Rheumatoid Arthritis

Transcription

1 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 nd 2015

2 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

3 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

4 Motivating physical activity in RA: Self-determination theory Self-determination Theory (Deci and Ryan, 1987) the why of motivation Autonomy support Autonomy Competence Relatedness M O T I V A T I O N Autonomous motivation High Low Controlled motivation Cognitive, affective and behavioural outcomes (e.g., PA/exercise) Promotes choice and understanding Provides rationale Input into decision making Considers the individual s point of view Positive association Negative association

5 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) = years Mean duration of RA = years 84% White British

6 The Physical Activity in Rheumatoid Arthritis (PARA) Study: Intervention design Both arms Prescribed a 3 month exercise programme at the local gym Tailored for the individual recognised RA and its constraints Intervention arm One on one consultations with physical activity advisor Physical Activity Advisor Trained in major principles of SDT/need supportive strategies to promote physical activity Same advisor for all intervention participants

7 Randomisation and measurement time scale Pre-Baseline T1 Baseline T2 T3 1 Month 2 Months 3 Months 5 Months 6 Months T4 12 Months Recruitment & Consent Experimental SDT- Based Consultation Randomisation Control Information Pack Protocol paper - BMC Musculoskeletal Disorders 2014, 15:445

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9 Randomisation and measurement time scale Pre-Baseline T1 Baseline T2 T3 1 Month 2 Months 3 Months 5 Months 6 Months T4 12 Months Recruitment & Consent Experimental Randomisation SDT- Based Consultation 3 Month Exercise Programme Action Heart Telephone Consultation Telephone Consultation Exit Consultation Telephone Consultation Outcome variables 1. Cardiovascular (e.g., VO 2 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) Control Information Pack 3 Month Exercise Programme Dudley Leisure Centre Participants retained for 3 month follow up (T2) N = 31 (26.96%) Intervention/control, N = 20/10 (psychological measures and accelerometer data) Protocol paper - BMC Musculoskeletal Disorders 2014, 15:445

10 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

11 Results: Intervention effects on competence need satisfaction at Time 2 (3 months) Competence need satisfaction at exercise programme end (T2) Competence need satisfaction Likert scale (1 6) * * P <.05 0 Intervention Control Significant interaction effect [F (1,30) = 5.91, p <.05, η 2 =.16] Participants in the intervention group reported significantly higher competence need satisfaction at Time 2

12 Results: Motivational processes and MVPA PA advisor autonomy support 3 months (T2) Exercise programme end Competence need.63** satisfaction.37* 3 months (T2) Exercise programme end Change in autonomous motivation (T1-T2) Baseline to exercise programme end.48* MVPA (min/day) T2 Exercise programme end * P <.05 ** P <.01 Positive association Autonomy support Autonomy Competence Relatedness Autonomous motivation Controlled motivation Physical activity and/or exercise

13 Results: Group differences in moderate physical activity Changes in moderate physical activity (min/day) from baseline to 12 month follow up Moderate physical activity (min/day) 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]

14 Conclusions and implications Autonomy support from the physical activity advisors fostered adaptive motivational processes for behaviour change among this patient group Fostering autonomous motivation towards physical activity may have positive implications for promoting engagement in moderate-tovigorous physical activity among RA patients Analysis of follow up data will determine implications for longer term adherence to participation in physical activity

15 Conclusions and implications 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 Strategy Social environment Autonomy Competence Relatedness M O T I V A T I O N Autonomous motivation High Low Controlled motivation Outcome Cognitive, affective and behavioural outcomes (e.g., PA/exercise)

16 Thank you for listening Sally Fenton, PhD School of Sport, Exercise and Rehabilitation Sciences University of Birmingham September 2015