (Deviations from usual movingit x Momentary mindfulnessit) + eit
(1)
Level-2: β0i = γ00 + γ01 (Agei) + γ02 (Genderi) + γ03 (Usual standingi) +
γ04 (Usual movingi) + γ05 (Usual autonomyi) +
γ06 (Usual mindfulnessi) + u0i
(2)
β(1 -14)i = γ(1-14)0 (3)
where γ00 represented the intercept for momentary negative affect, γ01 to γ06 represented the
between-person associations between negative affect and age (γ01), gender (γ02), usual standing
(γ03), usual moving (γ04), usual mindfulness level (γ05), and usual autonomy level (γ06); γ10 to γ70
represented the association between negative affect and response time (γ10) and day of the week
(i.e., γ20 for Monday, γ30 for Tuesday, etc.). Saturday had the lowest negative affect so was used
as the reference day. The parameters γ80 to γ110 represented associations between negative affect
and individual’s usual level of standing and moving (γ80 and γ90, both relative to sitting), usual
mindfulness level (γ100), and usual autonomy level (γ110), respectively; γ120 was the association
with lagged negative affect; γ130 and γ140 represented the association between negative affect and
interactions between momentary activity and momentary level of mindfulness. All predictors
were treated as fixed effects to reduce model complexity and accommodate the available sample
68
size. The coefficient u0i is the person-specific residual deviations that is uncorrelated with the
momentary-level residual eit.
Results
Participants provided a total of 14,591 responses (80.9% response rate) and an average of
92 responses per person (SD = 24.76) during the two-week study period. The frequency plot in
Figure 3.1 shows that almost all the responses (99%) were provided between 8AM and 12PM
(midnight), indicating a good coverage of typical waking hours.
As seen in Table 3.1, on average, participants reported low negative affect (M = 3.15 on a
0-12 scale), moderate mindfulness (M = 3.49 on a 0-8 scale) and moderate perceived autonomy
(M = 2.62 on a 0-4 scale). Sitting, moving, and standing were reported during 62%, 22%, and
16% of the valid experience samples, respectively. Table 3.1 also reports between- and within-
person correlation coefficients above and below the diagonal, respectively. Similar patterns were
observed in the between- and within-person correlations. For example, negative affect had a
moderate negative association with autonomy (between-person r = -0.48; within-person r = -
0.28), and weak negative associations with standing (between-person r = -0.07; within-person r
= -0.08), and moving (between-person r = -0.08; within-person r = -0.10). The ICC for negative
affect indicated that approximately 37% of the variance in scores was due to differences between
people with the remaining variance due to within-person fluctuations or measurement error. This
estimate justified testing both between- and within-person hypotheses in a multilevel modeling
framework.
Table 3.2 summarizes coefficients from the multilevel model that regressed negative
affect on a variety of predictors after controlling for other variables. The outcome variable in this
69
model is a composite negative affect score but, as a reminder, conclusions were identical when
individual models were tested for stress, anxiety and affective valence.
The first primary hypothesis was supported: People reported less negative affect while
moving (γ90 = -0.70, p < .01) or standing (γ100 = -0.51, p < .01) than sitting. At moments when
people were more active than their usual, they experienced lower levels of negative affect.
The second primary hypothesis was also supported: At moments when individuals were
more mindful than usual, the within-person associations between negative affect and moving
(γ150 = -0.10, p < .01) differed from when participants were sitting. A significant interaction
effect was not observed in the within-person interaction between standing and momentary
mindfulness (p > .05). People’s momentary negative affect and standing did not vary as a
function of their momentary mindfulness. Figure 3.2 presents this interaction in which
associations between momentary negative affect and moving varied as a function of their
momentary mindfulness. People reported significant less negative affect while moving mindfully
compared to sitting.
The hypothesis regarding the primary between-person association was supported: After
accounting for the within-person variations in people’s daily activity and mindfulness, the
differences between people’s usual activity level as well as their usual mindfulness level did not
predict negative affect (p > .05). People’s negative affect did not differ for people who more
frequently reported moving or standing relative to sitting, nor for people who reported being
mindful more frequently.
Both usual and momentary autonomy were negatively associated with negative affect.
Individuals with greater autonomy were less likely to experience higher negative affect (γ06 = -
0.93, p < .01). In moments when people were more autonomous than usual, they tended to
70
experience less negative affect (γ120 = -0.57, p < .01). The model also indicated that college
student’s negative affect levels differed by the day of the week. Compared to Saturdays, students
reported higher negative affect on all other days except Fridays. The model also showed that
students’ previous negative affective state carried over with time and positively predicted their
subsequent levels of negative affect (γ130 = 0.35, p < .01). The pseudo R2 for this model indicated
that the fixed effects of all the predictors in the model accounted for approximately 38% of the
variance in momentary negative affect.
Discussion
The current study applied experience sampling methods to investigate associations
between daily activity behaviors/postures, mindfulness and negative affect in college students’
daily lives. The key finding was that college students who reported being more mindful while
moving in everyday life reported lower levels of negative affect than they did when they were
less mindful or sitting. This finding was consistent with previous studies showing that engaging
in mindful physical activity is associated with lower perceived negative affect (Gotink et al.,
2016; Robert-McComb et al., 2015; Teut et al., 2013; Tsang et al., 2008). These results provide
the first evidence of mindful movement being associated with negative affect in a variety of life
contexts, without participating in a structured mindful moving program.
Both engaging in physical activity and mindfulness practice have been shown to reduce
negative affect in the college student population (Regehr, Glancy, & Pitts, 2013; Stults-
Kolehmainen & Sinha, 2013). The present study extended previous research by explicitly testing
the interaction between these two strategies. A potential synergetic effect emerged between
physical activity behavior/posture and mindfulness that dampened negative affect even more
71
than behavior/posture or mindfulness by itself. Higher levels of momentary mindfulness
strengthened the inverse association between physical activity and negative affect. This finding
implies that implementing mindfulness practices into everyday activity behaviors/postures may
lower students’ negative affective experiences to a greater degree. With the inclusion of usual
and momentary mindfulness levels, we also found that only students’ momentary activity
behavior/posture, but not their usual level of activity behavior/posture, was associated with
negative affect.
The finding that deviations from college students’ usual activity level, but not their usual
activity level, was significantly associated with negative affect was consistent with one prior
study (Haas, Schmid, Stadler, Reuter, & Gawrilow, 2017), but contradicted with another (Hyde,
Conroy, Pincus, & Ram, 2011). Study from Haas et al. (2017) found that when young adults
(mostly college students) engaged in more daily moderate to vigorous physical activity than their
usual level, they reported lower levels of negative affect in the same evening. The between-
person differences in daily physical activity level in this study did not yield the same association
with negative affect. On the other hand, study from Hyde et al. (2011) revealed that both college
students’ overall and daily free-time physical activity were not associated with daily unpleasant-
activated (nervous, embarrassed, upset, stress, and tense) or unpleasant-deactivated (sluggish,
sad, bored, depressed, and disappointed) affective responses. These mixed results indicate a need
for future studies to investigate whether people’s mindfulness level or the activation (arousal)
level of affect are determinants of the between- and within-person association between daily
physical activity and negative affect (Dunton et al., 2014; Kanning & Schlicht, 2010; Reed &
Ones, 2006).
72
Further, rather than focusing on moderate-to-vigorous physical activity level in daily life,
the present study showed that daily activity behaviors and postures (standing and moving relative
to sitting) also yield an inverse association with negative affect. When people moved or stood
(relative to sitting), they experienced lower levels of negative affect. This finding may also
inform future studies to investigate the role of everyday light activities or postures in improving
people’s mental health, which will provide tremendous public health implications.
The present study relied on self-reports and did not incorporate devices (e.g.,
accelerometers) to capture daily movements and postures. Those devices are often considered
gold standards for investigating daily variations in physical activity and affective states
(Kanning, Ebner-Priemer, & Schlicht, 2013). The self-reported daily activity patterns reported
here corresponded with population-based estimates of time spent in different activity behaviors
and postures from devices (Hansen, Kolle, Dyrstad, Holme, & Anderssen, 2012). For example,
the proportion of sedentary time reported in both studies was identical (both 62%). This
concordance is likely a product of intensive within-person assessments that averaged 909
responses per hour across a broad swatch of waking hours. Future studies should investigate
whether ecological momentary assessment approaches with frequent responses of physical
activity could be a valid proxy for the total amount of physical activity measured by devices.
The intensive longitudinal assessments in the current study extended prior mindfulness
work by demonstrating affective differences as a function of situational mindfulness levels in
college student’s everyday life. To reduce negative affect in college students, prior mindfulness-
based programs usually focused on affective differences between more and less mindful
students, and changes in global mindfulness level before and after the program (Chiesa &
Serretti, 2009; Eberth & Sedlmeier, 2012; Shapiro et al., 2008). Those studies usually included
73
limited samplings of mindfulness and negative affect, and thus could not disaggregate the
between-person and within-person variation in these time varying constructs (Beddoe & Murphy,
2004; Jain et al., 2007; Moscaritolo, 2009; Schure et al., 2008; Shapiro et al., 2008). The present
finding of a within-person association between mindfulness and negative affect has implications
for future intervention designs to examine the associations between people’s global, situational
mindfulness and negative affect. An experimental study with ecological momentary assessment
of mindfulness and negative affect is needed to establish causality between people’s increases in
global and/or momentary mindfulness and reductions in negative affect.
Perceived autonomy is the only predictor in our study that was significant in predicting
negative affect at both the between- and the within-person levels. People with higher levels of
perceived autonomy or who perceived greater autonomy at a given moment often experience
more enjoyment and pleasure while engaging in physical activity (Teixeira, Carraça, Markland,
Silva, & Ryan, 2012). It was not surprising to see that higher levels of usual and momentary
autonomy were related to lower levels of negative affect in the present study. This finding
reinforces the importance of cultivating a sense of autonomy, a key factor depicted in self-
determination theory, to support intrinsic motivation for physical activity and promote health and
well-being (Deci & Ryan, 2008).
To account for the potential threat of affective reactivity due to intensive measures, time
in study and response time variables were included in our analysis to control covariation with
negative affect. The model did not indicate any signs of elevated negative affect increased with
time, but suggested a significant decrease in negative affect as the numbers of days in the study
increased. Thus, concerns about experience sampling-induced reactivity should be minimal.
Moreover, with ecological momentary assessment over a course of two weeks, we were able to
74
test the differences between weekday and weekend differences in negative affect in college
students. After controlling for other variables, we identified that college students experienced
higher negative affect in most weekdays compared to Saturday. Such cyclicity of weekly
negative affective level has also been identified in previous study (Ragsdale et al., 2011). The
prevalence of experiencing greater negative affect in school days highlights the need for
effective interventions to promote well-being in college students’ daily schedule.
Several limitations in the current study should be noted. The age range of the sample was
narrow so conclusions may be age-specific and may not generalize to other populations in
different age groups. For instance, younger children usually do their daily activity with less
conscious awareness due to the lack of autonomy and agency, since their daily schedule has
mostly been instructed and planned out (Fodor & Hooker, 2008). On the other hand, with the
perception of limited future life time, older adults tend to pay more attention to their emotional
well-being and physical conditions in the present moment of everyday life (Scheibe &
Carstensen, 2010). Thus, it is possible that the same study in children or older could lead to
different results.
For physical activity measurement, the self-reported momentary activity in our study was
not sensitive to differences in the intensity, duration or mode of physical activity. Future work
with devices (i.e., accelerometers) that are capable of activity classification would help to extend
understanding of the processes of daily activities in predicting negative affect. Also, a number of
contextual factors that could influence negative affect were not assessed in the present study. For
example, the social context, the built environment, and the weather condition have been shown
to impact people’s daily affective responses (Galea, Ahern, Rudenstine, Wallace, & Vlahov,
75
2005; Kööts, Realo, & Allik, 2011; Society, 2004). These factors should be considered as
covariates in future research.
To minimize participant burden from responding to the frequent experience sampling
prompts, only a few items were selected to measure subjective experiences including negative
affect (assessed by three items), mindfulness (two items), and autonomy (one item). Using fewer
items to measure psychological constructs is common to reduce burden and fatigue in experience
sampling studies, but this approach may be more vulnerable to random measurement errors or
unidentified biases in interpretation of the question (Hoeppner, Kelly, Urbanoski, & Slaymaker,
2011). We sought to minimize measurement errors and sustain face validity by selecting and
modifying our experience sampling questions from available scales, but results may have
differed if other types of measures or more items were used to capture each construct in our
study. Finally, the research design was non-experimental, so causal inferences are not possible.
In sum, this study was the first to apply experience sampling methods to investigate the
interaction between momentary mindfulness, physical activity, and negative affect. Results
revealed a within-person association between daily activity and situational mindfulness in
predicting negative affect. Simply moving more or standing more rather than sitting in everyday
life may reduce negative affect but this conclusion requires replication using experimental
methods. Situational mindfulness may moderate the association between daily activity
behaviors/postures and negative affect. These findings suggest new possibilities for using
ecological momentary interventions to promote situational mindfulness during upright postures
and while moving in everyday life to amplify the effects of physical activity. Instructions on how
to carry out mindful movement or incorporate mindfulness techniques with movement-based
76
activities in college setting may be promising strategies for improving mental health among
college students.
77
References
American College Health Association. (2015). American College Health Association National
College Health Assessment II: Undergraduate Students Reference Group Data Report
Fall 2015. Linthicum.
