Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Forestier R, André-Vert J, Guillez P et al (2009) Non-drug treatment (excluding surgery) in rheumatoid arthritis: clinical practice guidelines. Joint Bone Spine 76:691–698

    Article  PubMed  Google Scholar 

  2. Sokka T, Hakkinen A, Kautiainen H et al (2008) Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Care Res 59:42–50

    Article  Google Scholar 

  3. Douglas KMJ, Pace AV, Treharne GJ et al (2006) Excess recurrent cardiac events in rheumatoid arthritis patients with acute coronary syndrome. Ann Rheum Dis 65:348–353

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Conn VS, Hafdahl AR, Minor MA et al (2008) Physical activity interventions among adults with arthritis: meta-analysis of outcomes. Semin Arthritis Rheum 37:307–316

    Article  PubMed  Google Scholar 

  5. Maes S, Karoly P (2005) Self-regulation assessment and intervention in physical health and illness: a review. Appl Psychol Int Rev 54:267–299

    Article  Google Scholar 

  6. Knittle K, Maes S, de Gucht V (2010) Psychological interventions for rheumatoid arthritis: examining the role of self-regulation with a systematic review and meta‐analysis of randomized controlled trials. Arthritis Care Res 62:1460–1472

    Article  Google Scholar 

  7. Conn VS, Hafdahl AR, Brown SA et al (2008) Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. Patient Educ Couns 70:157–172

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hurkmans EJ, van den Berg MH, Ronday KH et al (2010) Maintenance of physical activity after Internet-based physical activity interventions in patients with rheumatoid arthritis. Rheumatology 49:167–172

    Article  PubMed  Google Scholar 

  9. Mayoux-Benhamou A, Giraudet-Le Quintrec J, Ravaud P et al (2008) Influence of patient education on exercise compliance in rheumatoid arthritis: a prospective 12-month randomized controlled trial. J Rheumatol 35:216–223

    PubMed  Google Scholar 

  10. Schwarzer R (2008) Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Appl Psychol 57:1–29

    Google Scholar 

  11. Sheeran P, Abraham C (2003) Mediator of moderators: temporal stability of intention and the intention-behavior relation. Pers Social Psychol B 29:205–215

    Article  Google Scholar 

  12. Sniehotta FF, Scholz U, Schwarzer R (2006) Action plans and coping plans for physical exercise: a longitudinal intervention study in cardiac rehabilitation. Br J Health Psychol 11:23–37

    Article  PubMed  Google Scholar 

  13. Abraham C, Sheeran P, Johnston M (1998) From health beliefs to self-regulation: theoretical advances in the psychology of action control. Psychol Health 13:569–591

    Article  Google Scholar 

  14. Bandura A (2004) Health promotion by social cognitive means. Health Educ Behav 31:143–164

    Article  PubMed  Google Scholar 

  15. Gyurcsik NC, Brawley LR, Spink KS et al (2009) Physical activity in women with arthritis: examining perceived barriers and self-regulatory efficacy to cope. Arthritis Care Res 61:1087–1094

    Article  Google Scholar 

  16. Trost SG, Owen N, Bauman AE et al (2002) Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc 34:1996–2001

    Article  PubMed  Google Scholar 

  17. Steptoe A, Rink E, Kerry S (2000) Psychosocial predictors of changes in physical activity in overweight sedentary adults following counseling in primary care. Prev Med 31:183–194

    Article  CAS  PubMed  Google Scholar 

  18. Warner LM, Schüz B, Knittle K et al (2011) Sources of perceived self-efficacy as predictors of physical activity in older adults. Appl Psychol: Health Well-Being 3:172–192

    Google Scholar 

  19. Bandura A (1997) Self-efficacy: the exercise of control. Freeman, New York

    Google Scholar 

  20. Ryan RM, Deci EL (2000) Intrinsic and extrinsic motivations: classic definitions and new directions. Contemp Educ Psychol 25:54–67

    Article  PubMed  Google Scholar 

  21. Hurkmans EJ, Maes S, de Gucht V et al (2010) Motivation as a determinant of physical activity in patients with rheumatoid arthritis. Arthritis Care Res 62:371–377

    Article  CAS  Google Scholar 

  22. Markland D, Ryan RM, Tobin VJ et al (2005) Motivational interviewing and self-determination theory. J Soc Clin Psychol 24:811–831

    Article  Google Scholar 

  23. Fortier MS, Sweet SN, O’Sullivan TL et al (2007) A self-determination process model of physical activity adoption in the context of a randomized controlled trial. Psychol Sport Exerc 8:741–757

    Article  Google Scholar 

  24. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  CAS  PubMed  Google Scholar 

  25. Van den Berg M, Ronday H, Peeters A et al (2006) Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Care Res 55:935–945

    Article  Google Scholar 

  26. Michie S, Ashford S, Sniehotta FF et al (2011) A refined taxonomy of behavior change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health 26:1479–1498

