Abstract
Physical inactivity is prevalent in rheumatoid arthritis (RA) patients, increasing the risk of poor physical health and compromised well-being. Interventions are therefore required to support physical activity (PA) behavior change in this population. This study examined whether a self-determination theory (SDT) based exercise intervention for people with RA, increased autonomous motivation for PA and in turn, moderate-to-vigorous PA (MVPA) and subjective vitality RA patients (n = 115) were randomized to a 3-month SDT-based psychological intervention + RA-tailored exercise program (experimental group, n = 59) or a RA-tailored exercise program only (control group, n = 56). During the program, the SDT-based intervention group received one-on-one consultations with a PA advisor trained in delivering strategies to promote autonomous motivation for PA. Well-established questionnaires assessed autonomous and controlled motivation for PA, MVPA (min/week), and subjective vitality at baseline (T1) and 3 months (T2). Path analysis examined the hypothesized theoretical process model. The model demonstrated an excellent fit to the data (n = 70, χ2 (26) = 28.69, p = .33, comparative fit index = 0.99, root square mean error of approximation = 0.04). The intervention corresponded to higher autonomous motivation and lower controlled motivation for PA at T2, after controlling for T1 autonomous and controlled motivation. In turn, changes in autonomous motivation from T1 to T2 significantly positively predicted changes in MVPA and subjective vitality. Results suggest an SDT based psychological intervention comprising autonomy-supportive strategies for PA predicted greater reported autonomous reasons for PA in RA patients participating in a tailored 3-month exercise program. Increased autonomous motivation linked to increased engagement in MVPA and feelings of vitality in these patients.
Highlights
Results suggest a change in autonomous motivation is the psychological mechanism (“process of change”) underlying the positive changes in moderate-to-vigorous PA (MVPA) and subjective vitality observed among rheumatoid arthritis (RA) patients in this intervention
In testing the theoretical process model (Fig. 1b), we demonstrated that autonomysupportive interactions promoted more autonomous motivation for physical activity (PA) and, in turn, encouraged higher levels of engagement in MVPA and more optimal psychological functioning among RA patients
Future work in this area should aim to confirm the value of autonomy-supportive strategies for encouraging MVPA and increasing feelings of vitality in RA. This is the first randomized controlled trial (RCT) to investigate whether SDTbased PA consultations delivered in conjunction with an RA-tailored exercise program were effective for promoting autonomous motivation for PA among people with RA
Summary
Patients diagnosed with RA [30] were recruited from Rheumatology outpatient clinics at Russells Hall Hospital (Dudley, UK), between March 2010 and April 2014 (ISRCTN04121489). Eligible participants provided informed consent and were randomized to the experimental or control group (stratified based on gender, by a third party [Cancer Clinical Trials Unit, University of Birmingham]). All randomized participants (both experimental and control) were invited to participate in a 3-month exercise program in a local gym, tailored for people living with RA. Participants in the experimental group received an SDT-based psychological intervention to support autonomous motivation for engagement in PA [29]. Exercise program (all participants) The content of the exercise sessions was individualized and based on participants’ pre-intervention cardio-respiratory fitness (CRF) and physical abilities [7]. Participants were advised to complete 3 × 30 min exercise sessions per week (two in the gym + one at home, both at 60%–70% Heart Rate max). Participants completed at least one induction session in the gym until they page 3 of 12
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