American Psychological Association. (2015). Stress in America. Retrieved May 2, 2016, from
http://www.apa.org/news/press/releases/stress/2014/highlights.aspx
American Psychological Association (APA). (2011). Stress and Gender: 2011. Retrieved January
16, 2017, from http://www.apa.org/news/press/releases/stress/2011/gender.aspx
Beddoe, A. E., & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy
among nursing students? Journal of Nursing Education, 43(7), 305–312.
https://doi.org/10.3928/01484834-20040701-07
Beute, F., de Kort, Y., & IJsselsteijn, W. (2016). Restoration in its natural context: How
ecological momentary assessment can advance restoration research. International
Journal of Environmental Research and Public Health, 13(4), 420.
https://doi.org/10.3390/ijerph13040420
Biddle, S. J. H., & Asare, M. (2011). Physical activity and mental health in children and
adolescents: a review of reviews. British Journal of Sports Medicine, 45(11), 886-895.
https://doi.org/10.1136/bjsports-2011-090185
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., … Devins, G.
(2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science
and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077
Bolger, N., Davis, A., & Rafaeli, E. (2003). Diary methods: Capturing life as it is lived. Annual
Review of Psychology, 54(1), 579–616.
78
Box, G. E. P., & Cox, D. R. (1964). An analysis of transformations. Journal of the Royal
Statistical Society, 26(2), 211–252.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in
psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.
https://doi.org/10.1037/0022-3514.84.4.822
Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and
physical fitness: definitions and distinctions for health-related research. Public Health
Reports, 100(2), 126–131.
Chiesa, A., & Serretti, A. (2009). Mindfulness-Based Stress Reduction for Stress Management in
Healthy People: A Review and Meta-Analysis. The Journal of Alternative and
Complementary Medicine, 15(5), 593–600. https://doi.org/10.1089/acm.2008.0495
Conn, V. S. (2010). Anxiety outcomes after physical activity interventions: Meta-analysis
findings. Nursing Research, 59(3), 224–231.
https://doi.org/10.1097/NNR.0b013e3181dbb2f8
Cooney, G., Dwan, K., & Mead, G. (2014). Exercise for depression. JAMA, 311(23), 2432–2433.
https://doi.org/10.1001/jama.2014.4930
Crane-Okada, R., Kiger, H., Sugerman, F., Uman, G. C., Shapiro, S. L., Wyman-McGinty, W.,
& Anderson, N. L. R. (2012). Mindful movement program for older breast cancer
survivors: A pilot study. Cancer Nursing, 35(4), E1–E13.
https://doi.org/10.1097/NCC.0b013e3182280f73
Davidson, R. J. (2010). Empirical explorations of mindfulness: Conceptual and methodological
conundrums. Emotion, 10(1), 8–11. https://doi.org/10.1037/a0018480
79
Davis, D. M., & Hayes, J. A. (2011). What are the benefits of mindfulness? A practice review of
psychotherapy-related research. Psychotherapy, 48(2), 198–208.
https://doi.org/10.1037/a0022062
Deci, E. L., & Ryan, R. M. (2008). Self-Determination Theory: A macrotheory of human
motivation, development, and health. Canadian Psychology/Psychologie Canadienne,
49(3), 182–185. https://doi.org/10.1037/a0012801
Dunton, G. F. (2017). Ecological momentary assessment in physical activity research. Exercise
and Sport Sciences Reviews, 45(1), 48–54.
https://doi.org/10.1249/JES.0000000000000092
Dunton, G. F., Huh, J., Leventhal, A., Riggs, N., Spruijt-Metz, D., Pentz, M. A., & Hedeker, D.
(2014). Momentary assessment of affect, physical feeling states, and physical activity in
children. Health Psychology, 33(3), 255–263. https://doi.org/10.1037/a0032640
Eberth, J., & Sedlmeier, P. (2012). The Effects of Mindfulness Meditation: A Meta-Analysis.
Mindfulness, 3(3), 174–189. https://doi.org/10.1007/s12671-012-0101-x
Ekkekakis, P., & Petruzzello, S. J. (2002). Analysis of the affect measurement conundrum in
exercise psychology: IV. A conceptual case for the affect circumplex. Psychology of
Sport and Exercise, 3(1), 35–63. https://doi.org/10.1016/S1469-0292(01)00028-0
Enders, C. K., & Tofighi, D. (2007). Centering predictor variables in cross-sectional multilevel
models: A new look at an old issue. Psychological Methods, 12(2), 121–138.
https://doi.org/10.1037/1082-989X.12.2.121
Ensari, I., Greenlee, T. A., Motl, R. W., & Petruzzello, S. J. (2015). Meta-analysis of acute
exercise effects on state anxiety: An update of randomized controlled trials over the past
25 years. Depression and Anxiety, 32(8), 624–634. https://doi.org/10.1002/da.22370
80
Fodor, I. E., & Hooker, K. E. (2008). Teaching mindfulness to children. Gestalt Review, 12(1),
75–91.
Fogle, G. E., & Pettijohn, T. F. (2013). Stress and health habits in college students. Open Journal
of Medical Psychology, 2(2), 61–68. https://doi.org/10.4236/ojmp.2013.22010
Galea, S., Ahern, J., Rudenstine, S., Wallace, Z., & Vlahov, D. (2005). Urban built environment
and depression: a multilevel analysis. Journal of Epidemiology & Community Health,
59(10), 822–827. https://doi.org/10.1136/jech.2005.033084
Goodwin, R. D. (2003). Association between physical activity and mental disorders among
adults in the United States. Preventive Medicine, 36(6), 698–703.
https://doi.org/10.1016/S0091-7435(03)00042-2
Gotink, R. A., Chu, P., Busschbach, J. J. V., Benson, H., Fricchione, G. L., & Hunink, M. G. M.
(2015). Standardised mindfulness-based interventions in healthcare: An overview of
systematic reviews and meta-analyses of RCTs. PLOS ONE, 10(4), e0124344.
https://doi.org/10.1371/journal.pone.0124344
Gotink, R. A., Hermans, K. S. F. M., Geschwind, N., Nooij, R. D., Groot, W. T. D., & Speckens,
A. E. M. (2016). Mindfulness and mood stimulate each other in an upward spiral: a
mindful walking intervention using experience sampling. Mindfulness, 7(5), 1114–1122.
https://doi.org/10.1007/s12671-016-0550-8
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress
reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research,
57(1), 35–43. https://doi.org/10.1016/S0022-3999(03)00573-7
81
Guay, F., Vallerand, R. J., & Blanchard, C. (2000). On the assessment of situational intrinsic and
extrinsic motivation: The Situational Motivation Scale (SIMS). Motivation and Emotion,
24(3), 175–213. https://doi.org/10.1023/A:1005614228250
Haas, P., Schmid, J., Stadler, G., Reuter, M., & Gawrilow, C. (2017). Zooming into daily life:
within-person associations between physical activity and affect in young adults.
Psychology & Health, 32(5), 588–604. https://doi.org/10.1080/08870446.2017.1291943
Hansen, B. H., Kolle, E., Dyrstad, S. M., Holme, I., & Anderssen, S. A. (2012). Accelerometer-
determined physical activity in adults and older people. Medicine & Science in Sports &
Exercise, 44(2), 266–272. https://doi.org/10.1249/MSS.0b013e31822cb354
Harmon-Jones, E., Harmon-Jones, C., Amodio, D. M., & Gable, P. A. (2011). Attitudes toward
emotions. Journal of Personality and Social Psychology, 101(6), 1332–1350.
https://doi.org/10.1037/a0024951
Hoeppner, B. B., Kelly, J. F., Urbanoski, K. A., & Slaymaker, V. (2011). Comparative utility of
a single-item vs. multiple-item measure of self-efficacy in predicting relapse among
young adults. Journal of Substance Abuse Treatment, 41(3), 305–312.
https://doi.org/10.1016/j.jsat.2011.04.005
Hudd, S. S., Dumlao, J., Erdmann-Sager, D., Murray, D., Phan, E., Soukas, N., & Yokozuka, N.
(2000). Stress at college: effects on health habits, health status and self-esteem. College
Student Journal, 34(2), 217–228.
Hyde, A. L., Conroy, D. E., Pincus, A. L., & Ram, N. (2011). Unpacking the feel good effect of
free-time physical activity: between- and within-person associations with pleasant-
activated feeling states. Journal of Sport & Exercise Psychology, 33(6), 884–902.
82
Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. R.
(2007). A randomized controlled trial of mindfulness meditation versus relaxation
training: Effects on distress, positive states of mind, rumination, and distraction. Annals
of Behavioral Medicine, 33(1), 11–21. https://doi.org/10.1207/s15324796abm3301_2
Jorm, A. F., Windsor, T. D., Dear, K. B. G., Anstey, K. J., Christensen, H., & Rodgers, B.
(2005). Age group differences in psychological distress: the role of psychosocial risk
factors that vary with age. Psychological Medicine, 35(9), 1253–1263.
https://doi.org/10.1017/S0033291705004976
Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday
Life. New York: Hyperion.
Kabat-Zinn, J., & Hanh, T. N. (2009). Full Catastrophe Living: Using the Wisdom of Your Body
and Mind to Face Stress, Pain, and Illness. New York: Random House.
Kanning, Ebner-Priemer, & Schlicht. (2013). How to investigate within-subject associations
between physical activity and momentary affective states in everyday life: A position
statement based on a literature overview. Frontiers in Psychology, 4,187.
https://doi.org/10.3389/fpsyg.2013.00187
Kanning, & Schlicht. (2010). Be active and become happy: an ecological momentary assessment
of physical activity and mood. Journal of Sport and Exercise Psychology, 32(2), 253–
261.
Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological
health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056.
https://doi.org/10.1016/j.cpr.2011.04.006
83
Kööts, L., Realo, A., & Allik, J. (2011). The influence of the weather on affective experience.
Journal of Individual Differences, 32(2), 74–84. https://doi.org/10.1027/1614-
0001/a000037
Kreft, I. G. G., Kreft, I., & Leeuw, J. de. (1998). Introducing Multilevel Modeling. Thousand
Oaks: SAGE.
Liao, Y., Shonkoff, E. T., & Dunton, G. F. (2015). The acute relationships between affect,
physical feeling states, and physical activity in daily life: A review of current evidence.
Frontiers in Psychology, 6,1975. https://doi.org/10.3389/fpsyg.2015.01975
Mammen, G., & Faulkner, G. (2013). Physical activity and the prevention of depression: A
systematic review of prospective studies. American Journal of Preventive Medicine,
45(5), 649–657. https://doi.org/10.1016/j.amepre.2013.08.001
Moscaritolo, L. M. (2009). Interventional strategies to decrease nursing student anxiety in the
clinical learning environment. Journal of Nursing Education, 48(1), 17–23.
https://doi.org/10.3928/01484834-20090101-08
Nakagawa, S., & Schielzeth, H. (2013). A general and simple method for obtaining R 2 from
generalized linear mixed-effects models. Methods in Ecology and Evolution, 4(2), 133–
142. https://doi.org/10.1111/j.2041-210x.2012.00261.x
Ng, J. Y. Y., Ntoumanis, N., Thøgersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., &
Williams, G. C. (2012). Self-determination theory applied to health contexts: A meta-
analysis. Perspectives on Psychological Science, 7(4), 325–340.
https://doi.org/10.1177/1745691612447309
Osborne, J. W. (2010). Improving your data transformations: Applying the Box-Cox
transformation. Practical Assessment, Research & Evaluation, 15(12), 1–9.
84
Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., & Cella, D. (2011). Item
banks for measuring emotional distress from the Patient-Reported Outcomes
Measurement Information System (PROMIS® ): Depression, anxiety, and anger.
Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667
Pinheiro, Bates, DebRoy, Sarkar, & R Core Team. (2016). nlme: Linear and Nonlinear Mixed
Effects Models, R package version 3.1-128. Retrieved from http://CRAN.R-
project.org/package=nlme
Posner, J., Russell, J. A., & Peterson, B. S. (2005). The circumplex model of affect: An
integrative approach to affective neuroscience, cognitive development, and
psychopathology. Development and Psychopathology, 17(3).
https://doi.org/10.1017/S0954579405050340
Praissman, S. (2008). Mindfulness-based stress reduction: A literature review and clinician’s
guide. Journal of the American Academy of Nurse Practitioners, 20(4), 212–216.
https://doi.org/10.1111/j.1745-7599.2008.00306.x
R Core Team. (2013). R: A language and environment for statistical computing. R Foundation
for Statistical Computing, Vienna, Austria. Retrieved from
http://www.eea.europa.eu/data-and-maps/indicators/oxygen-consuming-substances-in-
rivers/r-development-core-team-2006
Ragsdale, J. M., Beehr, T. A., Grebner, S., & Han, K. (2011). An integrated model of weekday
stress and weekend recovery of students. International Journal of Stress Management,
18(2), 153–180. https://doi.org/10.1037/a0023190
Rebar, A. L., Stanton, R., Geard, D., Short, C., Duncan, M. J., & Vandelanotte, C. (2015). A
meta-meta-analysis of the effect of physical activity on depression and anxiety in non-
85
clinical adult populations. Health Psychology Review, 9(3), 366–378.
https://doi.org/10.1080/17437199.2015.1022901
Reed, J., & Ones, D. S. (2006). The effect of acute aerobic exercise on positive activated affect:
A meta-analysis. Psychology of Sport and Exercise, 7(5), 477–514.
https://doi.org/10.1016/j.psychsport.2005.11.003
Regehr, C., Glancy, D., & Pitts, A. (2013). Interventions to reduce stress in university students:
A review and meta-analysis. Journal of Affective Disorders, 148(1), 1–11.
https://doi.org/10.1016/j.jad.2012.11.026
Rives. (2007). Transcript of “The 4 a.m. mystery.” Retrieved February 15, 2016, from
https://www.ted.com/talks/rives_on_4_a_m/transcript
Robert-McComb, J. J., Cisneros, A., Tacón, A., Panike, R., Norman, R., Qian, X.-P., &
McGlone, J. (2015). The effects of mindfulness-based movement on parameters of stress.
