Maximising the treatment benefits of physical activity behaviour for those with axial spondyloarthritis: Tackling long-term adherence and maintenance

: (Alternative Format Thesis)

Abstract

Spondyloarthritis (SpA) is a heterogeneous group of chronic inflammatory diseases that can adversely affect people physically, psychologically, socially, and vocationally. Despite the demonstrable health benefits of participating in regular physical activity (PA) to SpA patients and the recommendations to engage in such behaviours (Rausch Osthoff et al., 2018a), people living with SpA are less active and more sedentary than general populations (O’Dwyer et al., 2015a). Thus, grounded in Self-Determination Theory (SDT; Ryan & Deci, 2017), the purpose of thesis was to explore the factors associated with PA and the psychosocial mechanisms that may support the maintenance of PA in people living with axial spondyloarthritis (axSpA). To understand the extant literature pertaining to correlates of PA in those with inflammatory arthritis and to provide a broad foundation from which to inform the studies in this thesis, Study One (Chapter Two) provided a systematic review and synthesis of the factors associated with PA behaviour in people living with SpA and rheumatoid arthritis (RA). Eleven SpA studies indicate that enhancing quality of life, motivation, and reducing functional disability, may be modifiable targets that could support people with SpA live a physically active lifestyle. The long-term benefits of PA-based rehabilitation therapy has been demonstrated is those with axSpA (Kjeken et al., 2013), yet little is known about the experiences of such rehabilitation programmes or the reasons why individuals are (in)active. Therefore, Study Two (Chapter Three), explored patient (N = 19) and health care professional (N = 9) perspectives of a PA-based, two-week residential rehabilitation programme and the maintenance of PA, thereafter. In doing so, this study identified elements during and after rehabilitation that can both support (e.g., enjoyment) and thwart (e.g., psychological challenges) one’s ability to engage in and maintain PA. Results indicated further support is needed once structured support is withdrawn, while the educational needs (i.e., behaviour change) of health care professionals were highlighted. Study Three (Chapter Four) reports a cross-sectional questionnaire survey that investigated the disease- and motivation-related factors associated with self-reported PA parameters in those with axSpA (N = 98). The findings offer support for the role of SDT constructs (e.g., important other autonomy support, psychological need satisfaction and frustration, autonomous motivation) in relation to self-reported PA behaviour. For individuals with axSpA, fostering intrinsic motivation (particularly enjoyment) for stretching may increase engagement in stretching. Study One (Chapter Two) identified a lack of studies using objective measures of PA or exploring PA correlates in those with non-radiographic axial spondyloarthritis (nr-axSpA). Thus, Study Four (Chapter Five) assessed the clinical and motivation-related factors that explain objectively measured PA parameters and sedentary behaviour (SB) in people living with nr-axSpA (N = 63). Multiple linear regression analyses revealed that controlled motivation was a significant and negative predictor of both total steps and moderate-to-vigorous PA (MVPA), while variation in SB was significantly explained by both age and controlled motivation. Study One (Chapter Two) demonstrated a paucity of longitudinal studies exploring PA correlates (including motivation) and Studies Three (Chapter Four) and Four (Chapter Five) are limited by their cross-sectional designs. Thus, Study Five (Chapter Six) advances current literature and represents the first to explore the longitudinal (two years) associations between SDT-constructs and objectively measured PA and SB in those with nr-axSpA. Simple linear regression analyses supported the “dark side” pathway of motivation, whereby changes in psychological need frustration positively predicted changes in controlled motivation, and controlled motivation negatively predicted changes in total steps and MVPA. Collectively, this programme of research offers support for the application of SDT as a theoretical framework for studying the motivational underpinnings of PA in this understudied population. This research supports the need for PA-based rehabilitation to be holistic in nature and offers practical recommendations to support people with axSpA maintain a physically active lifestyle. Exploring the dynamic interplay between motivational constructs and PA and testing the efficacy of SDT-based interventions in those with axSpA, provide exciting avenues for future research.

Date of Award	25 Aug 2023
Original language	English
Awarding Institution	University of Bath
Supervisor	Peter Rouse (Supervisor), Martyn Standage (Supervisor) & Raj Sengupta (Supervisor)