Background Health-enhancing physical activity (HEPA) is an active treatment in rheumatoid arthritis (RA) that may be difficult for patients to maintain over time. A two-year HEPA program including twice-weekly circuit training at public gyms and 150 weekly minutes of moderately intense aerobic exercise was conducted in Sweden between 2011 and 2013. Regular peer support sessions were held to guide adoption and maintenance of HEPA. Patient perceptions on maintained physical activity in RA have been minimally explored.

Objectives To describe perceptions of physical activity maintenance during the second year of an outsourced 2-year HEPA-program among people with RA

Methods A descriptive design with a qualitative inductive approach was used. Interviews were conducted with 18 participants with RA, including men and women differing in age, disease duration, activity limitation, perceived pain, levels of physical activity, training centers and peer support groups. Qualitative content analysis was used, and a pattern of theme, subthemes, categories, and subcategories was constructed based on the participants' perceptions of the phenomenon.

Results A main overarching theme and three subthemes were established, called `A necessary investment in future health through dedication, affinity and awareness', which described participants' experiences of maintenance during the second year of an outsourced 2-year HEPA-program. This was further described in eight categories with 16 subcategories. The categories described the participants'; `mindsets, habits, commitments, social support, PA contexts, monitoring, insights in PA, and health gains'.

Conclusions The findings are partly in line with the theoretically derived explanations for maintenance of behavior change formulated to date, such as maintenance motives (self-determination and identity), self-regulation (skills and processes, lapse, relapse and coping) habits, resources (psychological and physical) as well as environmental and social influences. The results of this study could also be transferable to similar groups of people with RA in similar settings and useful in designing future HEPA interventions to facilitate maintenance of behavior change.

Disclosure of Interest None declared