Peter Rouse

In the beginning: Role of autonomy support on the motivation, mental health and intentions of participants entering an exercise referral scheme

Self-determination theory (Deci & Ryan, 2000, Intrinsic motivation and self-determination in human behaviour. New York: Plenum Publishing) highlights the impact autonomy supportive environments can have on exercise motivation and positive health outcomes. Yet little is known about whether differential effects occur as a function of which significant other is providing this support. Further, no research has examined the relationship between motivation and the social environment with participants’ mental health and intentions to be physically active before entering an exercise intervention. Study participants were 347 British adults who were about to start an exercise referral scheme. Regression analyses revealed that the effects of autonomy support on mental health and physical activity intentions differed as a function of who provided the support (offspring, partner or physician), with the offspring having the weakest effects. A structural model was supported, indicating that autonomy support and more autonomous regulations led to more positive mental health outcomes and stronger intentions to be physically active. Knowledge of the social environmental and personal motivation of those about to commence an exercise programme can provide important insights for professionals supporting such efforts.

Perceived Barriers, Facilitators and Benefits for Regular Physical Activity and Exercise in Patients with Rheumatoid Arthritis: A Review of the Literature

Rheumatoid arthritis (RA) is an autoimmune disease, which not only affects the joints but can also impact on general well-being and risk for cardiovascular disease. Regular physical activity and exercise in patients with RA have numerous health benefits. Nevertheless, the majority of patients with RA are physically inactive. This indicates that people with RA might experience additional or more severe barriers to physical activity or exercise than the general population. This narrative review provides an overview of perceived barriers, benefits and facilitators of physical activity and exercise in RA. Databases were searched for articles published until September 2014 using the terms ‘rheumatoid arthritis’, ‘physical activity’, ‘exercise’, ‘barriers’, ‘facilitators’, ‘benefits’, ‘motivation’, ‘motivators’ and ‘enablers’. Similarities were found between disease-specific barriers and benefits of physical activity and exercise, e.g. pain and fatigue are frequently mentioned as barriers, but reductions in pain and fatigue are perceived benefits of physical activity and exercise. Even though exercise does not influence the existence of barriers, physically active patients appear to be more capable of overcoming them. Therefore, exercise programmes should enhance self-efficacy for exercise in order to achieve long-term physical activity and exercise behaviour. Encouragement from health professionals and friends/family are facilitators for physical activity and exercise. There is a need for interventions that support RA patients in overcoming barriers to physical activity and exercise and help sustain this important health behaviour.

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

BackgroundThe National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT)-based exercise referral consultation.Methods/DesignDesign: An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT) exercise on prescription intervention.Participants: 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n = 7) or to the SDT-based intervention (n = 6).Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise.DiscussionThis trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes) via structural equation modelling.Trial registrationThe trial is registered as Current Controlled trials ISRCTN07682833.

Cardiorespiratory fitness levels and their association with cardiovascular profile in patients with rheumatoid arthritis: a cross-sectional study

OBJECTIVE The aim of this study was to investigate the association of different physical fitness levels [assessed by the maximal oxygen uptake (VO2max) test] with cardiovascular disease (CVD) risk factors in patients with RA. METHODS A total of 150 RA patients were assessed for cardiorespiratory fitness with a VO2max test and, based on this, were split in three groups using the 33rd (18.1 ml/kg/min) and 66th (22.4 ml/kg/min) centiles. Classical and novel CVD risk factors [blood pressure, body fat, insulin resistance, cholesterol, triglycerides, high-density lipoprotein (HDL), physical activity, CRP, fibrinogen and white cell count], 10-year CVD risk, disease activity (DAS28) and severity (HAQ) were assessed in all cases. RESULTS Mean VO2max for all RA patients was 20.9 (s.d. 5.7) ml/kg/min. The 10-year CVD risk (P = 0.003), systolic blood pressure (P = 0.039), HDL (P = 0.017), insulin resistance and body fat (both at P < 0.001), CRP (P = 0.005), white blood cell count (P = 0.015) and fibrinogen (P < 0.001) were significantly different between the VO2max tertiles favouring the group with the higher VO2max levels. In multivariate analyses of variance, VO2max was significantly associated with body fat (P < 0.001), HDL (P = 0.007), insulin resistance (P < 0.003) and 10-year CVD risk (P < 0.001), even after adjustment for DAS28, HAQ and physical activity. CONCLUSION VO2max levels are alarmingly low in RA patients. Higher levels of VO2max are associated with a better cardiovascular profile in this population. Future studies need to focus on developing effective behavioural interventions to improve cardiorespiratory fitness in RA.

