Original Article

Construction of Exercise Behavior Model in Patients with Rheumatoid Arthritis


Background: Despite the awareness that regular exercise has a positive impact on maintaining health, patients with rheumatoid arthritis (RA) engage in markedly less exercise than do the general population. Weaimed to construct and test a structural equation model of exercise behavior in patients with RA based on self-determination theory and self-efficacy theory.

Methods: Participants were 214 outpatients with RA at Chonnam National University Hospital located in the Gwangju City, South Korea from Mar to Apr 2018. A structured self-report questionnaire was used to assess autonomy support, autonomy, competence, relatedness, autonomous motivation, self-efficacy, and exercise behavior. Collected data were analyzed using SPSS 22.0 and AMOS 22.0 program.

Results: The structural model showed a good fitness with the data (χ2= 727.27, df = 392, P<0.001, TLI = 0.92, CFI = 0.93, RMSEA = 0.07, SRMR = 0.07). Autonomous motivation and self-efficacy had a significant effect on exercise behavior in patients with RA. This model explained 21.2% of the variance of exercise behavior in patients with RA.

Conclusion: Self-efficiency and autonomous motivation should be promoted in order to strengthen the exercise behavior of patients with RA.

1. Lee DM, Weinblatt ME (2001). Rheumatoid arthritis. Lancet, 358(9285): 903–11.
2. Machin AR, Babatunde O, Haththotuwa R, et al (2020). The association between anx-iety and disease activity and quality of life in rheumatoid arthritis: a systematic re-view and meta-analysis. Clin Rheumatol, 39: 1471–82.
3. Rathbun AM, Reed GW, Harrold LR (2013). The temporal relationship between de-pression and rheumatoid arthritis disease activity, treatment persistence and re-sponse: a systematic review. Rheumatol, 2(10): 1785–94.
4. Matcham F, Davies R, Hotopf M, Hyrich KL, Norton S, Steer S, Galloway J (2018). The relationship between depression and biologic treatment response in rheuma-toid arthritis: an analysis of the British society for rheumatology biologics regis-ter. Rheumatol, 57(5): 835–43.
5. Szymczak H, Keller L, Debbeler LJ, et al (2020). An increase in vigorous but not moderate physical activity makes people feel they have changed their behav-ior. Front Psycho, 11: 1530.
6. Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD (2015). The role of exercise in the management of rheumatoid arthritis. Expert Rev Clin Immunol, 11(10): 1121–30.
7. Agca R, Heslinga SC, Rollefstad S, et al (2017). EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disor-ders: 2015/2016 update. Ann Rheum Dis, 76(1): 17–28.
8. Metsios GS, Stavropoulos-Kalinoglou A, Veldhuijzen van Zanten JJ, et al (2014). Individualised exercise improves endo-thelial function in patients with rheuma-toid arthritis. Ann Rheum Dis, 73(4): 748–51.
9. Stavropoulos-Kalinoglou A, Metsios GS, Veldhuijzen van Zanten JJ, Nightingale P, Kitas GD, Koutedakis Y (2013). Individ-ualized aerobic and resistance exercise training improves cardiorespiratory fit-ness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis, 72(11): 1819–25.
10. Wilcox S, Der AC, Abbott J, Vrazel J, Ram-sey C, Sharpe PA, Brady T (2006). Per-ceived exercise barriers, enablers, and benefits among exercising and nonexer-cising adults with arthritis: results from a qualitative study. Arthritis Rheumatol, 55(4): 616–27.
11. Henchoz Y, Zufferey P, So A (2013). Stages of change, barriers, benefits, and prefer-ences for exercise in RA patients: A cross-sectional study. Scand J Rheumatol, 42(2): 136–45.
