Assessing moderate-to-vigorous physical activity in hip and knee osteoarthritis using accelerometers: Implications of different patterns and cut-points for health and well-being.

OBJECTIVE: This cross-sectional study explored how using age-specific and non-age-specific cut-points to assess moderate-to-vigorous physical activity (MVPA) measured by GT3X accelerometers affected bouted and total volume MVPA associations with health and well-being. METHODS: MVPA correlations with physical function, BMI, joint pain, quality of life, anxiety and depression were tested. Steiger's z compared the strength of these correlations for each pair of cut-points. RESULTS: A total of 109 adults with hip/knee osteoarthritis [M= 63.8 years (±10.58), 63.3% women] participated. Applying age-specific cut-points resulted in significantly more time classified as MVPA (76/9.5min total volume/bouted) compared to non-age-specific (38.8/7min total volume/bouted). Only total volume MVPA correlations differed significantly as a function of cut-points for self-reported function, quality of life, anxiety and depression (p ≤ .05). For age-specific cut-points, more time spent in MVPA was associated with a worse psychological profile. DISCUSSION: Applying age-specific cut-points for MVPA assessment in older adults with lower limb OA had implications for MVPA associations with health and well-being when total volume, but not bouted, MVPA was considered. Age-specific total volume MVPA needs further understanding regarding patterns and affective responses it comprises. Bouted MVPA is an important pattern for MVPA accrual, but probably not an applicable PA target for many patients.

Pain and fatigue are longitudinally and bi-directionally associated with more sedentary time and less standing time in rheumatoid arthritis.

OBJECTIVES: The aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA. METHODS: People living with RA undertook identical assessments at baseline (T1, n = 104) and 6-month follow-up (T2, n = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to assess physical function (HAQ), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). Participants' free-living sedentary, standing and stepping time (min/day) were assessed over 7 days using the activPAL3µ™. For the statistical analysis, hierarchical regression analysis was employed to inform the construction of path models, which were subsequently used to examine bi-directional associations of pain and fatigue with sedentary, standing and stepping time. Specifically, where significant associations were observed in longitudinal regression analysis, the bi-directionality of these associations was further investigated via path analysis. For regression analysis, bootstrapping was applied to regression models to account for non-normally distributed data, with significance confirmed using 95% CIs. Where variables were normally distributed, parametric, non-bootstrapped statistics were also examined (significance confirmed via ß coefficients, with P < 0.05) to ensure all plausible bi-directional associations were examined in path analysis. RESULTS: Longitudinal bootstrapped regression analysis indicated that from T1 to T2, change in pain, but not fatigue, was positively associated with change in sedentary time. In addition, change in pain and fatigue were negatively related to change in standing time. Longitudinal non-bootstrapped regression analysis demonstrated a significant positive association between change in fatigue with change in sedentary time. Path analysis supported the hypothesized bi-directionality of associations between change in pain and fatigue with change in sedentary time (pain, ß = 0.38; fatigue, ß = 0.44) and standing time (pain, ß = -0.39; fatigue, ß = -0.50). CONCLUSION: Findings suggest pain and fatigue are longitudinally and bi-directionally associated with sedentary and standing time in RA.

Different types of physical activity are positively associated with indicators of mental health and psychological wellbeing in rheumatoid arthritis during COVID-19.

