A proof-of-concept study on the impact of a chronic pain and physical activity training workshop for exercise professionals.

OBJECTIVES: Physical activity is essential for long-term chronic pain management, yet individuals struggle to participate. Exercise professionals, including fitness instructors, and personal trainers, are preferred delivery agents for education and instruction on chronic pain, physical activity, and strategies to use adherence-promoting behavioral skills. However, exercise professionals receive no relevant training during certification or continuing education opportunities to effectively support their participants living with chronic pain. Based on the ORBIT model for early pre-efficacy phases of development and testing of new behavioral treatments, the present Phase IIa proof-of-concept study was conducted. The purpose was to examine the impacts of a newly developed chronic pain and physical activity training workshop on psychosocial outcomes among exercise professionals. Outcomes included knowledge and attitudes regarding chronic pain, attitudes and beliefs about the relationship between pain and impairment, and self-efficacy to educate and instruct participants with chronic pain. METHODS: Forty-eight exercise professionals (Mage=44.4±11.0 years) participated in a three-hour, in-person workshop that was offered at one of four different locations. Participants completed pre- and post-workshop outcome assessment surveys. RESULTS: Mixed MANOVA results comparing time (pre- versus post-workshop) by workshop location (sites 1 to 4) illustrated a significant within-subjects time effect (p<0.001). All outcomes significantly improved from pre- to post-workshop (p's<0.001), demonstrating large effect sizes (partial eta-squared values ranging from 0.45 to 0.59). CONCLUSIONS: Findings offer early phase preliminary support for the effectiveness of the chronic pain and physical activity training workshop for exercise professionals. Based on ORBIT model recommendations, findings warrant future phased testing via a pilot randomized clinical trial as well as testing for impacts that trained professionals have on activity adherence among their clients living with chronic pain. Eventual workshop adoption by exercise professional certification organizations would ensure widespread and sustainable access to qualified exercise professionals to help individuals engage in physical activity. By increasing the capacity of available exercise professionals to deliver effective support, active individuals could better manage their chronic pain and live well.

Understanding Physiotherapists' Intention to Counsel Clients with Chronic Pain on Exercise: A Focus on Psychosocial Factors.

Purpose: Twenty percent of Canadians experience chronic pain. Exercise is an effective management strategy, yet participation levels are low. Physiotherapists can be key to counselling clients to engage in long-term unsupervised exercise. Yet, investigations that identify psychosocial factors related to physiotherapists' intention to counsel are lacking. The purpose of this study was to examine whether physiotherapists' knowledge of chronic pain, beliefs about pain, and self-efficacy to counsel on exercise predicted their intention to counsel clients with chronic pain on exercise. Method: Practicing physiotherapists (N = 64) completed an online survey that assessed their knowledge of chronic pain, beliefs about pain, self-efficacy, and intention to counsel. A two-step hierarchical multiple regression predicted intention. Step 1 controlled for years of practice, and Step 2 included study variables significantly correlated with intention. Results: Beliefs about pain (r = -0.35, p < 0.01) and self-efficacy (r = 0.69, p < 0.01) were significantly correlated with intention. The overall regression model was significant, F 3,60 = 18.73; p < 0.001. Self-efficacy was the sole significant predictor, t 60 = 5.71, p < 0.0001, sr 2 = 28%. Conclusions: Self-efficacy may facilitate physiotherapists' intention to counsel on exercise for chronic pain. If shown to be a causal factor, interventions that target a change in physiotherapists' self-efficacy should be pursued.