International Journal of Yoga Therapy, 25(1), 79–88. https://doi.org/10.17761/1531-
2054-25.1.79
Rosenbaum, S., Tiedemann, A., Sherrington, C., Curtis, J., & Ward, P. B. (2014). Physical
activity interventions for people with mental illness: a systematic review and meta-
analysis. The Journal of Clinical Psychiatry, 75(9), 964–974.
https://doi.org/10.4088/JCP.13r08765
Rosenzweig, S., Reibel, D. K., Greeson, J. M., Brainard, G. C., & Hojat, M. (2003).
Mindfulness-based stress reduction lowers psychological distress in medical students.
Teaching and Learning in Medicine, 15(2), 88–92.
https://doi.org/10.1207/S15328015TLM1502_03
86
Rudolph, K. D., & Hammen, C. (1999). Age and gender as determinants of stress exposure,
generation, and reactions in youngsters: a transactional perspective. Child Development,
70(3), 660–677.
Schalet, B. D., Pilkonis, P. A., Yu, L., Dodds, N., Johnston, K. L., Yount, S., … Cella, D. (2016).
Clinical validity of PROMIS depression, anxiety, and anger across diverse clinical
samples. Journal of Clinical Epidemiology, 73, 119–127.
https://doi.org/10.1016/j.jclinepi.2015.08.036
Scheibe, S., & Carstensen, L. L. (2010). Emotional aging: Recent findings and future trends. The
Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65B(2),
135–144. https://doi.org/10.1093/geronb/gbp132
Schuch, F. B., Rocha, N., & Cadore, E. L. (2015). Progress in Physical activity and Exercise and
Affective and Anxiety Disorders: Translational Studies, Perspectives and Future
Directions. Frontiers Media SA.
Schure, M. B., Christopher, J., & Christopher, S. (2008). Mind-body medicine and the art of self-
care: Teaching mindfulness to counseling students through yoga, meditation, and qigong.
Journal of Counseling and Development : JCD; Alexandria, 86(1), 47–56.
Schwartz, J. E., & Stone, A. A. (1998). Strategies for analyzing ecological momentary
assessment data. Health Psychology, 17(1), 6–16.
Shapiro, S. L., Oman, D., Thoresen, C. E., Plante, T. G., & Flinders, T. (2008). Cultivating
mindfulness: effects on well-being. Journal of Clinical Psychology, 64(7), 840–862.
https://doi.org/10.1002/jclp.20491
87
Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress
reduction on medical and premedical students. Journal of Behavioral Medicine, 21(6),
581–599. https://doi.org/10.1023/A:1018700829825
Sharma, M., & Rush, S. E. (2014). Mindfulness-based stress reduction as a stress management
intervention for healthy individuals: A systematic review. Journal of Evidence-Based
Complementary & Alternative Medicine, 19(4), 271–286.
https://doi.org/10.1177/2156587214543143
Society, T. R. (2004). The social context of well–being. Philosophical Transactions of the Royal
Society of London B: Biological Sciences, 359(1449), 1435–1446.
https://doi.org/10.1098/rstb.2004.1522
Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. A. J., & Otto, M. W. (2006). Exercise
interventions for mental health: A quantitative and qualitative review. Clinical
Psychology: Science and Practice, 13(2), 179–193. https://doi.org/10.1111/j.1468-
2850.2006.00021.x
Stults-Kolehmainen, M. A., & Sinha, R. (2013). The effects of stress on physical activity and
exercise. Sports Medicine, 44(1), 81–121. https://doi.org/10.1007/s40279-013-0090-5
Tanay, G., & Bernstein, A. (2013). State Mindfulness Scale (SMS): Development and initial
validation. Psychological Assessment, 25(4), 1286–1299.
https://doi.org/10.1037/a0034044
Teixeira, P. J., Carraça, E. V., Markland, D., Silva, M. N., & Ryan, R. M. (2012). Exercise,
physical activity, and self-determination theory: A systematic review. International
Journal of Behavioral Nutrition and Physical Activity, 9, 78.
https://doi.org/10.1186/1479-5868-9-78
88
Teut, M., Roesner, E. J., Ortiz, M., Reese, F., Binting, S., Roll, S., … Brinkhaus, B. (2013).
Mindful walking in psychologically distressed individuals: A randomized controlled trial.
Evidence-Based Complementary and Alternative Medicine, 2013, e489856.
https://doi.org/10.1155/2013/489856
Thompson, B. L., & Waltz, J. (2015). Everyday mindfulness and mindfulness meditation:
Overlapping constructs or not? Personality and Individual Differences, 43(7), 1875–
1885. https://doi.org/10.1016/j.paid.2007.06.017
Towbes, L. C., & Cohen, L. H. (1996). Chronic stress in the lives of college students: Scale
development and prospective prediction of distress. Journal of Youth and Adolescence,
25(2), 199–217. https://doi.org/10.1007/BF01537344
Tsang, H. W. H., Chan, E. P., & Cheung, W. M. (2008). Effects of mindful and non-mindful
exercises on people with depression: A systematic review. British Journal of Clinical
Psychology, 47(3), 303–322. https://doi.org/10.1348/014466508X279260
Vallerand, R. J. (2007). Intrinsic and extrinsic motivation in sport and physical activity: A review
and a look at the future. In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of Sport
Psychology (pp. 59–83). John Wiley & Sons, Inc. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1002/9781118270011.ch3/summary
Zajacova, A., Lynch, S. M., & Espenshade, T. J. (2005). Self-Efficacy, stress, and academic
success in college. Research in Higher Education, 46(6), 677–706.
https://doi.org/10.1007/s11162-004-4139-z
89
Figure Captions
Figure 3.1. Frequency of experience sampling responses at each time during the study period.
Figure 3.2. Associations of momentary mindfulness and moving on negative affect.
90
91
92
Table 3.1. Descriptive statistics, correlations, and intraclass correlation coefficients of subjective experiences, physical activity, and
other variables of interest
M SD 1 2 3 4 5 6 7 8
1. Negative Affect 3.15 2.78 (.37) .05** -.48** -.07** -.08** -.14** -.08** .09**
2. Mindfulness 3.49 2.26 .09** (.59) .02* -.06** .22** -.07** .02** .10**
3. Autonomy 2.62 1.33 -.28** .08** (.17) .06** .09** .19** .23** -.06**
4. Standing (%) 0.16 0.07 -.08** -.01 .07** 1.00 -.22** -.08** .06** .15**
5. Moving (%) 0.22 0.09 -.10** .13** .09** -.23** 1.00 -.01 .13** .10**
6. Response Time (hour) 12.05 3.89 -.05** .04** .10** .03** -.05** 1.00 -.01 -.03**
7. Age 19.99 1.27 -.08** .01 .04** .01 .01 -.01 1.00 -.36**
8. Gender (0=male; 1=female)
0.59 0.49 .09** .03** .03** .01 -.01 -.03** -.36** 1.00
N=158, *p<.05, **p<.01. Intraclass correlations (ICC) were calculated in the diagonal parentheses of the matrix.
93
Table 3.2. Multilevel model coefficients for model predicting negative affect
Model Coefficient Std. Error
Fixed Effect
Intercept, 𝛾00 2.88 1.51
Age, 𝛾01 .08 .08
Gender, 𝛾02 .35 .19
Response Time, 𝛾10 .01 .01
Day in the Study, 𝛾20 -.01** <.01
Monday, 𝛾30 .30** .07
Tuesday, 𝛾40 .33** .07
Wednesday, 𝛾50 .38** .07
Thursday, 𝛾60 .15** .07
Friday, 𝛾70 <.01 .07
Sunday, 𝛾80 .34** .07
Usual standing, 𝛾03 -1.86 1.20
Usual moving, 𝛾04 -.95 1.03
Usual mindfulness, 𝛾05 .08 .05
Usual autonomy, 𝛾06 -.93** .16
Deviations from usual standing, 𝛾90 -.51** .05
Deviations from usual moving, 𝛾100 -.70** .05
Momentary mindfulness, 𝛾110 .14** .01
Momentary autonomy, 𝛾120 -.57** .01
Previous negative affective state, 𝛾130 .35** .01
Deviations from usual standing x Momentary mindfulness 𝛾140 -.02 .03
Deviations from usual moving x Momentary mindfulness 𝛾150 -.10** .03
Random Effect
Variance Intercept, 𝜎2𝑢0
1.03
Residual Variance, 𝜎𝑒2 3.34
*p<.05, **p<.01, N of group=150.
94
Chapter 4: Feasibility of an Outdoor Mindful Walking Program for Reducing Negative
Affect in Older Adults
95
Abstract
Mindful walking has emerged as a potential intervention strategy to improve mental
health and promote well-being in adult and clinical populations. This strategy has not been
implemented with older adults to date. This study evaluated the feasibility, acceptability,
sustainability, and preliminary efficacy of a mindful walking program for reducing negative
affect in older adults. Community-dwelling older adults (n = 29) completed a one-month,
outdoor mindful walking program distributed across eight 30-minute sessions. Overall, 93% of
the recruited participants (n = 27) completed all walking sessions and assessments. Responses
from the post-program and the follow-up questionnaires revealed that mindful walking was well-
accepted, highly-valued, and maintained after the program ended. Open-ended feedback
reinforced these findings. Analysis from the pre-walk and post-walk surveys also suggested the
preliminary efficacy of mindful walking program for reducing negative affect. In general, the
mindful walking program in the current study can be implemented as intended (i.e., feasible) and
should be considered acceptable and sustainable by older adults. Positive results identified in the
current feasibility study indicate readiness for randomized controlled trials to further examine the
efficacy and effectiveness of a mindful walking intervention for promoting health and well-being
in older populations.
96
Feasibility of an Outdoor Mindful Walking Program for Reducing Negative Affect in Older
Adults
The older adult population is growing rapidly. By 2050, over 20% of the population –
approximately two billion of the population globally – will be 60 years of age or older (WHO,
2017). To help this rapidly growing older adult population live longer, healthier and happier, the
promotion of healthy aging has become a priority to the society (McLaughlin, Connell, Heeringa,
Li, & Roberts, 2010). Approximately 10% of older adults report 14 or more days of poor mental
health including stress, depression, or other negative emotional symptoms within a month (CDC,
2008; Gerteis et al., 2014). Around 15% to 52% of community older adults also reported anxiety
symptoms based on a literature review (Bryant, Jackson, & Ames, 2008). The prevalence of poor
mental health among the elderly foreshadow significant health care challenges. People are now
living longer but have lower psychological well-being that may lead to poor health. National data
recently revealed that only 1% of the health cost for older Americans have been spent in health
prevention work (National Council on Aging, 2015). Therefore, the design and evaluation of
cost-effective, innovative, and scalable intervention strategies to improve well-being in older
adults is a pressing manner from a public health standpoint.
Engaging in regular physical activity and mindfulness practice have both been introduced
as promising strategies to promote successful aging (Harmell, Jeste, & Depp, 2014), but
strategies that integrate mindfulness practice and a single form of physical activity have not been
explored in depth, especially in older adults. It remains unclear whether a mindful walking
program would be feasible and acceptable for older adults or if it could potentially improve their
well-being by reducing negative affect. Given this, the present study was conducted to evaluate
97
the feasibility, acceptability, sustainability, and preliminary efficacy of an outdoor mindful
walking intervention for community-dwelling older adults.
Although the rates of psychological symptoms tend to decline with age, older adults
experience several aging-related stressors such as decreased physical and mental abilities,
physical pain and discomfort, insufficient time spend with family and friends, and concern about
their own death during everyday life (Stokes & Gordon, 2003). These stressors exact a toll on
older adults’ overall health and well-being, and could impair their quality of life. Poor well-being
is closely associated with worse cognitive functioning and physical health in older adults
(Federal Interagency Forum on Aging-Related Statistics, 2016). Better well-being is positively
associated with longevity and serves a protective role in maintaining physical health while
people get older, regardless of baseline mental/physical health and demographic backgrounds
(Steptoe, Deaton, & Stone, 2015). On the other hand, health risk behaviors, such as smoking,
inactivity, and poor diet, were more common among distressed older adults (CDC, 2008).
Epidemiologic data from older adults indicates that faster cognitive decline is associated with
increasing levels of perceived stress after adjusting for various biophysiological factors and
demographics (Aggarwal et al., 2014). Collectively, these findings point to the need for
prevention work for older adults to alleviate negative affect, improve well-being, and in turn,
sustain better mental and physical health.
Exercise, or moderate-to-vigorous physical activity, is widely recognized for its effects
on well-being by reducing negative affective states (Rebar et al., 2015; Rosenbaum, Tiedemann,
Sherrington, Curtis, & Ward, 2014; Stathopoulou, Powers, Berry, Smits, & Otto, 2006; Stults-
Kolehmainen & Sinha, 2013). Older adults engage in very limited amounts of exercise and
recent work has examined whether light physical activity, such as walking, can elicit similar
98
benefits for them. An observational study conducted in two major metropolitan regions in the
United States revealed a positive association between light intensity physical activity and well-
being (i.e., lower stress and depressed feelings, higher life satisfaction) among older adults
(Buman et al., 2010). Another large observational study indicated that older adults who
participated in self-selected light intensity for at least five times per week, or leisure walking for
at least an hour per week had higher levels of subjective well-being compared to their peers
(Black et al., 2015). Meta-analysis has reported that for improving older adults’ psychological
well-being, the effect size was modest for moderate exercise (d = 0.34) and was small for light-
intensity exercise (d =0.14), respectively (Netz, Wu, Becker, & Tenenbaum, 2005).