Nationwide lockdowns during SARS-CoV-2 (COVID-19) can compromise mental health and psychological wellbeing and limit opportunities for physical activity (PA), particularly in clinical populations, such as people with rheumatoid arthritis (RA), who are considered at risk for COVID-19 complications. This study aimed to investigate associations between PA and sedentary time (ST) with indicators of mental health and wellbeing in RA during COVID-19 lockdown, and examine the moderation effects of self-isolating. 345 RA patients completed an online questionnaire measuring PA (NIH-AARP Diet and Health Study Questionnaire), ST (International Physical Activity Questionnaire-Short Form), pain (McGill Pain Questionnaire and Visual Analogue Scale), fatigue (Multidimensional Fatigue Inventory), depressive and anxious symptoms (Hospital Anxiety and Depression Scale), and vitality (Subjective Vitality Scale) during the United Kingdom COVID-19 lockdown. Associations between PA and ST with mental health and wellbeing were examined using hierarchical multiple linear regressions. Light PA (LPA) was significantly negatively associated with mental fatigue (ß = - .11), depressive symptoms (ß = - .14), and positively with vitality (ß = .13). Walking was negatively related to physical fatigue (ß = - .11) and depressive symptoms (ß = - .12) and positively with vitality (ß = .15). Exercise was negatively associated with physical (ß = - .19) and general (ß = - .12) fatigue and depressive symptoms (ß = - .09). ST was positively associated with physical fatigue (ß = .19). Moderation analyses showed that LPA was related to lower mental fatigue and better vitality in people not self-isolating, and walking with lower physical fatigue in people self-isolating. These findings show the importance of encouraging PA for people with RA during a lockdown period for mental health and wellbeing.

Measurement of sedentary time and physical activity in rheumatoid arthritis: an ActiGraph and activPAL™ validation study.

Accurate measurement of sedentary time and physical activity (PA) is essential to establish their relationships with rheumatoid arthritis (RA) outcomes. Study objectives were to: (1) validate the GT3X+ and activPAL3µ™, and develop RA-specific accelerometer (count-based) cut-points for measuring sedentary time, light-intensity PA and moderate-intensity PA (laboratory-validation); (2) determine the accuracy of the RA-specific (vs. non-RA) cut-points, for estimating free-living sedentary time in RA (field-validation). Laboratory-validation: RA patients (n = 22) were fitted with a GT3X+, activPAL3µ™ and indirect calorimeter. Whilst being video-recorded, participants undertook 11 activities, comprising sedentary, light-intensity and moderate-intensity behaviours. Criterion standards for devices were indirect calorimetry (GT3X+) and direct observation (activPAL3µ™). Field-validation: RA patients (n = 100) wore a GT3X+ and activPAL3µ™ for 7 days. The criterion standard for sedentary time cut-points (RA-specific vs. non-RA) was the activPAL3µ™. Results of the laboratory-validation: GT3X-receiver operating characteristic curves generated RA-specific cut-points (counts/min) for: sedentary time = ≤ 244; light-intensity PA = 245-2501; moderate-intensity PA ≥ 2502 (all sensitivity ≥ 0.87 and 1-specificity ≤ 0.11). ActivPAL3µ™-Bland-Altman 95% limits of agreement (lower-upper [min]) were: sedentary = (- 0.1 to 0.2); standing = (- 0.7 to 1.1); stepping = (- 1.2 to 0.6). Results of the field-validation: compared to the activPAL3µ™, Bland-Altman 95% limits of agreement (lower-upper) for sedentary time (min/day) estimated by the RA-specific cut-point = (- 42.6 to 318.0) vs. the non-RA cut-point = (- 19.6 to 432.0). In conclusion, the activPAL3µ™ accurately quantifies sedentary, standing and stepping time in RA. The RA-specific cut-points offer a validated measure of sedentary time, light-intensity PA and moderate-intensity PA in these patients, and demonstrated superior accuracy for estimating free-living sedentary time, compared to non-RA cut-points.

Initial psychometric testing of the coach-adapted version of the empowering and disempowering motivational climate questionnaire: A Bayesian approach.

The present study examined the psychometric properties of the coach-adapted version of the Empowering and Disempowering Motivational Climate Questionnaire (EDMCQ) using Bayesian structural equation modelling (BSEM). The sample included 780 (Mage = 36.4; SD = 10.8; males n = 698; females n = 54; 28 participants did not report sex) youth sport coaches representing five European countries (i.e., England, France, Greece, Norway, and Spain). The results did not support a 34-item five-factor, hierarchical, a two-factor BSEM, or a bifactor BSEM model across the participating countries. However, the results supported a reduced 19-item first-order, two-factor BSEM model that largely showed approximate metric invariance, but not approximate scalar invariance across the five countries. The pool of items constituting empowering and disempowering motivational climates should be refined to further enhance the empirical operationalisation of the coach-adapted version of the EDMCQ. Advancing the quality of translation-back-translation procedures across cultures and conducting multi-national pilot testing seems warranted as well. These recommendations may help to identify the distinctive aspects of each underlying sub-dimension of the EDMCQ, where coaches are the respondents, and pave the way for further examination of the proposed hierarchical multidimensional factor structure and the cross-cultural equivalence of the EDMCQ for this population.

