Background and Purpose. The purpose of this study is to determine whether higher baseline levels of (a) self-efficacy for physical activity, (b) self-efficacy for arthritis self-management, and (c) outcome expectations for exercise are associated with higher physical activity levels following an exercise intervention for adults with arthritis. Methods. A secondary analysis of the intervention cohort ( ) within a randomized controlled trial of the People with Arthritis Can Exercise program was performed. Multiple linear regression evaluated the relationship between physical activity at a time point three months after the completion of an exercise intervention and three main explanatory variables. Results. After controlling for baseline physical activity, neither self-efficacy for arthritis self-management nor outcome expectations for exercise related to three-month physical activity levels. There was a relationship between three-month physical activity and self-efficacy for physical activity. Conclusions. Future research is needed to evaluate the ability of self-efficacy-enhancing programs to increase physical activity in adults with arthritis. 1. Introduction The benefits of physical activity are numerous and range from disease prevention and management to the enhancement of mental and physical well-being. In adults of all ages, physical activity is associated with lower death rates; prevention and management of hypertension; maintenance of strength, agility, and bone mass; and reduction in the symptoms of certain mental illnesses such as depression and anxiety [1]. Among those with chronic disabling conditions like arthritis, physical activity has additional benefits. For example, aerobic and resistive exercise programs have been shown to significantly decrease pain and self-reported disability and improve strength, maximum walking speed, maximal aerobic capacity, and functional performance measures [2–5]. On the other hand, inactivity among adults with arthritis is associated with several health consequences, including pain, onset of disability, loss of independence in activities of daily living, and decreased quality of life [6, 7]. Physically inactive adults with arthritis also incur substantially higher medical costs compared to more active individuals with arthritis. In one year, the medical costs associated with inactivity among adults with arthritis have been shown to exceed $1200 per person [8]. To achieve health benefits and avoid the consequences of inactivity, the Surgeon General in 1996 recommended that all Americans accumulate at least 30
References
[1]
United States Department of Health and Human Services, “2008 Physical activity guidelines for Americans,” 2008, http://www.health.gov/paguidelines.
[2]
W. H. Ettinger Jr., R. Burns, S. P. Messier et al., “A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST),” Journal of the American Medical Association, vol. 277, no. 1, pp. 25–31, 1997.
[3]
A. Hakkinen, P. Hannonen, K. Nyman, T. Lyyski, and K. Hakkinen, “Effects of concurrent strength and endurance training in women with early or longstanding rheumatoid arthritis: comparison with healthy subjects,” Arthritis & Rheumatism, vol. 49, no. 6, pp. 789–797, 2003.
[4]
C. H. Stenstrom and M. A. Minor, “Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis,” Arthritis & Rheumatism, vol. 49, no. 3, pp. 428–434, 2003.
[5]
E. Hurkmans, F. J. van der Giesen, T. P. Vliet Vlieland, J. Schoones, and E. C. van den Ende, “Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis,” Cochrane Database of Systematic Reviews, no. 4, Article ID CD006853, 2009.
[6]
M. S. Kaplan, N. Huguet, J. T. Newsom, and B. H. McFarland, “Characteristics of physically inactive older adults with arthritis: results of a population-based study,” Preventive Medicine, vol. 37, no. 1, pp. 61–67, 2003.
[7]
B. W. Penninx, S. P. Messier, W. J. Rejeski et al., “Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis,” Archives of Internal Medicine, vol. 161, no. 19, pp. 2309–2316, 2001.
[8]
G. Wang, C. G. Helmick, C. Macera, P. Zhang, and M. Pratt, “Inactivity-associated medical costs among US adults with arthritis,” Arthritis & Rheumatism, vol. 45, no. 5, pp. 439–445, 2001.
[9]
United States Department of Health and Human Services, Physical Activity and Health: A Report of the Surgeon General, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Ga, USA, 1996.
[10]
United States Department of Health and Human Services, “Healthy people 2020,” 2010, http://healthypeople.gov/2020/.
[11]
K. R. Fontaine, M. Heo, and J. Bathon, “Are US adults with arthritis meeting public health recommendations for physical activity?” Arthritis & Rheumatism, vol. 50, no. 2, pp. 624–628, 2004.
[12]
S. Austin, H. Qu, and R. M. Shewchuk, “Association between adherence to physical activity guidelines and health-related quality of life among individuals with physician-diagnosed arthritis,” Quality of Life Research, vol. 21, no. 8, pp. 1347–1357, 2012.
[13]
H. W. Kohl III, A. L. Dunn, B. H. Marcus, and S. N. Blair, “A randomized trial of physical activity interventions: design and baseline data from project active,” Medicine & Science in Sports & Exercise, vol. 30, no. 2, pp. 275–283, 1998.