Integrating other interventions that promote well-being may increase the effects of light
physical activity on well-being. Mindfulness is both a trait and a state form of mental experience
that is characterized by heightened attention, awareness, and acceptance of emotional and
physical sensations (Brown & Ryan, 2003). Trait and state mindfulness can also be
conceptualized via the three-level hierarchical framework (see Chapter 2). In this model, trait
mindfulness is synonymous with global mindfulness and is relatively time-invariant. State
mindfulness can be either contextually- or temporally-specific. Contextual mindfulness refers to
a person’s typical level of mindfulness in a particular activity or context, whereas situational
mindfulness refers to their momentary experience of mindfulness. Research on the mindfulness-
based stress reduction program (MBSR; Kabat-Zinn & Borysenko, 1996; Kabat-Zinn & Hanh,
2009) and the mindfulness-based cognitive therapy (MBCT; Morgan, 2003) indicated a negative
association between global mindfulness and negative affect (Fjorback, Arendt, Ø rnbøl, Fink, &
Walach, 2011; Gotink et al., 2015; Gu, Strauss, Bond, & Cavanagh, 2015). Older adults who
completed an eight-week MBSR or MBCT significantly decreased their reported depression and
99
anxiety symptoms, and improved their emotional well-being (Foulk, Ingersoll-Dayton,
Kavanagh, Robinson, & Kales, 2014; Young & Baime, 2010; Splevins, Smith, & Simpson,
2009). One review concluded that the average MBSR effect sizes on negative affect in distressed
older adults were moderate (d = 0.50), despite the large heterogeneity and publication bias in the
mindfulness literature (Young & Baime, 2010). Another meta-analysis focused on the effect of
MCBT in older adults, and suggested similar effect sizes for decreasing depressive (g = 0.55) and
anxious (g = 0.58) symptoms (Kishita, Takei, & Stewart, 2016).
Interventions have attempted to integrate physical activity and mindfulness to improve
people’s mental health (Russell, 2011; Tsang, Chan, & Cheung, 2008). Mindful movement can
be simply described as mindful components being implemented concurrently with physical
activity, although light physical activity is considered to be optimal for cultivating mindfulness
(La Forge, 2016). For older adults, practicing mindfulness with a slow walking pace may be
desirable because light physical activity is both safe and health-enhancing (Loprinzi, Lee, &
Cardinal, 2015; Nelson et al., 2007). Only a handful of studies have emphasized mindful
walking as primary intervention strategy to enhance people’s well-being or reduce negative
affect. Two randomized controlled trials have shown that mindful walking or walking meditation
can be effective for decreasing negative affect in adults with moderate to high levels of distress
or depressive symptoms (Prakhinkit, Suppapitiporn, Tanaka, & Suksom, 2013; Teut et al., 2013).
This literature has important limitations. For example, none of the available trials recruited
relatively healthy older adults from the community or engaged participants in walking
individually (versus in groups). Only one study provided follow-up information regarding the
maintenance rate after the end of the supervised program so it is not clear whether mindful
walking is potentially sustainable after an initial supervised period (Teut et al., 2013). Finally,
100
the mechanism for mindful walking benefits on negative affect likely involves momentary
changes mindfulness while walking but no studies have assessed those momentary changes.
The primary objective of the current study was to evaluate the feasibility of an outdoor
mindful walking program for community-dwelling older adults prior to designing a randomized
controlled trial. Eight 30-minute mindful walking sessions were delivered at an public arboretum
that has flat and wide walking trails. Participants were taught (in stages) to use basic and
common practices in traditional mindfulness training by focusing on their breath, steps,
emotional and bodily sensations while walking at a slow, fixed pace (Kabat-Zinn, 1994; Kabat-
Zinn & Hanh, 2009). Participants completed measures at the beginning and end of the program
as well as before and after each session to evaluate the feasibility of monitoring changes in
mindfulness and negative affect during the program. It was hypothesized that older adults in this
study would perceive this program to be acceptable, feasible and sustainable. Acceptability and
feasibility would be indicated by receiving an average score of six or above (out of a seven-point
Likert scale) on each of the questions regarding program feasibility and acceptability; acceptable
program sustainability would be indicated by obtaining an over 60% maintenance rate of mindful
walking at one month follow-up. Exploratory analyses were conducted to evaluate the benefit of
increasing mindfulness while walking. It was hypothesized that negative affect would decrease
most for older adults who increased their mindfulness most during the slow walks.
Methods
Participants
Recruitment was conducted over 6 weeks using fliers posted in a retirement village, a
senior learning institute and a variety of community locations (e.g., churches, restaurants). The
101
fliers invited older adults to participate in an outdoor slow walking program at a local arboretum.
Fliers did not mention the word “mindfulness” to minimize expectations and biases that could
influence the psychological outcomes (Davidson & Kaszniak, 2015). Instead, the project was
advertised as a “slow walking” study. Figure 4.1 presents the CONSORT diagram for enrollment
and follow-up. Participants were eligible if they were age 65 years or older, could walk without
assistance, spoke and read English fluently, and were not allergic to plants and flowers. Older
adults were excluded if they had any mobility limitations or contraindications for regular light
physical activity.
Over six weeks of advertising, volunteers (n = 29) were enrolled using advertisements in
the retirement village (n = 2), community locations (n = 13), and a senior learning institute (n =
14). The mean age of participants was 73.2 years (range = 66 to 89, SD = 6.47). Most
participants were female (83%), Caucasian (79%), and highly educated (62% of them earned at
least a bachelor’s degree). Three participants (10%) had up to several hours of
mindfulness/meditation experiences before but this experience was more than 18 months prior
(range = 1.5 to 20.0 years).
Procedure
In an initial lab visit, each participant completed a baseline assessment of demographic
characteristics. The researcher then scheduled the participant’s eight walking sessions. Prior to
the first walking session, the researcher sent each participant a reminder email. Walking sessions
involved 30 minutes of individual, slow walking along a flat, designated route in an arboretum.
Prior to each walking session, the researcher greeted each participant at the arboretum to provide
instructions and a small reminder sheet detailing the mindfulness tasks for that day’s walk.
Participants completed a brief survey at the beginning and end of each walking session to report
102
their negative affect and situational mindfulness. After the final walking session, participants
completed a second lab visit. In this visit, they rated the acceptability of the slow walking
program. One month after the second lab visit, a web-based follow-up questionnaire was emailed
to participants to inquire whether they continued to participate in the slow walking activity
following the end of the supervised program. Participants who completed the eight walking
sessions and two lab visits were enrolled in a raffle to win one of the nine $25 gift cards. The
study protocol and all materials were approved by the institutional review board.
Mindful Walking Intervention
The mindful walking program was designed to incorporate basic elements of mindfulness
practice or walking meditation in a way that would be accessible for the general older population
without extensive experience in meditation or mindfulness training. These elements involved
being attentive to the rhythm of their breathing and the movement of each step, and scanning the
body to identify sensations that arise (Kabat-Zinn, 1994; Kabat-Zinn & Borysenko, 1996; Kabat-
Zinn & Hanh, 2009). Table 4.1 summarizes the timing and content of slow walking and
mindfulness training in each of the eight sessions. The first session familiarized participants with
the walking route at the arboretum and provided an opportunity to practice walking at a slower
pace than normal. Older adults can lose their balance more easily when walking at a much
slower speed so participants were asked to select their most relaxing and comfortable way of
walking slowly (Morone & Greco, 2014). Paying attention to one’s breath is considered the most
fundamental mindful practice so it is incorporated beginning in session 2 (Kabat-Zinn, 1994).
Two other mindfulness tasks – namely, focusing on the movement and scanning the body – were
introduced in sessions four and six. The duration of mindfulness training during each session
increased from five minutes to a maximum of 30 minutes.
103
Measures
First lab visit. A demographic survey was administered to assess participants’ age,
gender, race, highest level of educational attainment, prior experiences in mindfulness
(meditation) training or practice, and divided attention. The 4-item Divided Attention subscale
from the Everyday Cognition Scale for older adults was applied to characterize participants’
baseline attentional ability (Farias et al., 2008).
Pre-walk survey. Prior to each walking session, participants rated their negative affect,
situational mindfulness, and the quality of their previous night’s sleep. Negative affect was
assessed using four items that sampled perceived stress (“I feel stressed now”), anxiety (“I feel
anxious now”), depression (“I feel depressed now”), and displeasure (“I feel unpleasant now”).
Participants responded to each item on a scale ranging from 1 (strongly disagree) to 7 (strongly
agree) before and after each walking session. Items were modified from items in the anxiety,
stress, and affect pools of the Patient Reported Outcomes Measurement Information System
(PROMIS; Ader, 2007; Pilkonis et al., 2011). The four negative affect items were moderately to
highly correlated before the walking sessions (r ranged from 0.30 to 0.85) across participants, so
the responses were summed to create a single score representing negative affect. The internal
consistency (α) of the four pre-walk items across all occasions was 0.81.
Situational mindfulness was assessed using two items that measured perceived awareness
of mental states (“I notice pleasant or unpleasant emotions now”) and physical states (“I notice
bodily sensations come and go now”). These items were selected from the State Mindfulness
Scale (SMS) because they sampled the two key components (mindful or physical sensation and
mental events) of state mindfulness (Tanay & Bernstein, 2013). Participants rated their perceived
mindfulness level on a scale ranging from 1 (strongly disagree) to 7 (strongly agree). The
104
internal consistency (Spearman-Brown ρ) of the two items in pre-walk surveys was 0.45
(Eisinga, Grotenhuis, & Pelzer, 2013). Additional analyses showed that the results did not differ
when the mindful-emotion or the mindful-body scores were separated in different models. Thus,
two situational mindfulness items were combine to represent a unidimensional construct of
mindfulness state (Tanay & Bernstein, 2013).
Participants reported their perceived past-night sleep quality on a 7-point bipolar scale
ranging from 1 (very bad) to 7 (very good). The researcher recorded the date, day of the week,
number of the session, and the time of both the pre- and post-surveys. Additionally, the daily
average temperature and weather conditions during each walking session was collected via the
https://weather.com website.
Post walk. Immediately after completing each walk, participants rated their negative
affect and situational mindfulness with the same items used prior to the walk. Correlations
between the negative affect items ranged from 0.40 to 0.76 and the internal consistency (α) of the
four post-walk items across all occasions was 0.80. The responses from the four items were
again summed to create a single score representing negative affect. Likewise, the two post-walk
situational mindfulness items were aggregated to represent a unified mindfulness state
(Spearman-Brown ρ = .38), consistent with the pre-walk measure.
Second lab visit. The feasibility and acceptability of the program were assessed using
items that sampled perceptions of satisfaction (“I feel satisfied with this program”), usefulness
(“I think this program is useful to me”), interest (“I am interested in participating in a similar
program in the future”), and overall quality (“I would recommend others to join this program”).
Participants rated the four items on the same scale ranging from 1 (strongly disagree) to 7
(strongly agree) after they completed the program, and the responses of the four items were
105
moderately to highly correlated (r ranged from 0.42 to 0.84). An open-ended question was used
to elicit any additional feedback, comments or concerns participants had after completing the
program.
One-month follow-up questionnaire. Maintenance was assessed with one binary item
(“After you finished the program, have you ever done the slow walking in the past month?”). If a
participant responded “yes,” additional questions were asked about the frequency and duration of
their slow walking. The frequency item was, “After you finished the program, how often did you
engage in slow walking for the past month?” and response options included “1 to 3 times”, “4 to
6 times”, “7 to 9 times”, and “more than 9 times.” The duration item was, “After you finished
the program, how long did you usually engage in slow walking each time for the past month?”
and response options included “less than 30 minutes”, “30 minutes to less than 1 hour”, “1 hour
to less than 2 hours”, and “more than 2 hours.” Finally, participants were asked to indicate their
continued use of the specific mindfulness training techniques while slow walking on a scale
ranging from 1 (almost never) to 4 (almost always).
Data Analysis
Descriptive statistics were calculated to characterize the feasibility, acceptability,
sustainability, and preliminary efficacy of the program. Single-group repeated measure t-tests
were used to determine the within-group differences before and after mindful walking sessions.
Standardized mean differences were calculated to represent paired-sample effect sizes. Finally,
to account for the inter-dependency of the nested data structure in the current study (the walking
session data nested within each participant), a multilevel model was utilized to analyze the
association between changes in mindfulness scores and negative affect after mindful walking
sessions (Steenbergen & Jones, 2002).
106
Results
Twenty-seven participants (93%) completed all eight slow walking sessions and the pre-
post program measurements, and 26 participants (90%) completed the one-month follow-up
questionnaire, indicating high adherence rates. One participant dropped out after her first slow
walking session because of difficulties navigating the path in arboretum; another participant
dropped out after finishing his fifth slow walking session due to an unexpected painful groin pull
during his leisure activity (unrelated to the study). With respect to the measurement completion
rate (95%), participants provided data on 525 out of the 551 possible measurement occasions (19
possible occasions/participant: two lab visits, eight pre-walk assessments, eight post-walk
assessments, one follow-up).
