Chen-an Yu

Fostering autonomous motivation, physical activity and cardiorespiratory fitness in rheumatoid arthritis: protocol and rationale for a randomised control trial

BackgroundPeople with rheumatoid arthritis are at greater risk of morbidity and mortality from cardiovascular disease than the general population. Sustained physical activity increases cardio-respiratory fitness and reduces cardiovascular disease risk factors. However, little is known about how we can effectively promote long-term participation in physical activity in patients with rheumatoid arthritis. The literature consistently calls for physical activity interventions, and their implementation, to be theoretically-grounded.Methods/DesignThis paper documents the protocol of a randomised control trial that investigates whether a Self-determination Theory-based intervention fosters the adoption and maintenance of physical activity (3, 6 and 12 months) sufficient to provide sustained cardiovascular and personal well-being benefits in patients with rheumatoid arthritis. The cost effectiveness of the intervention will also be determined. The trial is registered as Current Controlled Trials ISRCTN04121489.DiscussionResults from this trial will provide guidance regarding key social environmental factors that can be manipulated to support motivational processes conducive to positive health behaviour change and optimal functioning in patients with Rheumatoid Arthritis.

Motivation-related predictors of physical activity engagement and vitality in rheumatoid arthritis patients

This study tests the Basic Psychological Needs Theory (within the Self-determination framework), in relation to the prediction of physical activity and well-being among rheumatoid arthritis patients. Motivation regulations for physical activity were also considered in the process model. A total of 207 patients (150 females, mean age = 58 ± 11 years) completed a questionnaire pack and structural equation modelling was used to test expected relationships. Autonomy support provided by important other(s) regarding physical activity positively predicted rheumatoid arthritis patients’ need satisfaction which positively related to autonomous reasons for physical activity participation. Autonomous motivation positively predicted reported physical activity participation levels and feelings of vitality.

Feelings of competence and relatedness during physical activity are related to well-being in rheumatoid arthritis patients: preliminary findings from a randomized control trial

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes joint pain, swelling and stiffness with eventual structural damage leading to physical dysfunction. Consequently, people with RA tend to experience fatigue and psychological distress. As proposed by Self-determination Theory (SDT), feelings of ownership, competence and relatedness (basic human psychological needs) during physical activity (PA) are predicted to alleviate such disease-related symptoms and improve psychological well-being in RA patients. Objectives To examine whether a Self-determination Theory-based intervention fosters basic need satisfaction. In addition, to examine the relationships between need satisfaction and indicators of psychological well-being and disease related symptoms (i.e., fatigue, depression and subjective vitality) in patients with RA following a 3 month exercise programme. Methods A RCT compared two 3 month exercise programmes. The control arm participants received a standard exercise referral programme. Patients in the experimental arm received an additional psychological intervention that aimed to foster basic need satisfaction through contacts with a SDT trained PA advisor. Participants completed the following validated measures at the end of the 3 month exercise programme; Psychological Need Satisfaction in Exercise Scale, Multidimensional Assessment of Fatigue Scale, Hospital Anxiety and Depressions Scales, and Subjective Vitality Scale. Results Preliminary analyses (N = 41 patients; Mage = 55.4 yrs) indicated that the intervention arm patients (N = 22) reported significantly greater competence need satisfaction [F (1,39) = 6.9, p = .01] than the control arm. Differences between arms for autonomy [F (1,39) = 3.63, p = .06] and relatedness [F (1,39) = .88, p = .36] favoured the intervention. Pearson correlation coefficients from all data revealed feelings of competence and relatedness after the exercise programme were significantly and negatively related to depressive symptoms (r = -.43, p = .006 and r = -.39, p = .02 respectively). Competence also demonstrated a significant positive relationship with subjective vitality (r = .42, p = .01) and a negative relationship with fatigue (r = -.49, p = .002) at the end of the 3 month exercise programme. Conclusions Results suggest that a SDT-grounded PA intervention promotes need satisfaction during exercise. In addition, need satisfaction is associated with reductions in fatigue and enhancements in psychological well-being in patients with RA. Subsequent work will examine follow-up effects at 6 and 12 months. Disclosure of Interest None Declared

