A intervention fostering autonomous motivation, physical activity and cardiovascular fitness in rheumatoid arthritis

People with rheumatoid arthritis (a disease that affect the joints) develop heart disease more often than average. Physical activity can reduce heart problems, and there are many exercise programmes available for people with higher risk for heart disease. Unfortunately, people with rheumatoid arthritis are often not included in these programmes. This is most likely because both the people with arthritis and the people who should be referring the people with arthritis think that exercise will make the arthritis worse. There is a lot of evidence that exercise can be beneficial to arthritis patients. Getting these people to exercise is an important issue, however, keeping them physically active after the supervised exercise programme has stopped is also another important factor. In this study proposal we will design a psychological intervention to help people with rheumatoid arthritis to start exercise, and more importantly to motivate them to keep on exercising when the 3-month programme will stop. The exercise programme will be developed specifically for each participant. We will compare this exercise plus psychological intervention with a programme that will involve exercise only. We will then test if those who have the a 3-month supervised exercise programme combined with the psychological intervention, have better physical and psychological health over 1 year, compared to those who follow the same exercise programme but without the psychological intervention. We are specifically interested to see if there are any differences in the amount of physical activity and psychological well-being at 6 months and one year after the start of the study, and what the effects of the (hopefully increased) levels of physical activity are on the risk for heart disease.

Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. The beneficial effects of physical activity (PA) on physical and psychological health are well documented in both normal and clinical populations, including RA patients. In clinical populations, exercise promotion has been primarily carried out via supervised, hospital-based exercise programmes; although these exhibit short-term effects, there is no compelling evidence for sustained long-term improvements. Regardless of the known beneficial effects of PA, patients with RA tend to lead a sedentary lifestyle, due to fear of disease aggravation and lack of encouragement by health professionals. Thus, it is important to develop psychological interventions that optimise the motivation to adopt as well as maintain PA in this population.

Grounded in Self-Determination Theory (SDT), a psychological intervention will be developed and evaluated that centres on fostering more autonomous reasons for PA engagement. Autonomy support for PA will be provided via one-on-one exercise consultations with a counsellor trained up in SDT-based behavioural change strategies. Autonomy support will also be offered by exercise instructors during supervised exercise sessions. SDT proposes that autonomy-supportive interactions with significant others contribute to satisfaction of the needs for competence, autonomy, and relatedness. This, in turn, improves an individual?s autonomous motivation towards the behaviour at hand (e.g., PA). The impact of the intervention on the magnitude and sustainability of PA engagement, as well as PA-induced cardiovascular, physical function and QOL/mental health adjustments in patients with RA will be assessed. The patients will be randomly allocated to either a conventional 3-month individualised exercise programme (control group) or a 3-month individualised exercise programme combined with the psychological intervention (experimental group). Following the exercise programme, all patients will be left to their own devices to continue PA but either brief telephone-based autonomy-centred support (experimental arm) or more standard encouragement to maintain PA levels (control arm) will take place two months following the cessation of the exercise programme. Six months and one year following the start of the exercise programme, the two groups of patients will be compared on cardiovascular, self-reported PA (and objective PA, in a sub-sample), psychosocial/motivational, and RA-related outcomes. It is hypothesised that patients in the experimental group will have a better cardiovascular profile and exhibit greater psychological well-being at the 6 and 12 ms follow ups than those in the control group, due to enhanced autonomous motivation and better maintenance of PA after the initial supervised exercise programme.