[14]
R. K. Dishman, Exercise Adherence: Its Impact on Public Health, Human Kinetics, Champaign, Ill, USA, 1988.
[15]
A. Bandura, “Self-efficacy: toward a unifying theory of behavioral change,” Psychological Review, vol. 84, no. 2, pp. 191–215, 1977.
[16]
A. Bandura, Social Foundations of Thought and Action, Prentice-Hall, Englewood Cliffs, NJ, USA, 1986.
[17]
A. Bandura, Self-Efficacy: The Exercise of Control, WH Freeman and Company, New York, NY, USA, 1997.
[18]
C. Keller, J. Fleury, N. Gregor-Holt, and T. Thompson, “Predictive ability of social cognitive theory in exercise research: an integrated literature review,” The Online Journal of Knowledge Synthesis for Nursing, vol. 6, p. 2, 1999.
[19]
E. McAuley and B. Blissmer, “Self-efficacy determinants and consequences of physical activity,” Exercise and Sport Sciences Reviews, vol. 28, no. 2, pp. 85–88, 2000.
[20]
R. E. Rhodes, A. D. Martin, J. E. Taunton, E. C. Rhodes, M. Donnelly, and J. Elliot, “Factors associated with exercise adherence among older adults. An individual perspective,” Sports Medicine, vol. 28, no. 6, pp. 397–411, 1999.
[21]
N. E. Sherwood and R. W. Jeffery, “The behavioral determinants of exercise: implications for physical activity interventions,” Annual Review of Nutrition, vol. 20, pp. 21–44, 2000.
[22]
S. Ashford, J. Edmunds, and D. P. French, “What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis,” The British Journal of Health Psychology, vol. 15, part 2, pp. 265–288, 2010.
[23]
G. S. Brassington, A. A. Atienza, R. E. Perczek, T. M. DiLorenzo, and A. C. King, “Intervention-related cognitive versus social mediators of exercise adherence in the elderly,” The American Journal of Preventive Medicine, vol. 23, no. 2, supplement, pp. 80–86, 2002.
[24]
V. S. Conn, “Older adults and exercise: path analysis of self-efficacy related constructs,” Nursing Research, vol. 47, no. 3, pp. 180–189, 1998.
[25]
A. M. Jette, D. Rooks, M. Lachman et al., “Home-based resistance training: predictors of participation and adherence,” The Gerontologist, vol. 38, no. 4, pp. 412–421, 1998.
[26]
B. M. Pinto, H. Lynn, B. H. Marcus, J. DePue, and M. G. Goldstein, “Physician-based activity counseling: Intervention effects on mediators of motivational readiness for physical activity,” Annals of Behavioral Medicine, vol. 23, no. 1, pp. 2–10, 2001.
[27]
B. Resnick, “Testing a model of exercise behavior in older adults,” Research in Nursing & Health, vol. 24, no. 2, pp. 83–92, 2001.
[28]
C. Schuster, S. Petosa, and R. Petosa, “Using social cognitive theory to predict intentional exercise in post-retirement adults,” Journal of Health Education, vol. 26, pp. 14–24, 1995.
[29]
L. F. Callahan, T. Mielenz, J. Freburger et al., “A randomized controlled trial of the people with arthritis can exercise program: symptoms, function, physical activity, and psychosocial outcomes,” Arthritis & Rheumatism, vol. 59, no. 1, pp. 92–101, 2008.
[30]
B. H. Marcus, V. C. Selby, R. S. Niaura, and J. S. Rossi, “Self-efficacy and the stages of exercise behavior change,” Research Quarterly for Exercise and Sport, vol. 63, no. 1, pp. 60–66, 1992.
[31]
N. Owen and B. H. Marcus, “Motivational readiness, self-efficacy and decision-making for exercise,” Journal of Applied Social Psychology, vol. 22, pp. 3–16, 1992.
[32]
K. H. Miller, R. J. Ogletree, and K. Welshimer, “Impact of activity behaviors on physical activity identity and self-efficacy,” The American Journal of Health Behavior, vol. 26, no. 5, pp. 323–330, 2002.
[33]
K. Oliver and T. Cronan, “Predictors of exercise behaviors among fibromyalgia patients,” Preventive Medicine, vol. 35, no. 4, pp. 383–389, 2002.
[34]
R. E. Rhodes, A. D. Martin, and J. E. Taunton, “Temporal relationships of self-efficacy and social support as predictors of adherence in a 6-month strength-training program for older women,” Perceptual and Motor Skills, vol. 93, no. 3, pp. 693–703, 2001.