Sedentary behaviour in rheumatoid arthritis: definition, measurement and implications for health.

RA is a chronic autoimmune disease characterized by high grade-inflammation, and associated with elevated cardiovascular risk, rheumatoid-cachexia and functional impairment. Sedentary behaviour (SB) is linked to heightened inflammation, and is highly pervasive in RA, likely as a result of compromised physical function and persistent fatigue. This high sedentarity may exacerbate the inflammatory process in RA, and hold relevance for disease-related outcomes. The aim of this narrative review is to provide an overview of the definition, measurement and health relevance of SB in the context of RA. Contradictions are highlighted with regard to the manner in which SB is operationalized, and the significance of SB for disease outcomes in RA is outlined. The advantages and disadvantages of SB measurement approaches are also discussed. Against this background, we summarize studies that have reported SB and its health correlates in RA, and propose directions for future research.

Sitting time is negatively related to microvascular endothelium-dependent function in rheumatoid arthritis.

BACKGROUND: Sedentary behaviour is linked to increased cardiovascular disease risk in Rheumatoid Arthritis (RA), but the biological processes underlying this relationship are not understood. OBJECTIVES: To investigate the cross-sectional associations of habitual sedentary behaviour, with endothelial function in RA. METHODS: Sixty-eight RA patients (Mage = 55 ±â€¯12 years) underwent Laser Doppler Imaging with iontophoresis, to assess microvascular endothelium-dependent (acetylcholine, ACh) and endothelium-independent (sodium nitroprusside, SNP) function. Large-vessel endothelium-dependent and endothelium-independent functions were measured via flow-mediated dilation (FMD) and glyceryl trinitrate dilation (GTN), respectively. Habitual sedentary behaviour (hours/week sitting) was self-reported (International Physical Activity Questionnaire). RESULTS: Regressions revealed sitting time significantly negatively predicted microvascular endothelium-dependent function (ACh, unstandardizedß = -3.25, p = .02, 95% CI [-6.07, -.42], R2 = 0.06), but did not associate with other endothelial function outcomes (SNP, FMD, GTN). CONCLUSION: Habitual sedentary behaviour (sitting time) appears to be adversely linked to microvascular endothelium-dependent function among people living with RA.

Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity.

BACKGROUND: Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). The physical dysfunction symptomatic of RA means people living with this disease spend large periods of the day sedentary, which may further elevate their risk of CVD. The primary aim of this study was to investigate relationships between objectively assessed sedentary behaviour patterns and light physical activity (LPA) with 10-year risk of CVD. Secondary aims were to explore the role of sedentary behaviour patterns and LPA for individual CVD risk factors and functional disability in RA. The extent to which associations were independent of moderate-to-vigorous physical activity (MVPA) engagement was also examined. METHODS: Baseline data from a subsample of participants recruited to the Physical Activity in Rheumatoid Arthritis (PARA) study were used to answer current research questions. Sixty-one patients with RA (mean age (± SD) = 54.92 ± 12.39 years) provided a fasted blood sample and underwent physical assessments to evaluate factors associated with their cardiovascular health. Sedentary behaviour patterns (sedentary time, sedentary bouts, sedentary breaks), LPA and MVPA were measured via 7-days of accelerometry. Ten-year CVD risk was computed (Q-risk-score2), and functional disability determined via questionnaire. RESULTS: Regressions revealed significant positive associations between sedentary time and the number of sedentary bouts per day ≥20 min with 10-year CVD risk, with the reverse true for LPA participation. Associations were independent of MVPA engagement. CONCLUSIONS: Promoting LPA participation and restricting sedentary bouts to <20 min may attenuate long-term CVD risk in RA, independent of MVPA engagement. TRIAL REGISTRATION: ISRCTN04121489 (retrospectively registered 19/10/2012).

