Theory-informed interventions to promote physical activity and reduce sedentary behaviour in rheumatoid arthritis: a critical review of the literature

Abstract

Moderate-intensity physical activity (PA) is recommended for the management of Rheumatoid Arthritis (RA). Recent evidence suggests that reducing sedentary behaviour (promoting 'sedentary breaks' and light intensity PA) may also offer potential for improving RA outcomes, independently of the benefits of moderate-intensity PA. Unfortunately, people living with RA engage in very little moderate-intensity PA, and the spend the majority of the day sedentary. Interventions to support PA and sedentary behaviour change in this population are therefore required. Psychological theory can provide a basis for the development and implementation of intervention strategies, and specify the cognitive processes or mechanisms assumed to result in behavioural change. Application of psychological theory to intervention development and evaluation, therefore, permits evaluation of "how things work", helping to identify optimal intervention strategies, and eliminate ineffective components. In this review, we provide an overview of existing PA and sedentary behaviour change interventions in RA, illustrating the extent to which current interventions have been informed by psychological theories of behaviour change. Recommendations are provided for future interventional research in this domain, serving as a reference point to encourage proper application of behavioural theories into intervention design, implementation and appraisal.

Keywords: behaviour change; physical activity; rheumatoid arthritis; sedentary behaviour; theory.

Figure 1.

Applying psychological theory to intervention development, delivery and evaluation: steps and recommendations using the example of self-determination theory. Note: PA = physical activity; SB = sedentary behaviour; TCS = Theory Coding Scheme; TDF = Theoretical Domains Framework; BCT = Behaviour Change Taxonomy; IMBCT = Intervention Mapping Taxonomy; NIHBCC = National Institutes of Health Behavioural Change Checklist Dashed boxes represent recommendations for intervention development , delivery and evaluation . Guiding frameworks are shown as

Figure 2.

Study selection process. Note: PA = physical activity; SB = sedentary behaviour. Full text exclusions: (1) Interventions focussed on overall “arthritis self-management” (to include several topics, eg, medication, pain management, nutrition, problem solving etc.), were excluded to provide a more focussed overview of the current literature (n = 10).^{– **}Articles reporting interventions targeting PA/sedentary behaviour and one other behaviour (eg, medication adherence, nutrition) were included, as it was deemed that PA promotion/sedentary behaviour reduction were major components of these interventions; (2) Interventions where changes in PA or sedentary behaviour were not assessed/reported as an outcome (n = 3, where this could not be determined at the title/abstract screening stage),^– interventions that were not behavioural (n = 1), and those targeting RA and another population, where interventions effects on RA could not be isolated (n = 1). (3) Articles describing protocols for RCTs yet to be completed or reported on (n = 7).^– (4) Studies reporting secondary results for included interventions, but for which change in PA or sedentary behaviour was not the focus (eg, reporting the economic cost of the intervention) (n = 9).^– Reference lists of relevant systematic review articles were also searched,^,,– but no additional articles meeting inclusion criteria were identified.