[35]
T. J. Brady, “Measures of self-efficacy, helplessness, mastery, and control,” Arthritis & Rheumatism, vol. 49, pp. S147–S164, 2003.
[36]
S. Hewlett, Z. Cockshott, J. Kirwan, J. Barrett, J. Stamp, and I. Haslock, “Development and validation of a self-efficacy scale for use in British patients with rheumatoid arthritis (RASE),” Rheumatology, vol. 40, no. 11, pp. 1221–1230, 2001.
[37]
B. Resnick, S. I. Zimmerman, D. Orwig, A. L. Furstenberg, and J. Magaziner, “Outcome expectations for exercise scale: utility and psychometrics,” The Journals of Gerontology B, vol. 55, no. 6, pp. S352–S356, 2000.
[38]
B. Resnick, S. Zimmerman, D. Orwig, A.-L. Furstenberg, and J. Magaziner, “Model testing for reliability and validity of the outcome expectations for exercise scale,” Nursing Research, vol. 50, no. 5, pp. 293–299, 2001.
[39]
N. D. Harada, V. Chiu, A. C. King, and A. L. Stewart, “An evaluation of three self-report physical activity instruments for older adults,” Medicine & Science in Sports & Exercise, vol. 33, no. 6, pp. 962–970, 2001.
[40]
K. A. Martin, W. J. Rejeski, M. E. Miller, M. K. James, W. H. Ettinger Jr., and S. P. Messier, “Validation of the PASE in older adults with knee pain and physical disability,” Medicine & Science in Sports & Exercise, vol. 31, no. 5, pp. 627–633, 1999.
[41]
R. A. Washburn, A. M. Jette, and C. A. Janney, Eds., Physical Activity Scale for the Eldery: Administration and Scoring Instruction Manual, New England Research Institute, Watertown, Mass, USA, 1991.
[42]
R. A. Washburn, K. W. Smith, A. M. Jette, and C. A. Janney, “The physical activity scale for the elderly (PASE): development and evaluation,” Journal of Clinical Epidemiology, vol. 46, no. 2, pp. 153–162, 1993.
[43]
M. S. Kaplan, J. T. Newsom, B. H. McFarland, and L. Lu, “Demographic and psychosocial correlates of physical activity in late life,” The American Journal of Preventive Medicine, vol. 21, no. 4, pp. 306–312, 2001.
[44]
R. F. Oman and A. C. King, “Predicting the adoption and maintenance of exercise participation using self-efficacy and previous exercise participation rates,” The American Journal of Health Promotion, vol. 12, no. 3, pp. 154–161, 1998.
[45]
J. F. Fries, P. Spitz, R. G. Kraines, and H. R. Holman, “Measurement of patient outcome in arthritis,” Arthritis & Rheumatism, vol. 23, no. 2, pp. 137–145, 1980.
[46]
S. Greenland, “Modeling and variable selection in epidemiologic analysis,” The American Journal of Public Health, vol. 79, no. 3, pp. 340–349, 1989.
[47]
J. I. Robinson and M. A. Rogers, “Adherence to exercise programmes. Recommendations,” Sports Medicine, vol. 17, no. 1, pp. 39–52, 1994.
[48]
B. Resnick and L. S. Jenkins, “Testing the reliability and validity of the self-efficacy for exercise scale,” Nursing Research, vol. 49, no. 3, pp. 154–159, 2000.
[49]
R. A. Washburn, E. McAuley, J. Katula, S. L. Mihalko, and R. A. Boileau, “The physical activity scale for the elderly (PASE): evidence for validity,” Journal of Clinical Epidemiology, vol. 52, no. 7, pp. 643–651, 1999.
[50]
L. M. Hays and D. O. Clark, “Correlates of physical activity in a sample of older adults with type 2 diabetes,” Diabetes Care, vol. 22, no. 5, pp. 706–712, 1999.
[51]
T. E. Duncan and E. McAuley, “Social support and efficacy cognitions in exercise adherence: a latent growth curve analysis,” Journal of Behavioral Medicine, vol. 16, no. 2, pp. 199–218, 1993.
[52]
A. C. King and A. W. Garcia, “Predicting long-term adherence to aerobic exercise: a comparison of models,” Journal of Sport and Exercise Psychology, vol. 13, no. 4, pp. 394–410, 1991.
[53]
J. S. Hallam and R. Petosa, “The long-term impact of a four-session work-site intervention on selected social cognitive theory variables linked to adult exercise adherence,” Health Education & Behavior, vol. 31, no. 1, pp. 88–100, 2004.
