title: An outsourced health-enhancing physical activity programme for people with rheumatoid arthritis: exploration of adherence and response.
abstract: OBJECTIVE
  The aims of this study were to document adherence to and changes in health-enhancing physical activity (HEPA) levels and self-reported and assessed functioning and to explore aspects of adherence and response during the first year of an outsourced 2-year HEPA programme in people with RA.
  
  
  METHODS
  Two-hundred and twenty patients participated in this observational cohort study, which included daily physical activity, twice-weekly circuit training and biweekly support group meetings. Self-reported data included current (past week) and maintained (past 6 months) HEPA levels, sociodemographics and disease-related and psychosocial factors. Tests of aerobic capacity and muscle function were performed and anthropometric data were collected.
  
  
  RESULTS
  Eighty-eight per cent of the participants completed 1 year assessments. Self-reported current and maintained HEPA increased. General health perception and a number of other self-reported disease-related and psychosocial factors improved, while exercise self-efficacy declined. Aerobic capacity, timed standing and grip strength improved and waist circumference decreased. The mean number of circuit training sessions performed was 48, the mean number of days with HEPA was 189 and the mean number of support group meetings attended was 9. Better adherence to circuit training improved general health, and better adherence to group meetings improved timed standing. Exercise self-efficacy improved among those adhering more to circuit training or support group meetings.
  
  
  CONCLUSIONS
  The outsourced HEPA programme had high retention and reasonable adherence. A number of health outcomes improved. Relationships between adherence to the programme components and response were not clear-cut and need further attention.
  
  
  BACKGROUND
  ISRCTN register; http://www.controlled-trials.com. Trial registration number ISRCTN25539102.
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden birgitta.nordgren@ki.se.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Nordgren
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fridén
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Demmelmaier
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Bergström
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Lundberg
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Dufour
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Harvard Medical School, Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Boston, MA, USA and Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Christina H
authors.initials: CH
authors.lastname: Opava
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000534:rehabilitation*; D015444:Exercise / Q000523:psychology*; D005081:Exercise Therapy / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011788:Quality of Life; D020377:Self Efficacy; D057566:Self Report; D016896:Treatment Outcome; D055815:Young Adult
keywords: clinical trial; exercise; health behaviour; muscular strength; physical fitness; self-efficacy social cognitive theory; trans-theoretical model