Table 4.2 summarizes the temporal and environmental context of the slow walking
sessions. The majority of the slow walking sessions were held between 10am and 3pm (90%) on
weekdays (86% from Monday to Friday) in November (71%). The average daily temperature of
all slow walking sessions was 40.6°F (range: 9°F to 72°F), and 18% of the sessions had an
average daily temperature at or below 32°F (the freezing point). Adverse weather conditions
(e.g., rain, hail, snow) occurred during approximately 10% of the slow walking sessions. Among
the 222 scheduled sessions, 17 advance cancellation notices (8% of all scheduled sessions) were
received from participants due to adverse weather conditions (i.e., snow shower, n = 6) or
holiday traveling (i.e., Thanksgiving break, n = 11). None of the participants missed their
walking session without informing the researcher beforehand. Overall, participants completed
92% of their scheduled sessions.
At the end of the slow walking program, 96% of participants indicated that they would
recommend this program to others. Participants also reported high levels of satisfaction (M =
107
6.18, SD =0.78), usefulness (M = 6.15, SD = 0.87), and interest (M = 6.19, SD = 1.08). In the
follow-up questionnaire, 92% of participants indicated that they were still interested in slow
walking, and 65% reported that they continued to practice slow walking after program
completion. For those who maintained their slow walking practice, more than half (59%)
practiced more than 4 times within the past month, and the majority (65%) practiced mindful
strategies frequently during their slow walking. All participants who maintained their slow
walking practice reported that they practiced slow walking for more than 30 minutes each time.
Table 4.3 summarizes descriptive statistics and correlations for key study variables.
There was no temporal trend indicating systematic changes in negative affect or mindfulness as a
function of experience with the slow walking (number of attended walking sessions, p > .05).
Consequently, scores from each participant were averaged for comparisons of pre-post walk on
negative affect and mindfulness. Single-group repeated-measure t-tests revealed significant
differences between participants’ average pre-and post-walk negative affect (t[27] = -6.81, p
< .01) and situational mindfulness scores (t[27] = 4.50, p < .01). Participants reported
significantly less negative affect (average d = -0.61, range = -0.60 to -0.77) and greater
situational mindfulness (average d = 0.55, range = 0.37 to 0.79) following the walking sessions.
Of note, 92% of the participants reported lower or similar levels of negative affect (Mdiff = -2.45,
SD = 3.52), and 87% reported higher or similar levels of mindfulness in the post-walking survey
across all mindful walking sessions (Mdiff = 1.06, SD = 2.03).
Post-walk negative affect was then regressed on pre-walk negative affect and changes in
situational mindfulness, F (9,178) = 15.57, p < .01. As seen in Table 4.4, after controlling for the
pre-walk negative affect scores and other temporal and contextual factors, residualized changes
in negative affect were associated with increases in situational mindfulness scores after the
108
walking sessions (β = -0.25, p < .01). That is, older adults who increased their situational
mindfulness more than their usual level during the walks also decreased their negative affect
most. Overall, based on the conditional pseudo R2, the fixed factors in this model explained
approximately 50% of the variance in post-walk negative affect (Nakagawa & Schielzeth, 2013).
Open-ended feedback was very positive and there were no adverse events reported by
older adults related to participation. Participants mentioned that the program was interesting
(“Great experience! It was interesting overall”), beneficial (“There were days when I was upset
and could feel that my blood pressure was elevated, but I no longer felt that way after my walk”),
enjoyable (“I enjoyed it so much, even [though] sometimes very cold”), sustainable (“I liked the
environment and plan to return to the garden to walk after the program ends”), and fulfilled their
needs to reduce stress (“The program was very calming and very beneficial for me to relieve
stress”). Although mindfulness training was not explicitly addressed during the whole program,
several participants described feelings similar to what they had experienced during prior
meditation or yoga practice (“I found that slowing down my steps allowed relaxation, it’s almost
a meditation feeling”; “Helped me be more aware of myself and my surroundings, invigorating
somewhat like yoga”). Interestingly, some participants also mentioned that walking at the
arboretum helped them sustain physical activity or increase their intention for walking (“This
program increased my interest in walking in the arboretum periodically”). Some participants
raised concerns about the unpleasant weather while partaking this outdoor program in winter.
One participant reported not being able to concentrate on the mindfulness task and another
questioned whether the response scale on the survey could capture their mental experience.
109
Discussion
This study evaluated the feasibility, acceptability, and sustainability of an outdoor
mindful walking program for reducing negative affect among older adults from the community.
Prior work suggested that the combination of walking and mindfulness could be a promising
mind-body intervention for reducing negative affect in a few clinical and adult populations, but
this combination had not previously been implemented with non-clinical samples of older adults.
This population could benefit from the intervention because negative affective responses such as
depressive symptoms are critical predictors of overall health and well-being among the elderly.
Experiencing higher levels of depressive symptoms are related to higher rates of dementia,
physical illness, functional disability, and greater expenditure of health cost and resources in the
aging population (Federal Interagency Forum on Aging-Related Statistics, 2016). Consistent
with hypotheses, results indicated that (1) it was feasible to implement an outdoor mindful
walking program with older adults, (2) the target population found the program to be acceptable,
and (3) even a brief supervised program could lead to sustained behavior change one-month after
the end of the program.
The mindful walking program implemented in this study differed from previous mindful
walking interventions in important ways. First, previous studies have implemented mindful
walking in group settings where participants had opportunities to converse or interact with each
other while walking (Gotink et al., 2016; Prakhinkit et al., 2013; Shin et al., 2013; Teut et al.,
2013). This group approach provides social distractions and may interfere with mindfulness
practices that require heightened attention. In contrast, the slow walking program implemented
here minimized social interaction and emphasized individual walking to facilitate focus during
110
the mindfulness practices. Second, participants in previous outdoor mindful walking studies
typically walked in unfamiliar environments (e.g., forest, riverside), whereas the present study
used a consistent spatial context (Gotink et al., 2016; Shin et al., 2013). This consistency may
have facilitated situational mindfulness by reducing the attentional resources required while
walking. Third, previous interventions sometimes contained extra mindfulness or physical
activity components such as sitting meditation or gymnastic exercises (Gotink et al., 2016; Teut
et al., 2013). In contrast, the mindful walking program implemented here only included the
essential mindfulness practices to simplify the intervention design.
The high enrollment rate (85%) indicated that a slow walking program was appealing to
older adults and it is feasible to enroll older adults from the community. This rate may have been
impacted by the timing of recruitment to coincide with the approach of winter. Even better
recruitment rates might have been obtained if the program was advertised during a warmer
season. Despite the relatively cold weather, participants completed a large proportion of the
possible measures (95%), and 93% of the participants completed all study measures, lab visits,
and eight walking sessions as scheduled. The enrollment rate in our study was higher than two
previous mindful walking studies also reported the screening process. Studies from Teut et al.
(2013) and Gotink et al. (2016) had a 44% and 65% enrollment rate, respectively. Both studies
had similar sample sizes in mindful walking group (36 and 32 participants) as the current study.
The program completion rate in the current study was similar to previous mindful walking
studies which ranged from 85% to 92%. This consistent finding suggested that most participants
in mindful walking programs are able to comply and finish all study protocols, despite the
different designs and target populations. The high measurement completion and attendance rates
in this study further indicated that older adults in the community were committed and dedicated
111
to the program. The current mindful walking program can be delivered as intended to older
population.
Based on the post-program questionnaire, participants evaluated the program positively.
The majority of them rated this program as highly satisfactory, useful, and interesting. Most
participants also indicated that they would recommend the program to others. The written
feedback from the participants were also largely positive. Some participants reflected that this
program met their needs for relieving stress, and others mentioned that the slow walking
practices in the current study were easy to perform and were similar to yoga or meditation
training. These comments were noteworthy because mindfulness was not mentioned when
advertising the current study. A few participants commented that the program motivated them to
sustain their physical activity level and walking habits. Future studies should investigate whether
a mindful walking program can support intentions to be active or help older adults to develop
walking habits. Feedback also indicated that the arboretum was an optimal and safe place to
administer the walking program. Several participants raised concerns about doing mindful
walking in adverse weather conditions, but ultimately no study-related adverse events were
reported in the current study. Two prior studies had participants doing mindful walking on
indoor oval tracks, however, there were no feedback reported from both studies, so we are not
aware of whether participants have similar perceptions while walking indoors versus outdoors
(Prakhinkit et al., 2013; Shin et al., 2013).
Participants reported a moderate-to-high level of maintenance one-month after
completing their last supervised mindful walking session. This rate greatly exceeded the prior
two-month estimate of 14% from Teut et al. (2013). This difference may reflect differences in
either the follow-up intervals, the populations sampled, or the program components. For
112
example, Teut et al. (2013) recruited participants age between 18 to 65 who usually had not yet
retired, whereas participants in this study were all retired older adults. Time constraints related to
daily work schedules may be a barrier to maintaining mindful walking. Moreover, study from
Teut et al. (2013) also required participants to complete gymnastic exercises before and after the
mindful walking, whereas our program only required participants to walk slower while
practicing mindfulness. The extra component and burden required in that mindful walking
program may be another determinant of maintenance.
The study was not designed (or powered) to evaluate efficacy but preliminary analyses
indicated that participants who increased their situational mindfulness during walks also
decreased their negative affect. This result was consistent with previous mindfulness-based
walking programs showing significant reductions of negative affect after the walking sessions
among more distressed participants (Gotink et al., 2016; McCaffrey & Liehr, 2015; Prakhinkit et
al., 2013; Shin et al., 2013; Teut et al., 2013). It was also consistent with a previous mindfulness
study targeting older adults (Splevins et al., 2009). The present study concluded that an outdoor
mindful walking program was feasible, acceptable and sustainable. Due to the lack of a
comparison group in the present study, it was not possible to rule out factors from the program or
the environment that could account for the favorable changes (Duvall, 2011; Sternberg, 2010;
TKF Foundation, 2012). Future research should incorporate carefully-selected control groups
and assign participants to different conditions randomly to strengthen causal inferences about
intervention effects.
In contrast to prior studies, participants in this sample were not selected for high levels of
distress or negative affect. Participants in this study were mostly white, female, well-educated,
healthy, high-functioning, and had middle-to-high social economic status from a restricted
113
geographic area. It is not clear whether participants from other sub-populations would accept,
complete, or sustain the mindful walking program implemented in this study as well. Future
studies should recruit more diverse samples in broader geographical regions. On a related note,
arthritis symptoms are common among older adults (Hootman, Helmick, Barbour, Theis, &
Boring, 2016). These symptoms are closely related to changes in barometric pressure and
ambient temperature (McAlindon, Formica, Schmid, & Fletcher, 2007). Walking outdoors
during winter may intensify painful feelings from arthritis, and impact participants’ affective
responses after walking. If future studies are conducted in similar conditions, it would be useful
to collect information on arthritis symptoms, subjective pain, and real-feel temperature during
each session.
The intervention dose in this study was informed by previous mindful walking programs
(Prakhinkit et al., 2013; Teut et al., 2013). There are no consensus guidelines in terms of the
frequency, duration, or other essential elements of an outdoor mindful walking program.
Findings may differ with different doses of mindful walking. We included only three basic
mindfulness techniques (focusing on breaths, steps and body scan) that were easy to learn if
participants were naïve in mindfulness practices. More advanced strategies could be
implemented in a mindful walking program and the results may differ. For instance, some
mindful walking practices encourage participants to direct their attention to the environment
(e.g., the smell, sounds, breeze, sun light), use a phrase with the appropriate number of syllables
to pace their breathing or stepping, modify inspiratory and expiratory rhythm as a function of
step length, or pay attention on multiple objects simultaneously (Hanh, 1985, 2011; Insight
Meditation Center, 2003). The program implemented in this study involved focusing narrowly on
one object at a time and did not challenge participants to broaden their attention field. The
114
majority of the participants were female older adults and previous work has shown stronger
associations between light physical activity and well-being for women than men (Conroy, Wolin,
Blair, & Demark-Wahnefried, in press). It will be important to test potential sex differences in
intervention responses in future research. Finally, it was clear whether participants engaged in
extra mindful walking practice in their leisure time. Any differential changes could be due to any
additional practice they completed. Future studies should monitor activities outside of the
supervised sessions.
Conclusion
In sum, this study indicated that participants accepted and complied with the outdoor
mindful walking program. Many also sustained their engagement in mindful walking one-month
after the supervised sessions ended. This program was implemented as planned with older adults
and shows promise for helping them to regulate negative affect. The design of this study
precludes causal inferences about intervention effects but, based on the evidence for feasibility, it
would be appropriate to design and deliver a randomized controlled trial to evaluate efficacy.
115
References
Ader, D. N. (2007). Developing the patient-reported outcomes measurement information system
(PROMIS): deression, anxiety, and anger. Medical Care, 45(Suppl 1), S1–S2.
https://doi.org/10.1097/01.mlr.0000260537.45076.74
Aggarwal, N. T., Wilson, R. S., Beck, T. L., Rajan, K. B., Mendes de Leon, C. F., Evans, D. A.,
& Everson-Rose, S. A. (2014). Perceived stress and change in cognitive function among
adults aged 65 and older. Psychosomatic Medicine, 76(1), 80–85.
https://doi.org/10.1097/PSY.0000000000000016
Black, S. V., Cooper, R., Martin, K. R., Brage, S., Kuh, D., & Stafford, M. (2015). Physical
activity and mental well-being in a cohort aged 60–64 years. American Journal of
Preventive Medicine, 49(2), 172–180. https://doi.org/10.1016/j.amepre.2015.03.009
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in
psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.
https://doi.org/10.1037/0022-3514.84.4.822
Bryant, C., Jackson, H., & Ames, D. (2008). The prevalence of anxiety in older adults:
Methodological issues and a review of the literature. Journal of Affective Disorders,
109(3), 233–250. https://doi.org/10.1016/j.jad.2007.11.008
Buman, M. P., Hekler, E. B., Haskell, W. L., Pruitt, L., Conway, T. L., Cain, K. L., … King, A.
