A systematic review and meta-analysis was conducted of the techniques used to promote psychological need satisfaction and motivation within health interventions based on selfdetermination theory (SDT; Ryan & Deci, 2017). Eight databases were searched from 1970-2017. Studies including a control group and reporting pre-and post-intervention ratings of SDT-related psychosocial mediators (namely perceived autonomy support, need satisfaction and motivation) with children or adults were included. Risk of bias was assessed using items from the Cochrane risk of bias tool. 2496 articles were identified of which 74 met inclusion criteria; 80% were RCTs or cluster RCTs. Techniques to promote need supportive environments were coded according to two established taxonomies (BCTv1 and MIT), and 21 SDT-specific techniques, and grouped into 18 SDT based strategies. Weighted mean effect sizes were computed using a random effects model; perceived autonomy support g=0.84, autonomy g=0.81, competence g=0.63, relatedness g=0.28, and motivation g=0.41. One-to-one interventions resulted in greater competence satisfaction than group-based (g=0.96 vs. 0.28), and competence satisfaction was greater for adults (g=0.95) than children (g=0.11). Meta-regression analysis showed that individual strategies had limited independent impact on outcomes, endorsing the suggestion that a need supportive environment requires the combination of multiple co-acting techniques.

Rheumatoid arthritis (RA) is an autoimmune disease, which not only affects the joints but can also impact on general well-being and risk for cardiovascular disease. Regular physical activity and exercise in patients with RA have numerous health benefits. Nevertheless, the majority of patients with RA are physically inactive. This indicates that people with RA might experience additional or more severe barriers to physical activity or exercise than the general population. This narrative review provides an overview of perceived barriers, benefits and facilitators of physical activity and exercise in RA. Databases were searched for articles published until September 2014 using the terms ‘rheumatoid arthritis’, ‘physical activity’, ‘exercise’, ‘barriers’, ‘facilitators’, ‘benefits’, ‘motivation’, ‘motivators’ and ‘enablers’. Similarities were found between disease-specific barriers and benefits of physical activity and exercise, e.g. pain and fatigue are frequently mentioned as barriers, but reductions in pain and fatigue are perceived benefits of physical activity and exercise. Even though exercise does not influence the existence of barriers, physically active patients appear to be more capable of overcoming them. Therefore, exercise programmes should enhance self-efficacy for exercise in order to achieve long-term physical activity and exercise behaviour. Encouragement from health professionals and friends/family are facilitators for physical activity and exercise. There is a need for interventions that support RA patients in overcoming barriers to physical activity and exercise and help sustain this important health behaviour.

BackgroundThe National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation.MethodsAn exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres.Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.Blood pressure and weight were assessed at baseline and 6 months.ResultsPerceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported.ConclusionsSignificant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise referral and the SDT-based intervention at programme end. At 6-months, observed between arm and within intervention arm differences for indicators of emotional health, and the results of the process model, were in line with SDT. The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed.Trial registrationThe trial is registered as Current Controlled trials ISRCTN07682833.

In the beginning: Role of autonomy support on the motivation, mental health and intentions of participants entering an exercise referral scheme.

VO2max levels are alarmingly low in RA patients. Higher levels of VO2max are associated with a better cardiovascular profile in this population. Future studies need to focus on developing effective behavioural interventions to improve cardiorespiratory fitness in RA.

Objective We used ecological momentary assessment to understand the physical activity and sedentary behaviour patterns of university students. Study design Cross sectional, opportunistic sample from a university in the English midlands. Methods Ecological momentary assessment diaries were completed every 15 minutes across two days. The sample comprised 46 males (mean age 20.2 years) and 38 females (mean age 19.5 years). The majority of participants were undergraduates (96.5 per cent) and white European (85 per cent). Results Although 'studying' was the predominant behaviour (280 minutes), students spent time conducting a range of behaviours including 'watching television' (79.9 minutes), 'sitting and talking' (72.1 minutes) and 'hanging out' (64.0 minutes). Repeated measure ANOVAs revealed a significant gender effect for some behaviours with 'studying' [F(1,82) = 10.50, p < .006] and 'computer game playing' [F(1,82) = 7.97, p < .006] being higher in males, and 'sitting and talking' [F(1,82) = 24.49, p < .006] higher in females. Pearson correlations suggested that sedentary behaviours compete with each other for students' time. A significant small negative relationship existed between sedentary technology behaviours and physical activity for males (r = -.217) but not for females (r = -.182). Conclusions Students participate in a range of sedentary behaviours that differ by gender. Results question public perception that selected sedentary behaviours, such as 'watching television', are responsible for declining levels of sport and exercise participation in this age group. Implications for interventions are considered.

