Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial

Abstract

The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity (PA) among patients with rheumatoid arthritis (RA) not meeting current PA recommendations. In a randomised controlled trial, a control group—which received a group-based patient education session led by a physical therapist—was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse. Outcomes included leisure-time PA, days per week with at least 30 min of moderate-intensity PA, self-efficacy and autonomous motivation (cognitions which predict PA initiation and maintenance), disease activity, functional status, depressive symptoms and fatigue. Effects were assessed using mixed models repeated measures. Of the 78 patients randomised, 76 and 67 completed the post-treatment and follow-up assessments, respectively. Significant treatment effects were found for leisure-time PA (p = 0.022), active days/week (p = 0.016), self-efficacy (p = 0.008) and autonomous motivation (p = 0.001). At post-treatment and 6-months follow-up, significantly more treated patients than controls met current PA recommendations. No significant effects were found for disease activity, functional status, depressive symptoms or fatigue. Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA. However, further research is necessary to identify ways of helping patients with RA transition to—and maintain—more intensive forms of PA which are more likely to improve disease activity and functional status.

Explaining Physical Activity Maintenance After a Theory‐Based Intervention Among Patients With Rheumatoid Arthritis: Process Evaluation of a Randomized Controlled Trial

“…Although self-efficacy increased significantly from baseline to posttreatment within the intervention group (22), there was no significant difference in self-efficacy between groups at posttreatment, which meant that the a paths toward self-efficacy within our mediation models were nonsignificant. As there were indeed significant differences between groups for the other intermediate variables in the model (i.e., autonomous motivation and selfregulation skills), the amount of variance in PA left to be explained by the indirect effect through self-efficacy was diminished.…”

“…The RCT was approved by the Leiden University Medical Center Ethics Review Board and was conducted in accordance with the Declaration of Helsinki between August 2010 and December 2011. The trial protocol is registered with the Netherlands Trial Register (http:// www.trialregister.nl; identifier NTR2240) and its main results have been published elsewhere (22). …”

“…As improvements in these skills and cognitions were hypothesized to lead to greater initiation and maintenance of leisure-time PA among patients with RA, the intervention included techniques specifically designed to change each of these intermediate constructs: motivational interviewing to increase autonomous motivation (20), self-regulation coaching to increase the use of self-regulation skills (9), and goal setting and feedback to increase self-efficacy for PA (21). In a previous randomized controlled trial (RCT), we compared this combined motivational interviewing and self-regulation coaching intervention to a patient-education control group, and over the course of 32 weeks, the intervention group reported significantly greater improvements in autonomous motivation, self-efficacy for PA, and PA behavior itself (22).…”

“…In developing the intervention, the duration, quantity, and frequency of intervention sessions were chosen because they map well onto existing outpatient care for RA commonly provided in the LUMC. A full description of procedures used in the RCT is published elsewhere, and includes detailed intervention descriptions as well as additional patient characteristics and outcomes (22).…”

Trajectories of Physical Activity Over Two Years in Persons With Rheumatoid Arthritis

“…To further explore development over time, a wide approach, including sociodemographic, disease-related, and psychosocial variables and longitudinal data on physical activity, is needed. Specifically, more knowledge about maintained physical activity and its predictors is warranted (4,16,17).…”