Relationship between beliefs, motivation, and worries about physical activity and physical activity participation in persons with rheumatoid arthritis.

Among persons with arthritis, engaging in physical activity can help maintain or increase mobility, improve function, decrease pain, and decrease disability.1 Many individuals with arthritis are sedentary.2 Less than 25% of US adults engages in the amount of physical activity recommended by the Centers for Disease Control and Prevention (CDC) and the American Academy of Sports Medicine.3 A sedentary lifestyle is associated with cardiovascular disease, osteoporosis, decline in physical function (strength, endurance, flexibility), and an increased risk of all-cause mortality.4,5 Many people with rheumatoid arthritis (RA) are active at a level considered too low to maintain good health,6 and physically inactive people with RA have significantly worse cardiovascular disease risk compared to those who are active.6 Persons with arthritis may have disease-related reasons for their low activity levels. For example, joint symptoms have been cited as a barrier to exercise, a special subset of general physical activity.2 Lack of advice from health care providers to be physically active and lack of available arthritis-specific exercise programs have been identified as needs.7 Inactivity in persons with arthritis has also been associated with older age, lower education and having functional limitations. Additionally, inactivity has been associated with having anxiety or depression and needing special equipment for activity participation.2 To describe and assess the multiple influences on persons with arthritis’ physical activity participation, we applied the Interaction Model of Client Health Behavior (IMCHB) which incorporates both intrapersonal and contextual variables (see Figure 1).The model has been used successfully to explain a wide variety of health behaviors8–10 and to identify the moderators and mediators of behaviorally-related health outcomes.11–13 We used indicators of modifiable cognitive (beliefs), motivation (perceived competence), and affective (worries) constructs within the IMCHB to examine their potential association with physical activity participation in our study sample. Figure 1 Physical Activity Framework based on the Interaction Model of Client Health Behavior (IMCHB) revised 2003. Adapted with permission of the Oncology Nursing Society. From Cox, CL. (2003). A model of health behavior to guide studies of childhood cancer survivors. ... The IMCHB shares several concepts in common with other health behavior models, such as the Health Belief Model, Transtheoretical Model, and Social Learning Theory. A more extensive discussion of how these models informed the IMCHB can be found at (Cox, 1982)14. The IMCHB is broader in theoretical scope than Bandura’s model as it contains both motivation and affect as constructs separate and distinct from cognitive processing variables. In addition, self-efficacy is only one component of intrinsic motivation; other components that contribute to motivation and which can be targets for intervention include choice, autonomy, and self-determinism. The interrelationships between beliefs, motivation, and worries are complex. Each factor contributes to behavior change; they are measurable and can be manipulated. The development of interventions that target these potential predictors, moderators and/or mediators of physical activity have the potential to increase physical activity participation. Beliefs about the benefits of physical activity15 must be informed by an understood rationale for performing the behavior; this rationale includes simultaneous beliefs of the benefits of performing the behavior and the consequences of not performing the behavior. Positive health beliefs and knowledge10 ultimately help the person to formulate goals and to establish a sense of competency for engaging in a behavior. Goal setting and the belief that one has the skills to engage in the prescribed behavior represent the foundation for motivation to participate in the behavior.16 Finally, a positive affect related to the behavior and or consequences of the behavior is the third component that supports behavior change. The elimination of fears, worries, or concerns about participating in the behavior ultimately is derived from positive health beliefs and adequate knowledge about the benefits and risks of behavior participation.14 Currently, there is a knowledge gap in persons with RA regarding the relationship between beliefs, motivation, and worries about physical activity in relation to physical activity participation. The objective of this study is to determine if higher perceptions of beliefs that physical activity can be beneficial (cognitive appraisal), higher motivation for physical activity (perceived competence), and higher levels of worry that not doing physical activity can be detrimental (affective response) are associated with higher levels of physical activity participation in a sample of patients with RA.