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

Abstract

Objective. Regular physical activity (PA) benefits patients with rheumatoid arthritis (RA), particularly when maintained over time. Research in this area has largely focused on factors associated with initiating PA, while factors contributing to PA maintenance, particularly after lifestyle interventions, have received less attention. This study examined whether higher levels of autonomous motivation, self-efficacy for PA, and greater use of self-regulation skills mediated PA initiation and maintenance 6 months after a theory-based motivational interviewing and self-regulation coaching intervention. Methods. Seventy-eight individuals with RA were randomized to receive either a patient-education session (control group), or the patient-education session plus 1 motivational interview and 2 self-regulation coaching sessions (treatment group). Mediation analyses examined the effects of this intervention on PA initiation and maintenance through the intermediate variables autonomous motivation, self-efficacy for PA, and use of self-regulation skills. Analyses were controlled for age, sex, and previous levels of PA. Results. The treatment group reported significantly higher autonomous motivation and greater use of self-regulation skills than controls at posttreatment. Increases in PA from baseline to posttreatment were not mediated by any intermediate variables. However, maintenance of PA from posttreatment to followup (6 months later) was mediated by greater autonomous motivation and use of self-regulation skills. Conclusion. Greater autonomous motivation and use of self-regulation skills predict maintenance of PA following a motivational interviewing and self-regulation coaching intervention. In promoting PA among patients with RA, supporting patient autonomy and teaching self-regulation skills, which focus attention on achieving PA goals, may improve long-term maintenance of PA.

The effects of behavioural counselling on the determinants of health behaviour change in adults with chronic musculoskeletal conditions making lifestyle changes: A systematic review and meta‐analysis

“…Self‐efficacy was measured in six trials (Table ). Of these, four trials (Knittle et al, , ; Lonsdale et al, ; Thomsen et al, , ) measured self‐efficacy in relation to PA and two (Niedermann et al, , ; Vong et al, ) in relation to disease management. Although there was low‐quality evidence of no significant effect of behavioural counselling on self‐efficacy with respect to disease management (SMD 0.05 [95% CI −0.33, 0.44]; I 2 = 18.9%), there was very‐low‐quality evidence of a moderate effect on self‐efficacy with respect to PA (SMD 0.69 [95%CI 0.19, 1.18]; I 2 = 80.3%) (Figure ).…”

“…Various forms of motivation, including autonomous motivation, controlled motivation and amotivation, were measured (Table ) and had varying results. Only autonomous motivation was measured in two trials (Knittle et al, , ; Lonsdale et al, ), enabling meta‐analysis. Very‐low‐quality evidence suggests that behavioural counselling has no significant effect on autonomous motivation (SMD 0.38 [95% CI −0.15, 0.92]; I 2 = 73.5%).…”

“…PA and home exercise completion was measured in nine trials (Table ). PA was measured using only self‐reported questionnaires in seven trials (Allen et al, ; Ben‐Ami et al, ; Friedrich et al, ; Knittle et al, , ; Lonsdale et al, ; Vong et al, ; Williams et al, ), both a self‐reported questionnaire and accelerometry in one trial (Ang et al, ) and accelerometry only in one trial (Gilbert et al, ). Where multiple self‐reported measures were used, time duration was the most commonly used unit of measure.…”

Self‐compassion is associated with optimum self‐care behaviour, medical outcomes and psychological well‐being in a cross‐sectional sample of adults with diabetes

“…Recently, Pfattheicher et al . have argued that the negative items on the self‐compassion full scale are highly correlated with neuroticism ( r ≥ 0.85) and offer no additional predictive validity beyond a measure of neuroticism. Pfattheicher et al .…”

“…Whilst the present study found that self-compassion, as measured by the SCS-SF, did significantly relate to outcomes of interest, it is important to acknowledge the potential shortcomings of this construct. Recently, Pfattheicher et al [30] have argued that the negative items on the self-compassion full scale are highly correlated with neuroticism (r ≥ 0.85) and offer no additional predictive validity beyond a measure of neuroticism. Pfattheicher et al [30] do acknowledge that the construct self-compassion has clinical utility through outlining strategies to deal with painful experiences (which are not offered by the absence of neuroticism), yet the authors also conclude that further research into our theoretical conceptualization of selfcompassion is required.…”