Clinical Rheumatology

, Volume 34, Issue 2, pp 231–238 | Cite as

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

  • Keegan KnittleEmail author
  • Veronique De Gucht
  • Emalie Hurkmans
  • Andre Peeters
  • Karel Ronday
  • Stan Maes
  • Thea Vliet Vlieland
Original Article


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.


Behaviour change Motivational interviewing Physical activity Rheumatoid arthritis Self-efficacy Self-regulation 



The authors thank Wilfred Peter, Gerry Boerrigter, Jorit Meesters, Elles Voogt-van der Harst and Atie Jongma for their assistance in delivering the intervention. This work was supported by the Friends of Sole Mio Foundation (Stichting vrienden van de voormalige te Noordwijk gevestigde reumakliniek “Sole Mio”), who funded Dr. Hurkmans’ contributions to this research.




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Copyright information

© Clinical Rheumatology 2013

Authors and Affiliations

  • Keegan Knittle
    • 1
    • 2
    Email author
  • Veronique De Gucht
    • 2
  • Emalie Hurkmans
    • 3
    • 4
  • Andre Peeters
    • 5
  • Karel Ronday
    • 6
  • Stan Maes
    • 2
  • Thea Vliet Vlieland
    • 3
    • 7
  1. 1.MoveLab, Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
  2. 2.Department of Clinical and Health PsychologyLeiden UniversityLeidenNetherlands
  3. 3.Department of RheumatologyLeiden University Medical CenterLeidenNetherlands
  4. 4.Department of Health, Division of PhysiotherapyFH Campus Wien University of Applied SciencesViennaAustria
  5. 5.Department of RheumatologyReinier de Graaf GasthuisDelftNetherlands
  6. 6.Department of RheumatologyHAGA HospitalThe HagueNetherlands
  7. 7.Department of OrthopedicsLeiden University Medical CenterLeidenNetherlands

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