ASSOCIATIONS BETWEEN OBJECTIVE AND SELF-REPORTED PHYSICAL ACTIVITY DATA IN RHEUMATOID ARTHRITIS PATIENTS

Background Rheumatoid arthritis (RA) patients suffer from periodic flare-ups causing joint swelling, pain and potential bone destruction. In addition, RA patient are at greater risk of cardiovascular disease. Therefore, physical activity (PA) has been identified as an important component of a holistic treatment programme [1]. However, research suggests that RA patients fail to reach the recommended PA levels to gain the associated benefits [2]. PA is typically assessed in the exercise literature with self-report measures or via accelerometery. To our knowledge, little is known about the associations between self-reported and objective PA measures in RA patients. Objectives To describe and compare the self-reported and objectively measured physical activity profiles of RA patients. Secondly, to investigate the associations between self-reported and objectively measured PA levels in RA patients. Methods 68 participants (42 female, 4 missing) wore an accelerometer (Actigraph) for an average of 6±1 days. The International Physical Activity Questionnaire (IPAQ) was also completed in reference to the same targeted time period. The associations between objective/self-reported PA levels were examined on sedentary time/total sitting time, light PA/walking, and moderate, vigorous PA and moderate-to-vigorous PA (MVPA) from both meassurements. Results Self-reported time spent sitting (M=343±141 minutes) was significantly less than objectively measured sedentary time (M=583±98; t=-13.12, p<0.01). Participants reported significantly more moderate intensity PA behaviour (M=86±83 minutes) than was objectively recorded (M=19±17 minutes; t=6.65, p<0.01), and more vigorous PA (M=10±37 minutes) than that revealed via accelerometry (M≤1 minute; t=2.14, p<0.01). Objective sedentary time was positively correlated with self-reported levels of sitting (r=0.29, p<0.05). Objective light PA was positively associated with self-reported MVPA (r=0.27, p<0.05). Objective moderate PA was also positively correlated to subjective walking time (r=0.28, p<0.05) and reported moderate PA (r=0.30, p<0.05). Conclusions Patients with RA reported engagement in significantly less sedentary time and significantly more physical activity than was objectively revealed via accelerometry. Despite the over-estimation of subjective PA and under-estimation of obejctive sedentary behaviour, the observed moderate significant associations provide some evidence of convergent validity for the IPAQ echoing findings from previous research [3]. The significant moderate correlation between self-reported MVPA and objective light PA suggests that RA patients may perceive PA to require more exertion. Therefore, the PA intensity guidelines may need to be re-considered for RA patients. References Feinglass J, Thompson JA, et al. Effect of physical activity on functional status among older middle-age adults with arthritis. Arthritis & Rheumatism 2005;53(6):879-885. Fontaine KR, Heo M, & Bathon J. Are US adults with arthritis meeting public health recommendations for physical activity? Arthritism & Rheumatis 2004;50(2):624-628. Boon RM, Hamlin MJ, Steel GD, & Ross JJ. Validation of the New Zealand Physical Activity Questionnaire (NZPAQ-LF) and the International Physical Activity Questionnaire (IPAQ-LF) with accelerometry. British Journal of Sports Medicine 2008;44(10):741-746 Acknowledgements Medical Research Council and NPRI. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5529

THE SUBJECTIVE VITALITY SCALE IS AN INDICATOR OF PHYSICAL AND PSYCHOLOGICAL HEALTH AMONGST RHEUMATOID ARTHRITIS PATIENTS

Background Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory arthritis characterized by periods of remission and flares in disease activity unique to each individual. Consequently, patients with RA experience fluctuations in both physical and psychological health and well-being (1). Subjective vitality is an indicator of positive health/optimal functioning and has been conceptualised as a sense of being alive and full of energy. Therefore, if the Subjective Vitality Scale (2) demonstrates convergent validity with indicators of physical and psychological health in RA patients, it could provide a brief and clinically relevant assessment tool. Objectives To investigate the associations between subjective vitality and indicators of physical health (i.e. physical function and cardio-respiratory fitness), and psychological health (i.e. quality of life, fatigue, depression and anxiety) amongst RA patients. Methods Patients with RA (N=106, age 54.5±12.3 years, 68% women) completed a questionnaire pack and an exercise tolerance test to assess cardio-respiratory fitness (VO2max).The Subjective Vitality Scale contains five items (e.g. “I feel alive and full of vitality”). Participants responded to how much vitality, over the last two weeks, they felt, using a scale anchored by 1 (not at all true) and 7 (very true). Participants were also asked to complete the following measures: Multidimensional Assessment of Fatigue to measure physical function, (3) Hospital Anxiety and Depression Scales, (4) Health Assessment Questionnaire to measure physical function (5) and the EuroQol (6). A blood sample was provided to measure C-reactive protein, an indicator of disease activity. Results Partial correlations were conducted controlling for age, gender and disease activity. Results revealed significant (p<0.05) positive relationships between subjective vitality and two indicators of physical health (function r=0.55 and fitness r=0.22). Significant relationships, in the expected direction, were also observed between subjective vitality and indicators of psychological health (Quality of Life r=0.60, Fatigue r= -0.66, Depression r= -0.73 and anxiety r= -0.57). Conclusions The Subjective Vitality Scale is a brief self-reported questionnaire that associates with improvements in both physical and psychological health amongst patients with RA. These significant associations support the convergent validity of the instrument. Healthcare professional could use the Subjective Vitality Scale to identify RA patients experiencing compromised physical health and well-being as well as provide an additional outcome measure to assess the effectiveness of treatment programmes. References Covic T, Cumming S, Pallant J, Manolios N, Emery P, Conaghan P, et al. Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry 2012;12(1):6. Ryan RM, Frederick C. On energy, personality, and health: Subjective vitality as a dynamic reflection of well-being. Journal of Personality 1997;65(3):529-65. Acknowledgements Medical Research Council and NPRI Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5037