C. (2010). Objective light-intensity physical activity associations with rated health in
older adults. American Journal of Epidemiology, 172(10), 1155–1165.
https://doi.org/10.1093/aje/kwq249
116
CDC. (2008). The State of Mental Health and Aging in America Issue Brief 1: What Do the Data
Tell Us? National Association of Chronic Disease Directors. Atlanta, GA. Retrieved from
https://www.cdc.gov/aging/pdf/mental_health.pdf
Conroy, D. E., Wolin K.Y., Blair C.K., & Demark-Wahnefried W. (in press). Gender-varying
associations between physical activity intensity and mental quality of life in older cancer
survivors. Supportive Care in Cancer.
Davidson, R. J., & Kaszniak, A. W. (2015). Conceptual and methodological issues in research on
mindfulness and meditation. American Psychologist, 70(7), 581–592.
https://doi.org/10.1037/a0039512
Duvall, J. (2011). Enhancing the benefits of outdoor walking with cognitive engagement
strategies. Journal of Environmental Psychology, 31(1), 27–35.
https://doi.org/10.1016/j.jenvp.2010.09.003
Eisinga, R., Grotenhuis, M. te, & Pelzer, B. (2013). The reliability of a two-item scale: Pearson,
Cronbach, or Spearman-Brown? International Journal of Public Health, 58(4), 637–642.
https://doi.org/10.1007/s00038-012-0416-3
Farias, S. T., Mungas, D., Reed, B. R., Cahn-Weiner, D., Jagust, W., Baynes, K., & DeCarli, C.
(2008). The measurement of everyday cognition (ECog): Scale development and
psychometric properties. Neuropsychology, 22(4), 531–544.
https://doi.org/10.1037/0894-4105.22.4.531
Federal Interagency Forum on Aging-Related Statistics. (2016). Older Americans 2016: Key
indicators of well-being. The Federal Interagency Forum on Aging-Related Statistics.
Fjorback, L. O., Arendt, M., Ø rnbøl, E., Fink, P., & Walach, H. (2011). Mindfulness-Based
Stress Reduction and Mindfulness-Based Cognitive Therapy – a systematic review of
117
randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102–119.
https://doi.org/10.1111/j.1600-0447.2011.01704.x
Foulk, M. A., Ingersoll-Dayton, B., Kavanagh, J., Robinson, E., & Kales, H. C. (2014).
Mindfulness-Based Cognitive Therapy with older adults: An exploratory study. Journal
of Gerontological Social Work, 57(5), 498–520.
https://doi.org/10.1080/01634372.2013.869787
Gerteis J. Izrael D. Deitz D. LeRoy L. Ricciardi R. Miller T. & Basu J. (2014). Multiple Chronic
Conditions Chartbook. Rockville, MD: Agency for Healthcare Research and Quality.
Retrieved from
https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-
care/decision/mcc/mccchartbook.pdf
Gotink, R. A., Chu, P., Busschbach, J. J. V., Benson, H., Fricchione, G. L., & Hunink, M. G. M.
(2015). Standardised mindfulness-based interventions in healthcare: An overview of
systematic reviews and meta-analyses of RCTs. PLOS ONE, 10(4), e0124344.
https://doi.org/10.1371/journal.pone.0124344
Gotink, R. A., Hermans, K. S. F. M., Geschwind, N., Nooij, R. D., Groot, W. T. D., & Speckens,
A. E. M. (2016). Mindfulness and mood stimulate each other in an upward spiral: A
mindful walking intervention using experience sampling. Mindfulness, 7(5), 1114–1122.
https://doi.org/10.1007/s12671-016-0550-8
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive
therapy and mindfulness-based stress reduction improve mental health and wellbeing? A
systematic review and meta-analysis of mediation studies. Clinical Psychology Review,
37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006
118
Hanh, T. N. (1985). A Guide to Walking Meditation. Nyack, NY: Fellowship Publications.
Hanh, T. N. (2011). The Long Road Turns to Joy: A Guide to Walking Meditation. Berkeley:
Parallax Press.
Harmell, A. L., Jeste, D., & Depp, C. (2014). Strategies for successful aging: A research update.
Current Psychiatry Reports, 16(10), 1–6. https://doi.org/10.1007/s11920-014-0476-6
Hootman, J. M., Helmick, C. G., Barbour, K. E., Theis, K. A., & Boring, M. A. (2016). Updated
projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable
activity limitation among US adults, 2015-2040. Arthritis & Rheumatology, 68(7), 1582–
1587. https://doi.org/10.1002/art.39692
Insight Meditation Center. (2003). Instructions for Walking Meditation. Retrieved from
http://www.insightmeditationcenter.org/books-articles/articles/instructions-for-walking-
meditation/
Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday
Life. New York: Hyperion.
Kabat-Zinn, J., & Borysenko, J. Z. (1996). Full Catastrophe Living: How to Cope with Stress,
Pain and Illness Using Mindfulness Meditation. London: Piatkus Books.
Kabat-Zinn, J., & Hanh, T. N. (2009). Full Catastrophe Living: Using the Wisdom of Your Body
and Mind to Face Stress, Pain, and Illness. New York: Random House.
Kishita, N., Takei, Y., & Stewart, I. (2016). A meta-analysis of third wave mindfulness-based
cognitive behavioral therapies for older people. International Journal of Geriatric
Psychiatry. https://doi.org/10.1002/gps.4621
La Forge, R. (2016). Mind-body (mindful) exercise in practice. ACSM’s Health & Fitness
Journal, 20(4), 6–8.
119
Loprinzi, P. D., Lee, H., & Cardinal, B. J. (2015). Evidence to support including lifestyle light-
intensity recommendations in Physical Activity Guidelines for Older Adults. American
Journal of Health Promotion, 29(5), 277–284. https://doi.org/10.4278/ajhp.130709-
QUAN-354
McAlindon, T., Formica, M., Schmid, C. H., & Fletcher, J. (2007). Changes in barometric
pressure and ambient temperature influence osteoarthritis pain. The American Journal of
Medicine, 120(5), 429–434. https://doi.org/10.1016/j.amjmed.2006.07.036
McCaffrey, R., & Liehr, P. (2015). The effect of reflective garden walking on adults with
increased levels of psychological stress. Journal of Holistic Nursing, 898010115594934.
https://doi.org/10.1177/0898010115594934
McLaughlin, S. J., Connell, C. M., Heeringa, S. G., Li, L. W., & Roberts, J. S. (2010).
Successful aging in the United States: Prevalence estimates from a national sample of
older adults. The Journals of Gerontology: Series B, 65B(2), 216–226.
https://doi.org/10.1093/geronb/gbp101
Morgan, D. (2003). Mindfulness-based cognitive therapy for depression: A new approach to
preventing relapse. Psychotherapy Research, 13(1), 123–125.
https://doi.org/10.1080/713869628
Morone, N. E., & Greco, C. M. (2014). Adapting mindfulness meditation for the older adult.
Mindfulness, 5(5), 610–612. https://doi.org/10.1007/s12671-014-0297-z
Nakagawa, S., & Schielzeth, H. (2013). A general and simple method for obtaining R 2 from
generalized linear mixed-effects models. Methods in Ecology and Evolution, 4(2), 133–
142. https://doi.org/10.1111/j.2041-210x.2012.00261.x
120
National Council on Aging. (2015). Facts About Chronic Disease Management. Retrieved May
23, 2017, from https://www.ncoa.org/news/resources-for-reporters/get-the-facts/chronic-
disease-facts/
Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., …
Castaneda-Sceppa, C. (2007). Physical activity and public health in older adults.
Recommendation from the American College of Sports Medicine and the American
Heart Association. Circulation.
https://doi.org/10.1161/CIRCULATIONAHA.107.185650
Netz, Y., Wu, M.-J., Becker, B. J., & Tenenbaum, G. (2005). Physical Activity and
psychological well-being in advanced age: A meta-analysis of intervention studies.
Psychology and Aging, 20(2), 272–284. https://doi.org/10.1037/0882-7974.20.2.272
Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., & Cella, D. (2011). Item
banks for measuring emotional distress from the Patient-Reported Outcomes
Measurement Information System (PROMIS® ): Depression, anxiety, and anger.
Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667
Prakhinkit, S., Suppapitiporn, S., Tanaka, H., & Suksom, D. (2013). Effects of Buddhism
walking meditation on depression, functional fitness, and endothelium-dependent
vasodilation in depressed elderly. The Journal of Alternative and Complementary
Medicine, 20(5), 411–416. https://doi.org/10.1089/acm.2013.0205
Rebar, A. L., Stanton, R., Geard, D., Short, C., Duncan, M. J., & Vandelanotte, C. (2015). A
meta-meta-analysis of the effect of physical activity on depression and anxiety in non-
clinical adult populations. Health Psychology Review, 9(3), 366–378.
https://doi.org/10.1080/17437199.2015.1022901
121
Rosenbaum, S., Tiedemann, A., Sherrington, C., Curtis, J., & Ward, P. B. (2014). Physical
activity interventions for people with mental illness: a systematic review and meta-
analysis. The Journal of Clinical Psychiatry, 75(9), 964–974.
https://doi.org/10.4088/JCP.13r08765
Russell, T. (2011). Body in mind training: mindful movement for severe and enduring mental
illness. Br. J. Wellbeing, 2(3), 13–16.
Shin, Y.-K., Kim, D. J., Jung-Choi, K., Son, Y., Koo, J.-W., Min, J.-A., & Chae, J.-H. (2013).
Differences of psychological effects between meditative and athletic walking in a forest
and gymnasium. Scandinavian Journal of Forest Research, 28(1), 64–72.
https://doi.org/10.1080/02827581.2012.706634
Splevins, K., Smith, A., & Simpson, J. (2009). Do improvements in emotional distress correlate
with becoming more mindful? A study of older adults. Aging & Mental Health, 13(3),
328–335. https://doi.org/10.1080/13607860802459807
Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. A. J., & Otto, M. W. (2006). Exercise
interventions for mental health: A quantitative and qualitative review. Clinical
Psychology: Science and Practice, 13(2), 179–193. https://doi.org/10.1111/j.1468-
2850.2006.00021.x
Steenbergen, M. R., & Jones, B. S. (2002). Modeling Multilevel Data Structures. American
Journal of Political Science, 46(1), 218–237. https://doi.org/10.2307/3088424
Steptoe, A., Deaton, A., & Stone, A. A. (2015). Psychological wellbeing, health and ageing.
Lancet, 385(9968), 640–648. https://doi.org/10.1016/S0140-6736(13)61489-0
Sternberg, E. M. (2010). Healing Spaces: The Science of Place and Well-Being. Cambridge,
MA; London: Belknap Press of Harvard University Press.
122
Stokes, S. A., & Gordon, S. E. (2003). Common stressors experienced by the well elderly:
Clinical implications. Journal of Gerontological Nursing; Thorofare, 29(5), 38–46.
Stults-Kolehmainen, M. A., & Sinha, R. (2013). The effects of stress on physical activity and
exercise. Sports Medicine, 44(1), 81–121. https://doi.org/10.1007/s40279-013-0090-5
Tanay, G., & Bernstein, A. (2013). State Mindfulness Scale (SMS): Development and initial
validation. Psychological Assessment, 25(4), 1286–1299.
https://doi.org/10.1037/a0034044
Teut, M., Roesner, E. J., Ortiz, M., Reese, F., Binting, S., Roll, S., … Brinkhaus, B. (2013).
Mindful walking in psychologically distressed individuals: A randomized controlled trial.
Evidence-Based Complementary and Alternative Medicine, 2013, e489856.
https://doi.org/10.1155/2013/489856
TKF Foundation. (2012). Research on the beneficial aspects of the experience of nature in cities:
A literature review. Retrieved from http://your.kingcounty.gov/dnrp/library/water-and-
land/land-conservation/meeting-09-29-2016/benefits-of-nature-in-cities-lit-review-02-
12.pdf
Tsang, H. W. H., Chan, E. P., & Cheung, W. M. (2008). Effects of mindful and non-mindful
exercises on people with depression: A systematic review. British Journal of Clinical
Psychology, 47(3), 303–322. https://doi.org/10.1348/014466508X279260
WHO. (2017). Mental health and older adults. Retrieved from
http://www.who.int/mediacentre/factsheets/fs381/en/
Young, L. A., & Baime, M. J. (2010). Mindfulness-based stress reduction: Effect on emotional
distress in older adults. Complementary Health Practice Review, 15(2), 59–64.
https://doi.org/10.1177/1533210110387687
123
Figure Caption
Figure 4.1. CONSORT flow diagram of mindful walking program.