Observing the coach-created motivational environment across training and competition in youth sport.

Adopting an integrated achievement goal (Nicholls, J. G. (1989). The competitive ethos and democratic education. Cambridge, MA: Harvard University Press.) and self-determination theory (Deci, E. L., & Ryan, R. M. (2000). The "what" and "why" of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11, 227-268. doi:10.1207/S15327965PLI1104_01) perspective as proffered by Duda, J. L. (2013). (The conceptual and empirical foundations of empowering coachingTM: Setting the stage for the PAPA project. International Journal of Sport and Exercise Psychology, 11, 311-318. doi:10.1080/1612197X.2013.839414), the aim of the current study was to observe empowering and disempowering features of the multidimensional motivational coaching environment in training and competition in youth sport. Seventeen grass-roots soccer coaches were observed and rated in training and competitive settings using the multidimensional motivational climate observation system (MMCOS; Smith, N., Tessier, D., Tzioumakis, Y., Quested, E., Appleton, P., Sarrazin, P., … Duda, J. L. (2015). Development and validation of the multidimensional motivational climate observation system (MMCOS). Journal of Sport and Exercise Psychology, 37, 4-22. doi:10.1123/jsep.2014-0059). In line with our hypotheses, coaches created different motivational environments in the two contexts. More specifically, coaches were observed to create a less empowering and more disempowering environment in competition compared to in training. The observed differences were underpinned by distinctive motivational strategies used by coaches in the two contexts. Findings have implications for the assessment of the coach-created motivational environment and the promotion of quality motivation for young athletes taking part in grass-roots-level sport.

Predicting athletes' functional and dysfunctional emotions: The role of the motivational climate and motivation regulations.

This study examined the relationships between perceptions of the motivational climate, motivation regulations, and the intensity and functionality levels of athletes' pleasant and unpleasant emotional states. Specifically, we examined the hypothesised mediational role of motivation regulations in the climate-emotion relationship. We also tested a sequence in which emotions were assumed to be predicted by the motivational climate dimensions and then served as antecedents to variability in motivation regulations. Participants (N = 494) completed a multi-section questionnaire assessing targeted variables. Structural equation modelling (SEM) revealed that a perceived task-involving climate was a positive predictor of autonomous motivation and of the impact of functional anger, and a negative predictor of the intensity of anxiety and dysfunctional anger. Autonomous motivation was a partial mediator of perceptions of a task-involving climate and the impact of functional anger. An ego-involving climate was a positive predictor of controlled motivation, and of the intensity and impact of functional anger and the intensity of dysfunctional anger. Controlled motivation partially mediated the relationship between an ego-involving climate and the intensity of dysfunctional anger. Good fit to the data also emerged for the motivational climate, emotional states, and motivation regulations sequence. Findings provide support for the consideration of hedonic tone and functionality distinctions in the assessment of athletes' emotional states.

Sedentary behaviour in people with multiple sclerosis: Is it time to stand up against MS?

Historically, people with multiple sclerosis (MS) have been considered sedentary, although the actual scientific study of sedentary behaviour in MS did not originate until 2011. Sedentary behaviour, which is conceptually distinct from physical inactivity, is defined as any waking activity characterised by an energy expenditure ⩽ 1.5 metabolic equivalents and in a sitting or reclining posture. In the general population, the volume of sitting time is associated with increased risks of morbidity and mortality, independent of physical activity, and has been suggested to carry a greater risk of mortality than smoking behaviour. There are many symptoms of MS (e.g. mobility disability and fatigue) that could increase the prevalence of sedentary behaviour, and sedentary behaviour may have considerable implications for the development of comorbid conditions prevalent in MS. This review provides a summary of the rates, correlates, consequences and interventions attempting to reduce sedentary behaviour in MS. We provide a research agenda that guides future research on sedentary behaviour in MS. This paper provides a clarion call that it is time to 'stand up against MS'.

Factors associated with parasympathetic activation following exercise in patients with rheumatoid arthritis: a cross-sectional study.