Objectif : une proportion de 20 % des Canadiens souffre de douleurs chroniques. L'exercice est une stratégie de prise en charge efficace, mais les taux de participation sont faibles. Les physiothérapeutes peuvent jouer un rôle déterminant dans les conseils aux clients afin qu'ils suivent un programme d'exercices non supervisés à long terme. Il n'existe pourtant pas d'études pour déterminer les facteurs psychosociaux liés à l'intention de conseiller des physiothérapeutes. La présente étude visait à examiner si les connaissances des physiothérapeutes à l'égard de la douleur chronique, leurs convictions au sujet de la douleur et leur auto-efficacité à donner des conseils sur l'exercice étaient prédictives de leur intention de donner des conseils sur l'exercice à leurs clients ayant des douleurs chroniques. Méthodologie : des physiothérapeutes en exercice (n = 64) ont rempli un sondage en ligne évaluant leurs connaissances sur la douleur chronique, leurs convictions au sujet de la douleur, leur auto-efficacité et leur intention de conseiller. Une analyse de régression hiérarchique multiple en deux étapes a prédit leur intention. L'étape 1 assurait un contrôle par rapport aux années d'exercice et l'étape 2 incluait des variables ayant une corrélation significative avec l'intention. Résultats : les convictions sur la douleur (r = ­0,35, p < 0,01) et l'auto-efficacité (r = 0,69, p < 0,01) avaient une corrélation significative avec l'intention. Le modèle de régression globale était substantiel : F 3,60 = 18,73; p < 0,001. L'auto-efficacité était le seul prédicteur significatif : t 60 = 5,71, p < 0,0001, sr 2 = 28 %. Conclusion : l'auto-efficacité peut faciliter l'intention des physiothérapeutes de donner des conseils sur l'exercice en cas de douleur chronique. S'il est démontré qu'il s'agit d'un facteur causal, il faudrait prévoir des interventions afin de changer l'auto-efficacité des physiothérapeutes.

Facing Multiple Barriers to Exercise: Does Stronger Efficacy Help Individuals with Arthritis?

BACKGROUND: Research about exercise adherence amongst adults with arthritis has been largely correlational, and theoretically based causal studies are needed. We used an experimental design to test the social cognitive theory premise that high self-efficacy helps to overcome challenging barriers to action. METHODS: Exercising individuals (N = 86; female = 78%; M age = 53; BMI = 27) with differential self-regulatory efficacy for managing salient, non-disease barriers were randomly assigned to many or few barrier conditions. Individuals responded about the strength of their anticipated persistence to continue exercise, and their self-regulatory efficacy to use exercise-enabling coping strategies. RESULTS: In the many barriers condition, higher barriers-efficacy individuals expressed (a) greater persistence (Cohen's d = 0.75 [-0.029, 1.79]) and (b) more confidence in their coping solutions (Cohen's d = 0.65 [-0.30, 1.60]) than lower barriers-efficacy counterparts. CONCLUSION: Experimental support was obtained for the theoretical premise that when facing the greatest barrier challenge, individuals highest in self-regulatory efficacy still view exercise as possible. Findings suggest that identifying lower efficacy exercisers with arthritis to tailor their exercise to increase self-regulatory efficacy might also improve their adherence.

Self-Regulatory Efficacy Encourages Exercise Persistence Despite Arthritis Flare Symptoms.

BACKGROUND: The study of exercise adherence during an arthritis flare is recommended by arthritis researchers. Studies to date have been correlational. METHODS: Social cognitions of exercising individuals with arthritis who consider exercise adherence under different levels of challenge of an arthritis flare were examined using an experimental design. Exercising individuals with differential self-regulatory efficacy for managing arthritis flare symptoms (SRE-flare) were randomly assigned to conditions where flare symptoms were perceived as either many or few. Individuals in each condition responded about the strength of their anticipated persistence to continue exercise, and their self-regulatory efficacy to use coping strategies to enable exercise. RESULTS: Higher SRE-flare individuals expressed significantly (a) greater persistence (Cohen's d = 1.17) and (b) more confidence to use their flare coping solutions (Cohen's d = 1.44). CONCLUSION: Main findings were as hypothesised. When exposed to the condition with more limiting flare symptoms (i.e. greater challenge), high SRE participants were the most confident in dealing with flare symptoms and exercising. Identifying lower SRE-flare individuals less likely to persist with exercise during arthritis flares may improve tailored exercise counselling.