    Article  PubMed  Google Scholar 

  27. Wendel-Vos GCW, Schuit AJ, Saris WHM et al (2003) Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 56:1163–1169

    Article  PubMed  Google Scholar 

  28. Douwes M, Hildebrandt V (2000) Vragen naar de mate van lichamelijke activiteit. Geneeskunde en Sport 33:9–16

    Google Scholar 

  29. Bandura A (2006) Guide for constructing self-efficacy scales. In: Pajares F, Urdan T (eds) Self-efficacy beliefs of adolescents. Information Age, Charlotte, pp 307–337

    Google Scholar 

  30. Levesque CS, Williams GC, Elliot D et al (2007) Validating the theoretical structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors. Health Educ Res 22:691–702

    Article  PubMed  Google Scholar 

  31. Fransen J, Langenegger T, Michel BA et al (2000) Feasibility and validity of the RADAI, a self-administered rheumatoid arthritis disease activity index. Rheumatology 39:321–327

    Article  CAS  PubMed  Google Scholar 

  32. Fries JF, Spitz PW, Young DY (1982) The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol 9:789–793

    CAS  PubMed  Google Scholar 

  33. Derogatis L, Spencer P (1992) The brief symptom inventory: administration, scoring, and procedures manual. Clinical Psychometric Research Inc, Baltimore

    Google Scholar 

  34. Vercoulen JHMM, Swanink C, Fennis JFM et al (1994) Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 38:383–392

    Article  CAS  PubMed  Google Scholar 

  35. Borenstein M et al (2011) Comprehensive meta-analysis [computer program], version 2.2. BioStat, Engelwood

    Google Scholar 

  36. Oguma Y, Shinoda-Tagawa T (2004) Physical activity decreases cardiovascular disease risk in women: review and meta-analysis. Am J Prev Med 26:407–418

    Article  PubMed  Google Scholar 

  37. Callahan LF, Mielenz T, Freburger J et al (2008) A randomized controlled trial of the people with arthritis can exercise program: symptoms, function, physical activity, and psychosocial outcomes. Arthritis Care Res 59:92–101

    Article  Google Scholar 

  38. Brodin N, Eurenius E, Jensen I et al (2008) Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study. Arthritis Care Res 59:325–331

    Article  Google Scholar 

  39. Markland D, Ingledew DK (2007) Exercise participation motives. In: Hagger MS, Chatzisarantis NLD (eds) Intrinsic motivation and self-determination in exercise and sport. Human Kinetics, Champaign, pp 23–34

    Google Scholar 

  40. Ziebland S, Fitzpatrick R, Jenkinson C et al (1992) Comparison of two approaches to measuring change in health status in rheumatoid arthritis: the Health Assessment Questionnaire (HAQ) and modified HAQ. Ann Rheum Dis 51:1202–1205

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Greenwood MC, Rathi J, Hakim AJ et al (2007) Regression to the mean using the DAS in eligibility and response criteria for prescribing TNF alpha inhibitors in adults with RA. Rheumatology 46:1165–1167

    Article  CAS  PubMed  Google Scholar 

  42. van den Berg MH, De Boer IG, le Cessie S et al (2007) Most people with rheumatoid arthritis undertake leisure-time physical activity and exercise in the Netherlands: an observational study. Aust J Physiother 53:113–118

    Article  PubMed  Google Scholar 

  43. Hurkmans E, van der Giesen FJ, Vliet Vlieland T et al (2009) Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane DB Syst Rev. doi:10.1002/14651858.CD006853.pub2

    Google Scholar 

  44. Williams GC, Grow VM, Freedman ZR et al (1996) Motivational predictors of weight loss and weight-loss maintenance. J Pers Soc Psychol 70:115–126

    Article  CAS  PubMed  Google Scholar 

  45. Taber DR, Stevens J, Murray DM et al (2009) The effect of a physical activity intervention on bias in self-reported activity. Ann Epidemiol 19:316–322

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

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.

Disclosures

None.

Author information

Authors and Affiliations

  1. MoveLab, Institute of Cellular Medicine, Newcastle University, 4th Floor William Leech Building, NE2 4HH, Newcastle upon Tyne, UK

    Keegan Knittle

  2. Department of Clinical and Health Psychology, Leiden University, Leiden, Netherlands

    Keegan Knittle, Veronique De Gucht & Stan Maes

  3. Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

    Emalie Hurkmans & Thea Vliet Vlieland

  4. Department of Health, Division of Physiotherapy, FH Campus Wien University of Applied Sciences, Vienna, Austria

    Emalie Hurkmans

  5. Department of Rheumatology, Reinier de Graaf Gasthuis, Delft, Netherlands

    Andre Peeters

  6. Department of Rheumatology, HAGA Hospital, The Hague, Netherlands

    Karel Ronday

  7. Department of Orthopedics, Leiden University Medical Center, Leiden, Netherlands

    Thea Vliet Vlieland

Authors
  1. Keegan Knittle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Veronique De Gucht
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emalie Hurkmans
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andre Peeters
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karel Ronday
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stan Maes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thea Vliet Vlieland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keegan Knittle.

Additional information

Trial registration: Netherlands Trial Register, http://www.trialregister.nl; Identifier NTR2240.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Knittle, K., De Gucht, V., Hurkmans, E. et al. Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial. Clin Rheumatol 34, 231–238 (2015). https://doi.org/10.1007/s10067-013-2425-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-013-2425-x

Keywords

Search

Navigation