Rheumatoid Arthritis

A Self-determination theory based intervention to promote autonomous motivation for physical activity engagement among patients with Rheumatoid Arthritis

Sally Fenton, PhD

Research Fellow

School of Sport, Exercise and Rehabilitation Sciences and Russells Hall Hospital, Dudley NHS Foundation Trust

University of Birmingham

September 22

2015

Rheumatoid Arthritis

• Rheumatoid Arthritis (RA) is a systemic inflammatory disease affecting 0.5%- 1% of the population

• Associated with increased risk of cardiovascular disease (CVD)

Inflammatory burden associated

with the disease

Physical inactivity

Rheumatoid Arthritis: The role of physical activity

• Physical activity associates with lower levels of inflammation and improved cardiovascular (and psychological) health in RA patients

• Does not induce further joint damage

How can we encourage patients with RA to start being physically active and stay active?

• Evidenced based interventions

• Grounded in theories of behaviour change

Motivating physical activity in RA: Self-determination theory

Self-determination Theory (Deci and Ryan, 1987) – the ‘why’ of motivation

Competence

High

Low

Cognitive, affective and

behavioural outcomes (e.g., PA/exercise) Autonomy

Autonomy support

Relatedness

M O T I V A T I O N

Autonomous motivation

Controlled motivation

• Promotes choice and understanding

• Provides rationale

• Input into decision making

• Considers the individual’s point of view

Positive association Negative association

The Physical Activity in Rheumatoid Arthritis (PARA) Study

Rouse et al., (2014). BMC Musculoskeletal Disorders, 155: 445

A multi-component psychological intervention to promote cardiovascular fitness and autonomous motivation for physical activity engagement in rheumatoid arthritis patients

Patients recruited (N = 115)

Intervention arm, N = 59 (50.4%) Control arm, N = 56 (49.6%)

Participant characteristics

• 68 % female

• M (Age) = 53.98 + 12.47 years

• Mean duration of RA = 7.40 + 8.61 years

• 84% White British

The Physical Activity in Rheumatoid Arthritis (PARA) Study:

Intervention design

Intervention arm

• One on one consultations with physical activity advisor

• Trained in major principles of SDT/need supportive strategies to promote physical activity

• Same advisor for all intervention participants Physical Activity Advisor

Both arms

• Prescribed a 3 month exercise programme at the local gym

• Tailored for the individual – recognised RA and its constraints

Randomisation and measurement time scale

Protocol paper - BMC Musculoskeletal Disorders 2014, 15:445

SDT- Based Consultation Information Pack Randomisation

Experimental

Control

1 Month 2 Months 5 Months

Baseline T1

3 Months T2

6 Months T3

12 Months T4

Pre-Baseline

Recruitment &

Consent

Randomisation and measurement time scale

Protocol paper - BMC Musculoskeletal Disorders 2014, 15:445

3 Month Exercise Programme Action Heart

SDT- Based Consultation Exit Consultation

Telephone

Consultation Telephone Consultation

Information Pack

3 Month Exercise Programme Dudley Leisure Centre

Randomisation Experimental

Control

1 Month 2 Months 5 Months

Baseline T1

3 Months T2

6 Months T3

12 Months T4

Pre-Baseline

Recruitment &

Consent

Telephone Consultation

Outcome variables

1. Cardiovascular (e.g., VO₂ max) 2. Rheumatoid Disease (e.g., DAS-28)

3. Psychological wellbeing (e.g., depression) 4. Motivational processes (SDT variables)

5. Objectively assessed PA (GT3X accelerometers)

Participants retained for 3 month follow up (T2) N = 31 (26.96%) – Intervention/control, N = 20/10 (psychological measures and accelerometer data)

The PARA Study: SDT based intervention content

Telephone interviews (10 minutes)

• Support attempts to change behaviour/encourage attempts made

• Normalize failed attempts to be physically active

• Problem solve – formulate strategies to enhance self-efficacy

• Elicit/brainstorm solutions to PA barriers

• Revisit goals set and discuss further goals

Results: Intervention effects on competence need satisfaction at Time 2 (3 months)

0 1 2 3 4 5 6

Intervention Control

* * P <.05

• Significant interaction effect [F (1,30) = 5.91, p <.05, η² = .16]

• Participants in the intervention group reported significantly higher competence need satisfaction at Time 2

Competence need satisfaction

Likert scale (1 – 6)

Competence need satisfaction at exercise programme end (T2)

Results: Motivational processes and MVPA

* P <.05 ** P <.01

.63** .37*

PA advisor autonomy support

3 months (T2) Exercise programme

end

.48*

Competence need satisfaction 3 months (T2) Exercise programme

end

Change in autonomous motivation (T1-T2) Baseline to exercise

programme end

MVPA (min/day) Exercise programme T2

end

Competence Physical activity

and/or exercise Autonomy

Relatedness

Autonomous motivation

Controlled motivation Autonomy

support

Positive association

Results: Group differences in moderate physical activity

10 12 14 16 18 20 22 24 26 2830

Baseline

Intervention Control

• Participants with valid data: N = 20, 11 intervention, 9 control

• Significant interaction effect for moderate physical activity from T1 to T4 [F (18,1) = 4.79, p <.05, η2 = .21]

Moderate physical activity

(min/day)

Changes in moderate physical activity (min/day) from baseline to 12 month follow up

Conclusions and implications

• Autonomy support from the physical activity advisors fostered adaptive motivational processes for behaviour change among this patient group

• Analysis of follow up data will determine implications for longer term adherence to participation in physical activity

• Fostering autonomous motivation towards physical activity may have positive implications for promoting engagement in moderate-to- vigorous physical activity among RA patients

Competence

High

Low

Cognitive, affective and

behavioural outcomes (e.g., PA/exercise) Autonomy

Social environment

Relatedness

M O T I V A T I O N Strategy

Outcome Autonomous

motivation

Controlled motivation

• Self-determination theory offers a useful framework upon which to base physical activity behaviour change interventions

• Provides a strategy (autonomy support) that will be effective in enhancing autonomous motivation towards physical activity

Conclusions and implications

Thank you for listening

Sally Fenton, PhD

School of Sport, Exercise and Rehabilitation Sciences University of Birmingham

[email protected]

September 2015