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.

Measurement of Physical Activity and Energy Expenditure in Wheelchair Users: Methods, Considerations and Future Directions

Accurately measuring physical activity and energy expenditure in persons with chronic physical disabilities who use wheelchairs is a considerable and ongoing challenge. Quantifying various free-living lifestyle behaviours in this group is at present restricted by our understanding of appropriate measurement tools and analytical techniques. This review provides a detailed evaluation of the currently available measurement tools used to predict physical activity and energy expenditure in persons who use wheelchairs. It also outlines numerous considerations specific to this population and suggests suitable future directions for the field. Of the existing three self-report methods utilised in this population, the 3-day Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) telephone interview demonstrates the best reliability and validity. However, the complexity of interview administration and potential for recall bias are notable limitations. Objective measurement tools, which overcome such considerations, have been validated using controlled laboratory protocols. These have consistently demonstrated the arm or wrist as the most suitable anatomical location to wear accelerometers. Yet, more complex data analysis methodologies may be necessary to further improve energy expenditure prediction for more intricate movements or behaviours. Multi-sensor devices that incorporate physiological signals and acceleration have recently been adapted for persons who use wheelchairs. Population specific algorithms offer considerable improvements in energy expenditure prediction accuracy. This review highlights the progress in the field and aims to encourage the wider scientific community to develop innovative solutions to accurately quantify physical activity in this population.

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.

The development and validation of the interpersonal support in physical activity consultations observational tool

Abstract This study describes the development and psychometric characteristics of an observational instrument that examines four aspects of interpersonal support (or lack of) provided during physical activity (PA) promotion consultations (i.e., Autonomy Support, Involvement, Structure and Interpersonal Control), as identified by Self-determination Theory (SDT). The reliability and validity of the Interpersonal Support in Physical Activity Consultations Observational Tool (ISPACOT) were examined within an exploratory randomised control trial. Recorded consultations (N = 42) conducted by qualified PA advisors (N = 14) at 13 leisure centres across the West Midlands (UK) were rated. Intra-class correlation coefficients (ICC) indicated moderate to high inter-rater reliability for overall interpersonal support (0.80), and the Autonomy Support (0.74), Involvement (0.73) and Structure (0.91) dimensions, but low reliability for Interpersonal Control (0.35). The advisors, who conducted PA promotion consultations that were rated as low in their interpersonally supportive features, were perceived by their clients as being less supportive (F(1,10) = 5.0, p <.05). Ratings on the ISPACOT differentiated advisors who were trained in SDT principles and those who were not. Overall, the findings provided preliminary evidence for the reliability and convergent validity of the ISPACOT.

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

A meta-analysis of techniques to promote motivation for health behaviour change from a self-determination theory perspective

ABSTRACT A systematic review and meta-analysis was conducted of the techniques used to promote psychological need satisfaction and motivation within health interventions based on self-determination theory (SDT; Ryan & Deci, 2017. Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York, NY: Guilford Press). Eight databases were searched from 1970 to 2017. Studies including a control group and reporting pre- and post-intervention ratings of SDT-related psychosocial mediators (namely perceived autonomy support, need satisfaction and motivation) with children or adults were included. Risk of bias was assessed using items from the Cochrane risk of bias tool. 2496 articles were identified of which 74 met inclusion criteria; 80% were RCTs or cluster RCTs. Techniques to promote need supportive environments were coded according to two established taxonomies (BCTv1 and MIT), and 21 SDT-specific techniques, and grouped into 18 SDT based strategies. Weighted mean effect sizes were computed using a random effects model; perceived autonomy support g = 0.84, autonomy g = 0.81, competence g = 0.63, relatedness g = 0.28, and motivation g = 0.41. One-to-one interventions resulted in greater competence satisfaction than group-based (g = 0.96 vs. 0.28), and competence satisfaction was greater for adults (g = 0.95) than children (g = 0.11). Meta-regression analysis showed that individual strategies had limited independent impact on outcomes, endorsing the suggestion that a need supportive environment requires the combination of multiple co-acting techniques.