To determine if: i) mean power output and enjoyment of high-intensity interval training (HIIT) are enhanced by virtual-reality (VR)-exergaming (track mode) compared to standard ergometry (blank mode), ii) if mean power output of HIIT can be increased by allowing participants to race against their own performance (ghost mode) or by increasing the resistance (hard mode), without compromising exercise enjoyment.Methods: Sixteen participants (8 males, 8 females, VO2max: 41.2 ± 10.8 ml -1 • kg -1 • min -1 ) completed four VR-HIIT conditions in a partially-randomised cross-over study; 1a) blank, 1b) track, 2a) ghost, and 2b) hard. VR-HIIT sessions consisted of eight 60 s high-intensity intervals at a resistance equivalent to 70% (77% for hard) maximum power output (PMAX), interspersed by 60 s recovery intervals at 12.5% PMAX, at a self-selected cadence. Expired gases were collected and VO2 measured continuously. Post-exercise questionnaires were administered to identify differences in indices related to intrinsic motivation, subjective vitality, and future exercise intentions.Results: Enjoyment was higher for track vs. blank (difference: 0.9; 95% CI: 0.6, 1.3) with no other differences between conditions. There was no difference in mean power output for track vs. blank, however it was higher for track vs. ghost (difference: 5 Watts; CI: 3, 7), and hard vs. ghost (difference: 19 Watts; 95% CI: 15, 23). Conclusions:These findings demonstrate that VR-exergaming is an effective intervention to increase enjoyment during a single bout of HIIT in untrained individuals. The presence of a ghost may be an effective method to increase exercise intensity of VR-HIIT.

IntroductionThe aims of the present study were: (a) to examine the agreement between subjective (assessed via the International Physical Activity Questionnaire; IPAQ) and objective (accelerometry; GT3X) physical activity (PA) levels in patients with rheumatoid arthritis (RA), and (b) to evaluate the associations of RA patients’ subjective and objective PA to their scores on the maximal oxygen uptake test (VO2max).MethodsThe participants wore the GT3X for seven days before completing the IPAQ and VO2max test. The Bland-Altman plot was used to illustrate the agreement between the objective and subjective PA data, and the Wilcoxon test was employed to examine the differences. The association between the PA measurement and VO2max test was examined via the correlations and the magnitude was presented by the Steiger’s Z value.ResultsSixty-eight RA patients (age = 55 ± 13 years, body mass index: 27.8 ± 5.4 kg/m2, median of disease duration = 5 (2–8) yrs) were recruited. Smaller differences between the subjective and objective measures were found when PA was assessed at the moderate level. Wilcoxon tests revealed that patients reported less time spent engaged in sedentary behaviours (Z = −6.80, P < 0.01) and light PA (Z = −6.89, P < 0.01) and more moderate PA (Z = −6.26, P < 0.01) than was objectively indicated. Significant positive correlations were revealed between VO2max with all PA levels derived from accelerometry (light PA rho = .35, P < .01; moderate PA rho = .34, P = .01; moderate and vigorous PA, (MVPA) rho = .33, P = .01), and a negative association to sedentary time (ST) emerged (rho = −.27, P = .04). IPAQ-reported moderate PA and MVPA positively correlated with maxV02 (rho = .25, P = .01, rho = .27, P = .01, respectively). Differences between the magnitude of correlations between the IPAQ-VO2 max and GT3X-VO2 max were only significant for ST (Z = 3.43, P < .01).ConclusionsVia responses to the IPAQ, RA patients reported that they were less sedentary and engaged in more higher intensity PA than what was objectively assessed. Accelerometry data correlated with VO2max at all PA levels. Only subjective moderate and MPVA correlated with VO2max. Findings suggest that self-reported PA and ST should be interpreted with caution in people with RA and complemented with accelerometry when possible.Trial registrationTrial registration: ClinicalTrials.gov ISRCTN04121489. Registered 5 September 2012.