124
Assessed for eligibility (n= 34)
Assessed for eligibility (n= 34)
Excluded (n= 5)
Not meeting inclusion criteria (n=1)
Declined to participate (n=3)
Other reason – Injured before the initial
lab visit (n=1)
Date Analysed (n= 27)
Attending initial lab visit (n= 29)
Completed baseline assessment (n= 29)
Started walking program (n=29)
Attending initial lab visit (n= 29)
Completed baseline assessment (n= 29)
Started walking program (n=29)
Completed program and post assessment
(n= 27)
Completed program and post assessment
(n= 27)
Intervention
Analysis
Analysis
End of Program
End of Program
Enrollment
Enrollment
Dropped out (n= 2)
Injured from leisure activity
participation (n=1)
Incapability of self-navigating (n=1)
Lost to follow-up (n=1)
Lost contact
Follow-Up
Follow-Up
Follow-up Date Analysed (n= 26)
)
Completed one-month follow-up (n= 26)
Completed one-month follow-up (n= 26)
Analysis
Analysis
125
Table 4.1. Overview of the eight walking sessions in the mindful walking program
Session Mindful
walking
Slow
walking
Mindfulness task and duration
1 0 minutes 30 minutes No mindfulness task. Participants familiarized
themselves with the arboretum trail and practice slow
walking individually.
2 5 minutes 25 minutes Walking slowly while sustaining their attention on the
rhythm of their every breath.
3 10 minutes 20 minutes Walking slowly while sustaining their attention on the
rhythm of their every breath.
4 10 minutes 20 minutes Same as session 3
5 20 minutes 10 minutes First 10 minutes: walking slowly while sustaining their
attention on the rhythm of their every breath.
Second 10 minutes: awareness of the gentle heel-to-toe
rhythm for each step they make.
6 20 minutes 10 minutes Same as session 5
7 30 minutes 0 minutes First 10 minutes: walking slowly while sustaining their
attention on the rhythm of their every breath.
Second 10 minutes: awareness of the gentle heel-to-toe
rhythm for each step they make.
Last 10 minutes: full body scan to expand their attention
to any bodily sensation or emotional feelings that may
arise.
8 30 minutes 0 minutes Same as session 7
126
Table 4.2. Contexts of the mindful walking sessions
N (%)
Month
October 4 (2%)
November 158 (71%)
December 60 (27%)
Day of the week
Monday 40 (18%)
Tuesday 51 (23%)
Wednesday 40 (18%)
Thursday 21 (10%)
Friday 39 (17%)
Saturday 18 (8%)
Sunday 13 (6%)
Time of the day
9am-11am 67 (30%)
11am-1pm 106 (48%)
1pm-3pm 31 (14%)
3pm-5pm 18 (8%)
Daily average temperature
15-32°F 41 (18%)
32-45°F 97 (44%)
46-60°F 84 (38%)
Prevailing Weather Condition
Sunny 56 (25%)
Fair, partly or mostly cloudy 82 (37%)
Cloudy and wind 62 (28%)
Rain shower or rain snow 11 (5%)
Snow or hailing 11 (5%)
127
Table 4.3. Correlation coefficient matrix of the pre-post walking session variables. M
(SD)
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
1. Age 73.2
(6.47) 1
2. Gender - -0.04 1
3. Sequence of
walking session - -0.01 -0.03 1
4. Day of the week - 0.02 0.02 0.04 1
5. Average
Temperature (°F)
40.6
(8.36) 0.10 0.07 -0.36** 0.01 1
6. Survey time
(hour)
11.78
(1.57) 0.03 0.01 -0.05 -0.28** 0.08 1
7. Sleep quality 5.40
(1.38) -0.11 0.05 0.04 0.08 -0.02 -0.06 1
8. Baseline
Attention
4.98
(0.78) 0.11 -0.06 -0.01 0.02 -0.01 0.16* 0.19** 1
9. Pre-session
negative affect
8.22
(4.49) 0.05 -0.13* 0.05 -0.01 -0.07 -0.06 -0.17* -0.29** 1
10. Post-session
negative affect
5.78
(3.29) 0.04 0.01 0.01 0.01 -0.09 -0.04 -0.17* -0.33** 0.60** 1
11. Pre-session
mindful level
9.46
(2.23) 0.03 -0.21** 0.19** -0.03 0.01 0.06 0.02 0.10 0.13 0.02 1
12. Post-session
mindful level
10.52
(2.08) -0.09 -0.17** 0.14* -0.03 -0.01 -0.08 0.17* 0.01 0.01 -0.17* 0.54** 1
Note: *p< .05; **p<.01; N=222.
128
Table 4.4. Result of multilevel model examining associations between mindfulness level and
negative affective reactivity
Model Coefficient SE
Fixed Effect
(Intercept) 6.69 4.39
Age -0.02 0.04
Gender
0.55 0.72
Number of walking session 0.08 0.09
Day of the week -0.01 0.09
Average temperature -0.03 0.02
Baseline attention -0.60 0.38
Survey time 0.07 0.12
Previous day sleep quality -0.20 0.14
Average pre-walking negative affect 0.55** 0.09
Deviations from average negative affect 0.22** 0.05
Average mindfulness change (pre-walk to post-walk) -0.31 0.24
Deviations from average mindfulness change
(pre-walk to post-walk)
-0.27** 0.09
Random Effect
Variance Intercept 1.35
Residual Variance 4.41
Note: Analysis was based on 7 walking sessions with mindfulness practice incorporated.
*p < .05; **p < .01.
129
Chapter 5: Conclusions
130
This dissertation investigated relations between physical activity and mindfulness to
understand how their interaction influenced well-being in college students and older adults.
Findings from this dissertation can be applied to inform future research on mindfulness and
physical activity, as well as to guide the development of mind-body approaches to improve
health and well-being. Specific contributions of this work are reviewed below.
This dissertation provided the first systematic review on the association between physical
activity and mindfulness. Previous reviews have briefly synthesized the salutary impact of
mindfulness on cardiovascular disease risk, physical and mental health and provided several
supporting studies (Gilbert & Waltz, 2010; Kennedy & Resnick, 2015; Loucks et al., 2015).
These reviews provided evidence on the positive relation between physical activity and
mindfulness but did not investigate the strength of the relation based on all available quantitative
studies. This dissertation presented current evidence of physical activity-mindfulness association
through a systematic literature search of quantitative studies in major academic databases. After
screening over 1500 articles, 13 studies generally supported the conclusion that physical activity
level is positively related to people’s mindfulness level, but there was a lack of evidence from
experimental studies. Future research should be devoted to conduct more quantitative studies
including randomized controlled trials to provide stronger evidence on how mindfulness may
impact individual’s physical activity level.
This review also identified critical gaps in the literature that may hinder the advance of
studying the role of mindfulness in physical activity. Mindfulness is a mental construct that
involves both between-person and within-person variation (Bishop et al., 2004; Brown & Ryan,
2003). Current studies exclusively focused on people’s trait mindfulness level and failed to
consider the variability of people’s mindfulness levels that are context- and situational-
131
dependent. Without highlighting the trait and state differences, we are not able to obtain accurate
and precise understanding of the association between physical activity and mindfulness. The
proposed three-level hierarchical framework is a specific contribution of this work. This model
differentiates between global, contextual, and situational forms of mindfulness based on the
contextual and temporal specificity of the phenomenon. To enhance communication and advance
knowledge in the field, future studies should study the association between physical activity and
the contextual or situational mindfulness. Measures are needed to assess contextual and
situational levels of mindfulness. These developments will facilitate research on within-person
associations between mindfulness, physical activity, and health and well-being outcomes.
This dissertation also revealed the within-person association between daily activity
(posture) and mindfulness in predicting negative affect among college students. Previous
experience sampling studies reported mixed findings regarding the impact of daily physical
activity level in predicting subsequent negative affect. Some studies suggested an inverse
association whereas others found no significant results between the two variables (Liao,
Shonkoff, & Dunton, 2015). This dissertation expended previous work by exploring the role of
mindfulness during physical activity and its association with negative affect. A clear inverse
relation between daily activity and negative affect was observed and different levels of
situational mindfulness may moderate momentary activity (posture) in predicting negative affect
in college students. Students with higher situational mindfulness while moving or standing
(compared to sitting) experienced greater reductions in negative affect in their daily life. This
finding indicated that interventions may lead to greater mental health benefits by integrating
mindfulness practices with physical activity.
132
Additionally, the research in this dissertation established a negative association between
daily postures and negative affective states. Relative to being sedentary, when college students
move or stand more in their daily life, they reported lower levels of negative affect. The physical
activity literature thus far has documented the effect of moderate to vigorous physical activity on
well-being and mental health (Ensari, Greenlee, Motl, & Petruzzello, 2015; Penedo & Dahn,
2005; Rebar et al., 2015). The preliminary effect of low-intensity physical activity on physical
health has also been investigated in recent years (Bann et al., 2015; Carson et al., 2013; Herzig et
al., 2014). This dissertation provided extra contribution to the physical activity literature by
showing that low-intensity daily activities were positively related to college student’s
psychological well-being. Most importantly, a useful public health message can be implied from
this result was that simply by moving or standing more and not sitting in everyday life may
reduce negative affect and thus improve well-being in the college population.
The final study in this dissertation evaluated the feasibility of implementing a mind-body
intervention program based on the premise that combining physical activity and situational
mindfulness may decrease negative affect among older adults. In this mindful walking program,
an integration of mindfulness practice with walking activity was delivered to older adults to
evaluate its feasibility, acceptability, and sustainability in reducing negative affect. This
feasibility study was initiated because none of the mindful walking programs to date have
targeted psychological well-being in the non-clinical older adult populations. The major
hypothesis that an outdoor mindful walking program was well-accepted, engaged, and
maintained were later supported by both the self-report ratings and the written feedback from
older adults. The secondary hypothesis that mindful walking program could show preliminary
133
efficacy in decreasing older adults’ negative affect was also suggested by the analysis from the
repeated measures across mindful walking sessions.
Finally, this dissertation demonstrated that this mind-body intervention with eight 30-
minutes mindful walking within one month is feasible to deliver to healthy, community-dwelling
older adults. Based on the positive results of program feasibility, future experimental studies
should be developed and executed to test the effect of mindful walking in improving well-being
and healthy aging in the older population. Randomized controlled trials with different control
arms are also needed to disentangle the relative effectiveness of mindful walking intervention
with other individual or environmental factors. For example, outdoor physical activities have
been reported to impact negative affective response greater than indoor physical activities
(Dunton, Liao, Intille, Huh, & Leventhal, 2015). Different control arms such as sitting
meditation, indoor mindful walking, and walking with cognitive training may help to further
elaborate whether different types of mindful activity, or different mindful walking environments,
or different forms of mental task engaged during walking may play relatively critical roles in
explaining the beneficial psychological effect.
Limitations, Future Directions, and Conclusion
Although this dissertation achieved its scientific objectives, several limitations should be
noted to guide future research. First, the associations between mindfulness, physical activity, and
negative affect identified in this dissertation were based on self-report measures exclusively. The
systematic review reported in Chapter 2 did not identify any studies that applied objective
measures of mindfulness in relation to physical activity. In the experience sampling study
reported in Chapter 3, two items from a validated scale were used to assess situational
mindfulness. This ecological momentary assessment of mindfulness was recommended by
134
Davidson and Kaszniak (2015) to minimize retrospective bias from self-reporting mindfulness.
In the feasibility study reported in Chapter 4, the same two mindfulness items were included in
the pre-walk and post-walk surveys. Mindfulness has been conceptualized as both a
unidimensional and multidimensional phenomenon and there is no consensus on the necessary
components or the number of facets that should be included in a mindfulness scale. The validity
of assessing subjective mindfulness experience with self-report questionnaires is also under
discussion (Baer, 2016; Bergomi, Tschacher, & Kupper, 2012; Davidson, 2010; Goldberg et al.,
2015; Sauer et al., 2012). Physical activity researchers should strive to include objective
measures of mindfulness based on cognitive and attentional tasks, neuroimaging or
neuropsychological measures to strengthen conclusions about the association between physical
activity and mindfulness.
Similarly, physical activity measures have largely relied on self-report methods in this
literature. Only one study in our literature review provided accelerometry-based data on
participants’ physical activity level (Kangasniemi, Lappalainen, Kankaanpää, & Tammelin,
2014). Although our ecological momentary assessment on physical activity and postural patterns
exhibited similar results as population-based studies, future studies should consider device-based
measures of physical activity when studying the within-person relation between physical activity
and subjective experiences (Kanning, Ebner-Priemer, & Schlicht, 2013).
The subjective negative affect assessed in the studies reported in Chapters 3 and 4
involved stress, anxiety, and depression. The common component of this selective set of negative
affective states involves a generalized sense of distress (Akin, 2007). There are in fact other
common aspects of negative affect (e.g., anger, fatigue, upset, disappointed) which have been
assessed in other studies (Kuppens, Van Mechelen, Nezlek, Dossche, & Timmermans, 2007;
135
Watson & Clark, 1999). Future studies should include different negative affective states in
mindfulness and physical activity research to investigate whether the results may differ when
different aspects of negative affect are assessed.
Second, the participants were relatively homogeneous in each of the empirical studies
reported here. The younger sample in Chapter 3 was mostly White, not Hispanic, and educated.
Findings may not generalize to college student samples from other geographical locations, to
people from more diverse racial and ethnic backgrounds, or to young adults who do not attend
college or university. Young adults without college experience likely encounter different stressors
in daily life and may have different affective patterns. Likewise, the older sample in Chapter 4
was mostly White, healthy, and affluent. Results may differ if the program is launched in an
urban area with a more diverse population, or in older adults with clinical issues. For example,
urban environments pose an extra threat on people’s well-being (Lederbogen et al., 2011;
Matheson et al., 2006). The limited green space and the crowded environment in the city also
may limit opportunities to implement this mindful walking program in urban environments.