BACKGROUND: Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) with poor parasympathetic function being implicated as an underlying factor. Factors related to parasympathetic function, commonly assessed by heart rate recovery (HRR) following maximal exercise, are currently not known in RA. We aimed to explore the association between HRR with CVD risk factors, inflammatory markers, and wellbeing in patients with RA. METHODS: Ninety-six RA patients (54.4 ± 12.6 years, 68 % women) completed a treadmill exercise test, during which heart rate (HR) was monitored. HRR1 and HRR2 were defined as the absolute change from HR peak to HRR 1 min post HR peak and 2 min post HR peak, respectively. Cardiorespiratory fitness, CVD risk factors, and serological markers of inflammation were measured in all patients. The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD events, and wellbeing was assessed by questionnaires. RESULTS: Mean HRR1 and HRR2 were 29.1 ± 13.2 bpm and 46.4 ± 15.3 bpm, respectively. CVD risk factors as well as most inflammatory markers and measures of wellbeing were inversely correlated with HRR1 and HRR2. Multivariate regression analyses revealed that 27.9 % of the variance in HRR1 and 37.9 % of the variance in HRR2 was explained collectively by CVD risk factors, measures of inflammation, and wellbeing (p = 0.009, p = 0.001 respectively), however no individual measure was independently associated with HRR1 or HRR2. CONCLUSION: Parasympathetic activation was associated with overall CVD risk, arthritis-related burden and wellbeing in patients with RA. TRIAL REGISTRATION: [Exercise, cardiovascular disease and rheumatoid arthritis, ISRCTN04121489 ].

Optimising physical activity engagement during youth sport: a self-determination theory approach.

Research suggests participation in youth sport does not guarantee physical activity (PA) guidelines are met. Studies indicate few children achieve recommended levels of moderate-to-vigorous physical activity (MVPA) during their youth sport involvement, and habitual levels of MVPA are below the recommended 60 min per day. Informed by self-determination theory, this study examined whether the coach-created social environment and related player motivation predict variability in objectively measured MVPA within the youth sport setting. Seventy three male youth sport footballers (Mean age = 11.66 ± 1.62) completed a multisection questionnaire assessing their perceptions of the social environment created in youth sport (autonomy supportive and controlling) and motivation towards their football participation (autonomous and controlled). Intensity of PA during youth sport was measured using accelerometers (GT3X, ActiGraph). Results supported a model in which perceptions of autonomy support significantly and positively predicted autonomous motivation towards football, which in turn significantly and positively predicted youth sport MVPA (% time). A significant indirect effect was observed for perceptions of autonomy support on youth sport %MVPA via autonomous motivation. Results have implications for optimising MVPA engagement during youth sport and increasing daily MVPA towards recommended and health-enhancing levels on youth sport days.

Inter-participant variability in daily physical activity and sedentary time among male youth sport footballers: independent associations with indicators of adiposity and cardiorespiratory fitness.

Participation in youth sport is assumed to promote and contribute towards more physically active lifestyles among children and adolescents. The aim of this study was to examine inter-participant variability in objectively measured habitual physical activity (PA) behaviours and sedentary time among youth sport participants and their implications for health. One-hundred-and-eighteen male youth sport footballers (Mean ± s = 11.72 ± 1.60) wore a GT3X accelerometer for 7 days. Average daily PA [min · day(-1), in light (LPA), moderate (MPA), vigorous (VPA) and combined moderate-to-vigorous (MVPA)] and sedentary time were calculated. Participants' body mass index adjusted for age and sex (BMI-standard deviation score), per cent body fat (BF%), waist circumference and cardiorespiratory fitness were assessed. Results revealed that variability in daily PA behaviours and sedentary time (min · day(-1)) was associated with BMI-standard deviation score [VPA (-), MVPA (-)], BF% [sedentary time (+), VPA (-), MVPA (-)], waist circumference [sedentary time (+), LPA (-)] and cardiorespiratory fitness [sedentary time (-), MPA (+), VPA (+), MVPA (+)]. Whilst sedentary time and MVPA were not related to health outcomes independent of one another, associations with markers of adiposity and cardiorespiratory fitness were stronger for sedentary time. Sedentary time was also significantly positively related to waist circumference independent of VPA. Results demonstrate inter-participant variability in habitual PA and sedentary time among youth sport participants which holds implications for their health. Thus, promoting PA and, in particular, reducing sedentary time may contribute towards the prevention of adverse health consequences associated with a physically inactive lifestyle for children and adolescents active in the youth sport context.

