Background A large proportion of persons with rheumatoid arthritis (RA) do not meet recommendations on health-enhancing physical activity (HEPA) (1). We performed a complex theory-based intervention in a group format at public gyms, aiming to support behavior change towards HEPA (2). To evaluate the intervention from a user perspective, a combination of quantitative and qualitative methods was applied.
Objectives The aim of this mixed methods study was to explore and describe how persons with RA perceive their participation in the first year of a two-year program targeting adoption and maintenance of HEPA.
Methods Data collection was performed by a postal survey to 211 of 220 intervention participants and by interviews with a sub-group of 35 purposefully selected informants. A total of 191 participants (91%) responded to the survey; mean age was 60 years and 81% were women. Survey data were analyzed by descriptive statistics and the interviews were analyzed by qualitative content analysis.
Results Increased physical activity compared to the previous year was reported by 165 participants (86%) with circuit training and everyday physical activity performed regularly or periodically during the year by 78% and 92%, respectively. The behavioral support most frequently used was: responding to weekly text messages about performed physical activity (96% regularly), participating in support group sessions (73% regularly or periodically), and use of pedometer (58% regularly or periodically). The highest valued intervention components were: circuit training, physical activity in daily life, both rated median 5 on a 1-5 scale with 5 representing “Very valuable”, responding to text messages, coach support and expert lectures on RA-related topics, all rated median 4. A question on recommending the program to someone with a similar condition was rated median 5 (“Yes, definitely”). The content analysis of the interviews resulted in five categories: 1) “Starting point”, concerning previous experiences and current expectations on the program, 2) “Get going”, concerning intervention components that facilitated adoption of HEPA, 3) “Cashing in”, describing perceived gains from HEPA, 4) “Keep it going', concerning components that supported maintained HEPA and 5) `Trouble shooting”, describing individual obstacles to reach HEPA and suggestions for improvement of a future HEPA program. The suggestions mainly concerned more individualization in all aspects of the program.
Conclusions The results indicate that self-monitoring by text messages and pedometers as well as professional coaching are perceived useful to facilitate HEPA in RA. Physical activity programs targeting maintained HEPA should be tailored to individuals' different needs concerning setting, exercise form and behavioral support.
Demmelmaier I, Bergman P, Nordgren B, Jensen I, Opava C. Current and maintained health-enhancing physical activity in rheumatoid arthritis – a cross-sectional study. Arthritis Care & Research. 2013;65(7):1166-76.
Nordgren B, Fridén C, Demmelmaier I, Bergström G, Opava C. Long-term health-enhancing physical activity in rheumatoid arthritis. BMC Public Health. 2012;12(397).
Acknowledgements The Swedish Research Council, Combine Sweden, the Swedish Rheumatism Association, the National Postgraduate School of Health Care Sciences at Karolinska Institutet, the Strategic Research Program in Health Care Research at Karolinska Institutet and the Swedish Rheumatology Quality Registers.
Disclosure of Interest None declared
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