Future research should target more diverse samples and test whether the beneficial outcomes
identified in this dissertation may vary as a function of demographic factors.
Third, this dissertation mainly focused on intrapersonal factors and did not assess many
other external factors that may also regulate negative affect. Data analyses adjusted for variation
associated with the temporal factors that may impact negative affect in college students, but did
not involve other interpersonal factors such as the presence of others (classmates, friends, or
family members), or contextual factors such as the location (classroom, dorm, or home) at the
time of daily prompts. These factors may influence or interact with students’ mindfulness and
physical activity in predicting negative affect. Temporal factors and environmental conditions
136
were also modeled in the feasibility study, however, unexpected life events can also influence
older adult’s affective states. For example, one participant acknowledged in her written feedback
that her mood seemed to be dampened by a major political event – the US presidential election –
that occurred during the study. Thus, the adoption of a more complete social-ecological
perspective in future studies could advance understanding of the interpersonal, intrapersonal and
external factors that regulate individual’s affective states (Evans, 2003; Lakhan & Ekúndayò,
2013).
Finally, the mindful walking program designed in this dissertation cultivated participants’
attention, awareness, acceptance, and non-judgmental attitudes to their mental or physical
experiences. These techniques are basic and fundamental mindfulness practices (Hart, Ivtzan, &
Hart, 2013), however, other mindfulness components such as curiosity, empathy, and compassion
have also been applied in mindfulness programs and were not included in this study (Birnie,
Speca, & Carlson, 2010; Greeson, 2009; Langer, 1992). Mindfulness interventions emphasizing
self-compassion have previously shown promise for regulating negative affect (Van Dam,
Sheppard, Forsyth, & Earleywine, 2011). It would be interesting to examine whether mindful
walking programs consisting of different mindfulness components yield similar findings in
future studies. Experimental studies can also can be conducted to explore the relative impact of
different mindfulness components in reducing negative affect.
People face a variety of stressors across adulthood and stress can detract from health and
well-being. There is great interest in mind-body approaches to promote health and well-being
and both physical activity and mindfulness represent promising strategies. This dissertation
enriched understanding of how physical activity and mindfulness can be used to promote well-
being. The proposed three-level framework of mindfulness can be used to direct future studies
137
and advance understanding of relations between mindfulness and physical activity. This
dissertation further investigated the interplay between physical activity and mindfulness in
reducing negative affect. Knowing that negative affect may decrease to a greater degree by being
more active and mindful momentarily provides a foundation for designing just-in-time
interventions to improve well-being in our everyday life. Furthermore, the potential impact of
non-exercise-related bodily postures on negative affect converges with assertions that, “some
activity is better than none” (Physical Activity Guidelines Advisory Committee, 2008). Finally,
this dissertation demonstrated that an outdoor mindful walking program can be delivered to
community-dwelling older adults. The ease of combining mindful practice with daily walks, and
the minimal fitness level required for mindful walking makes it a viable preventative strategy for
improving well-being and promoting healthy aging in older adults. The efficacy of this program
for reducing negative affect and improving other indicators of health and well-being remains to
be determined and should be a logical next step in this rapidly-developing literature on mind-
body approaches to improve health and well-being.
138
References
Akin, A. (2007). The Depression Anxiety and Stress Scale (DASS): The study of validity and
reliability.
Baer, R. (2016). Assessment of mindfulness and closely related constructs: Introduction to the
special issue. Psychological Assessment, 28(7), 787–790.
https://doi.org/10.1037/pas0000309
Bann, D., Hire, D., Manini, T., Cooper, R., Botoseneanu, A., McDermott, M. M., … for the LIFE
Study Group. (2015). Light intensity physical activity and sedentary behavior in relation
to body mass index and grip strength in older adults: Cross-sectional findings from the
Lifestyle Interventions and Independence for Elders (LIFE) study. PLoS ONE, 10(2),
e0116058. https://doi.org/10.1371/journal.pone.0116058
Bergomi, C., Tschacher, W., & Kupper, Z. (2012). The assessment of mindfulness with self-
report measures: Existing scales and open issues. Mindfulness, 4(3), 191–202.
https://doi.org/10.1007/s12671-012-0110-9
Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-compassion and empathy in the
context of mindfulness-based stress reduction (MBSR). Stress and Health, 26(5), 359–
371. https://doi.org/10.1002/smi.1305
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., … Devins, G.
(2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science
and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in
psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.
https://doi.org/10.1037/0022-3514.84.4.822
139
Carson, V., Ridgers, N. D., Howard, B. J., Winkler, E. A. H., Healy, G. N., Owen, N., … Salmon,
J. (2013). Light-intensity physical activity and cardiometabolic biomarkers in US
adolescents. PLoS ONE, 8(8), e71417. https://doi.org/10.1371/journal.pone.0071417
Davidson, R. J. (2010). Empirical explorations of mindfulness: Conceptual and methodological
conundrums. Emotion, 10(1), 8–11. https://doi.org/10.1037/a0018480
Davidson, R. J., & Kaszniak, A. W. (2015). Conceptual and methodological issues in research on
mindfulness and meditation. American Psychologist, 70(7), 581–592.
https://doi.org/10.1037/a0039512
Dunton, G. F., Liao, Y., Intille, S., Huh, J., & Leventhal, A. (2015). Momentary assessment of
contextual influences on affective response during physical activity. Health Psychology:
Official Journal of the Division of Health Psychology, American Psychological
Association, 34(12), 1145–1153. https://doi.org/10.1037/hea0000223
Ensari, I., Greenlee, T. A., Motl, R. W., & Petruzzello, S. J. (2015). Meta-analysis of acute
exercise effects on state anxiety: An update of randomized controlled trials over the past
25 years. Depression and Anxiety, 32(8), 624–634. https://doi.org/10.1002/da.22370
Evans, G. (2003). The built environment and mental health. Journal of Urban Health, 80(4),
536–555. https://doi.org/10.1093/jurban/jtg063
Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4), 227–234.
https://doi.org/10.1007/s12671-010-0032-3
Goldberg, S. B., Wielgosz, J., Dahl, C., Schuyler, B., MacCoon, D. S., Rosenkranz, M., …
Davidson, R. J. (2015). Does the Five Facet Mindfulness Questionnaire measure what we
think it does? Construct validity evidence from an active controlled randomized clinical
trial. Psychological Assessment, 28(8), 1009-1014. https://doi.org/10.1037/pas0000233
140
Greeson, J. M. (2009). Mindfulness research update: 2008. Complementary Health Practice
Review, 14(1), 10–18. https://doi.org/10.1177/1533210108329862
Hart, R., Ivtzan, I., & Hart, D. (2013). Mind the gap in mindfulness research: A comparative
account of the leading schools of thought. Review of General Psychology, 17(4), 453–
466. https://doi.org/10.1037/a0035212
Herzig, K.-H., Ahola, R., Leppäluoto, J., Jokelainen, J., Jämsä, T., & Keinänen-Kiukaanniemi, S.
(2014). Light physical activity determined by a motion sensor decreases insulin
resistance, improves lipid homeostasis and reduces visceral fat in high-risk subjects:
PreDiabEx study RCT. International Journal of Obesity, 38(8), 1089–1096.
https://doi.org/10.1038/ijo.2013.224
Kangasniemi, A., Lappalainen, R., Kankaanpää, A., & Tammelin, T. (2014). Mindfulness skills,
psychological flexibility, and psychological symptoms among physically less active and
active adults. Mental Health and Physical Activity, 7(3), 121–127.
https://doi.org/10.1016/j.mhpa.2014.06.005
Kanning, M. K., Ebner-Priemer, U. W., & Schlicht, W. M. (2013). How to investigate within-
subject associations between physical activity and momentary affective states in everyday
life: A position statement based on a literature overview. Frontiers in Psychology, 4.
https://doi.org/10.3389/fpsyg.2013.00187
Kennedy, A. B., & Resnick, P. B. (2015). Mindfulness and physical activity. American Journal of
Lifestyle Medicine, 9(3), 221–223. https://doi.org/10.1177/1559827614564546
Kuppens, P., Van Mechelen, I., Nezlek, J. B., Dossche, D., & Timmermans, T. (2007). Individual
differences in core affect variability and their relationship to personality and
141
psychological adjustment. Emotion, 7(2), 262–274. https://doi.org/10.1037/1528-
3542.7.2.262
Lakhan, R., & Ekúndayò, O. T. (2013). Application of the ecological framework in depression:
An approach whose time has come. AP J Psychol Med, 14, 103–9.
Langer, E. J. (1992). Matters of mind: Mindfulness/mindlessness in perspective. Consciousness
and Cognition, 1(3), 289–305. https://doi.org/10.1016/1053-8100(92)90066-J
Lederbogen, F., Kirsch, P., Haddad, L., Streit, F., Tost, H., Schuch, P., … Meyer-Lindenberg, A.
(2011). City living and urban upbringing affect neural social stress processing in humans.
Nature, 474(7352), 498–501. https://doi.org/10.1038/nature10190
Liao, Y., Shonkoff, E. T., & Dunton, G. F. (2015). The acute relationships between affect,
physical feeling states, and physical activity in daily life: A review of current evidence.
Frontiers in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.01975
Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G., Brewer, J. A.,
& Fulwiler, C. (2015). Mindfulness and cardiovascular disease risk: State of the
evidence, plausible mechanisms, and theoretical framework. Current Cardiology Reports,
17(12). https://doi.org/10.1007/s11886-015-0668-7
Matheson, F. I., Moineddin, R., Dunn, J. R., Creatore, M. I., Gozdyra, P., & Glazier, R. H.
(2006). Urban neighborhoods, chronic stress, gender and depression. Social Science &
Medicine, 63(10), 2604–2616. https://doi.org/10.1016/j.socscimed.2006.07.001
Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: a review of mental and physical
health benefits associated with physical activity. Current Opinion in Psychiatry, 18(2),
189–193.
142
Physical Activity Guidelines Advisory Committee. (2008). Physical activity guidelines advisory
committee report, 2008. Washington, DC: US Department of Health and Human
Services, 2008, A1-H14.
Rebar, A. L., Stanton, R., Geard, D., Short, C., Duncan, M. J., & Vandelanotte, C. (2015). A
meta-meta-analysis of the effect of physical activity on depression and anxiety in non-
clinical adult populations. Health Psychology Review, 9(3), 366–378.
https://doi.org/10.1080/17437199.2015.1022901
Sauer, S., Walach, H., Schmidt, S., Hinterberger, T., Lynch, S., Büssing, A., & Kohls, N. (2012).
Assessment of mindfulness: Review on state of the art. Mindfulness, 4(1), 3–17.
https://doi.org/10.1007/s12671-012-0122-5
Van Dam, N. T., Sheppard, S. C., Forsyth, J. P., & Earleywine, M. (2011). Self-compassion is a
better predictor than mindfulness of symptom severity and quality of life in mixed
anxiety and depression. Journal of Anxiety Disorders, 25(1), 123–130.
https://doi.org/10.1016/j.janxdis.2010.08.011
Watson, D., & Clark, L. A. (1999). The PANAS-X: Manual for the positive and negative affect
schedule-expanded form. Retrieved from
http://ir.uiowa.edu/cgi/viewcontent.cgi?article=1011&context=psychology_pubs
143
Curriculum Vitae Chih-Hsiang Yang
CONTACT INFORMATION
17 Rec Hall (Motivation Lab)
Department of Kinesiology
The Pennsylvania State University
University Park, PA 16803 USA
Office: 814-654-7935
Cell phone: 814-777-6976
Email: [email protected]
EDUCATION
PhD (candidate), Department of Kinesiology, The Pennsylvania State University,
University Park, PA, USA.
Specialization: Psychology of Physical Activity
Minor Program: Human Development and Family Studies
Advisor: David E. Conroy, Ph.D.
2013-
2017
Master of Education, National Taiwan Normal University, Taipei, Taiwan.
Major: Educational Psychology and Counseling
Advisor: Sheue-Mei Lu, Ph.D.
Bachelor of Education, National Taipei University of Education, Taipei, Taiwan.
Major: Psychology and Counseling
2010
2005
AWARDS AND FUNDINGS
Student Mentoring and Travel Grant, The 5th International Conference on
Ambulatory Monitoring of Physical Activity and Movement.
The National Science Foundation’s Smart and Connected Health Program.
2017
Highly-Cited Paper, Essential Science Indicators/Web of Science, based on
Conroy, Yang & Maher (2014) receiving enough citations by June 2017 to
place it in the top 1% of the academic field of Social Sciences.
2017
RESEARCH
1. Yang, C. H., Maher, J. P., & Conroy, D. E. (2015). Acceptability of mobile health
interventions to reduce inactivity-related health risk in central Pennsylvania adults.
Preventive Medicine Reports, 2, 669-672.
2. Yang, C. H., Maher, J. P., & Conroy, D. E. (2015). Implementation of behavior change
techniques in mobile apps for physical activity. American Journal of Preventive
Medicine. 48(4), 452-55.
3. Conroy, D.E., Yang, C. H., & Maher J.P. (2014). Behavior change techniques in top-ranked
mobile apps for physical activity. American Journal of Preventive Medicine. 46(6), 649-
52.
4. Ashour, M., Bekiroglu, K., Yang, C. H., Lagoa, C., Conroy, D., Smyth, J., & Lanza, S. T..
(2016, September). On the mathematical modeling of human physical activity.
Proceedings of the IEEE Multi-conference on Systems and Control (pp. 1084-1091),
Buenos Aires, Argentina. http://ieeexplore.ieee.org/abstract/document/7587951/