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.

The Contribution of Youth Sport Football to Weekend Physical Activity for Males Aged 9 to 16 Years: Variability Related to Age and Playing Position.

The aims of this study were (1) to determine minutes of moderate-to-vigorous physical activity (PA) and vigorous PA accrued in youth sport football (also internationally referred to as soccer), and the contribution toward daily weekend moderate-to-vigorous PA and vigorous PA for males aged 9-16 years, and (2) to investigate variability in these outcomes related to age and playing position. One hundred and nine male grassroots footballers (Mean age = 11.98 ± 1.75 years) wore a GT3× accelerometer for 7 days. Weekend youth sport football participation and playing position were recorded. Youth sport football moderate-to-vigorous PA (M = 51.51 ± 17.99) and vigorous PA (M = 27.78 ± 14.55) contributed 60.27% and 70.68% toward daily weekend moderate-to-vigorous PA and vigorous PA, respectively. Overall, 36.70% of participants accumulated ≥60 min moderate-to-vigorous PA and 69.70% accrued ≥ 20 min of vigorous PA during youth sport. For participants aged 13 to16 years, youth sport football moderate-to-vigorous PA and vigorous PA were significantly higher, and contributed a greater amount toward daily weekend moderate-to-vigorous PA and vigorous PA than for participants aged 9-12 years (p = <.01). Youth sport football is an important source of moderate-to-vigorous PA and vigorous PA at the weekend for male youth, and particularly for adolescents. Participation may offer opportunity for weekend engagement in vigorous PA toward health enhancing levels.

Development and validation of the multidimensional motivational climate observation system.

This article outlines the development and validation of the Multidimensional Motivational Climate Observation System (MMCOS). Drawing from an integration of the dimensions of the social environment emphasized within achievement goal theory and self-determination theory (as assumed within Duda's [2013] conceptualization of "empowering" and "disempowering" climates), the MMCOS was developed to enable an objective assessment of the coach-created motivational environment in sport. Study 1 supported the initial validity and reliability of the newly developed observation system. Study 2 further examined the interobserver reliability and factorial structure of the MMCOS. Study 3 explored the predictive validity of the observational system in relation to athletes' reported basic psychological need satisfaction. Overall, the results of these studies provide preliminary support for the inter- and intraobserver reliability, as well as factorial and predictive validity of the MMCOS. Suggestions for the use of this observational system in future research in sport are provided.

Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial.

BACKGROUND: The National Institute for Health and 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 feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. METHODS: An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres.Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.Blood pressure and weight were assessed at baseline and 6 months. RESULTS: Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. CONCLUSIONS: Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise referral and the SDT-based intervention at programme end. At 6-months, observed between arm and within intervention arm differences for indicators of emotional health, and the results of the process model, were in line with SDT. The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed. TRIAL REGISTRATION: The trial is registered as Current Controlled trials ISRCTN07682833.

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

BACKGROUND: People 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/DESIGN: This 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. DISCUSSION: Results 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.

Physical activity adoption to adherence, lapse, and dropout: a self-determination theory perspective.

Grounded in Self-Determination Theory, we aimed to explore and identify key motivational processes involved in the transition from a physically inactive to an active lifestyle, and the processes involved in lapse and dropout behavior within a walking program. We implemented a qualitative, longitudinal case study method, using semistructured interviews and theoretical thematic analyses. Fifteen women were interviewed over 10 months and three profiles were generated: (a) nonadherence, (b) lapse/readoption of physical activity, and (c) adherence. Internalization of walking behavior was key to adherence. Satisfaction of the needs for competence and relatedness were central for participation during exercise at the adoption stages, and autonomy was particularly pertinent in facilitating adherence. Those who lapsed and restarted physical activity experienced feelings of autonomy at the point of readoption. Sources of support were driving forces in the adoption and adherence phases.