12. Ryan RM, Williams GC, Patrick H, Deci EL (2009). Self‐determination theory and physical activity: the dynamics of motiva-tion in development and wellness. Hellenic J Psychol, 6: 107–24.
13. Deci EL, Ryan RM (2002). Handbook of self-determination research. New York: University of Rochester Press.
14. Sheldon KM, Williams GC, Joiner T (2003). Self-determination theory in the clinic: Motivating physical and mental health. New Haven: Yale University Press.
15. Wilson PM, Mack DE, Grattan KP (2008). Understanding motivation for exercise: a self-determination theory perspective. Can Psychol, 49(3): 250-6.
16. Yu CA, Rouse PC, Van Zanten JV, Metsios GS, Ntoumanis N, Kitas GD, Duda JL (2015). Motivation-related predictors of physical activity engagement and vitality in rheumatoid arthritis patients. Health Psy-chol Open, 2(2): 1-9.
17. Ryan RM (1995). Psychological needs and the facilitation of integrative processes. J Personal, 63(3): 397-427.
18. Deci EL, Ryan RM (2008). Facilitating opti-mal motivation and psychological well-being across life’s domains. Can Psychol, 49(1); 14-23.
19. Hurkmans EJ, Maes S, de Gucht V, Knittle K, Peeters AJ, Ronday HK, Vlieland TP (2010). Motivation as a determinant of physical activity in patients with rheuma-toid arthritis. Arthritis Care Res, 62(3): 371–7.
20. Sweet SN, Fortier MS, Guérin E, Tulloch H, Sigal RJ, Kenny GP, Reid RD (2009). Understanding physical activity in adults with type 2 diabetes after completing an exercise intervention trial: a mediation model of self-efficacy and autonomous motivation. Psychol Health Med, 14: 419-29.
21. Bandura A (1997). Self-efficacy: the exercise of control. New York: Freeman.
22. Bandura A (2006). Guide for constructing self-efficacy scales. In: Urdan T, Pajares F, editors. Self-efficacy beliefs of adolescents. Connecticut: Information Age Publishing. p.307-37.
23. Ryan RM, Deci EL (2020). Intrinsic and ex-trinsic motivation from a self-determination theory perspective: Defini-tions, theory, practices, and future direc-tions. Contemp Educ Psychol, 61: 101860.
24. Rodgers WM, Markland D, Selzler AM, Murray TC, Wilson PM (2014). Distin-guishing perceived competence and self-efficacy: an example from exercise. Res Q Exerc Sport, 85(4): 527-39.
25. Marsh HW, Pekrun R, Parker PD, Muraya-ma K, Guo J, Dicke T, Arens AK (2019). The murky distinction between self-concept and self-efficacy: beware of lurk-ing jingle-jangle fallacies. J Educ Psychol, 111(2): 331-53.
26. Williams GC, Lynch MF. McGregor HA, Sharp D, Deci EL (2006). Validation of the "important other" climate question-naire: assessing autotomy support for health-related change. Fam Syst Health, 24(2): 179-94.
27. Wilson PM, Rogers W, Rodgers WM, Wild TC (2006). The psychological need satis-faction in exercise scale. J Sport Exerc Psy-chol, 28(3): 231-51.
28. Jeong JH, Kim EJ (2015). Psychometric properties of the psychological need sat-isfaction in exercise scale. Korean J Meas Eval in Phys Educ & Sports Sci, 17(1): 57-68.
29. Shin YH, Jang HJ, Pender NJ (2001). Psy-chometric evaluation of the exercise self-efficacy scale among Korean adults with chronic disease. Res Nurs Health, 24(1): 68-76.
30. Wilson PM, Rogers WM (2004). The rela-tionship between perceived autonomy support, exercise regulations and behav-ioral intentions in women. Psychol Sport Exerc, 5(3): 229-42.
31. Deci EL, Ryan RM (2000). The “what” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychol Inq, 11: 227-68.
32. Oh JY, Yang YJ, Kim BS, Kang JH (2007). Validity and reliability of Korean version of international physical activity question-naire (IPAQ) short form. Korean J Fam Med, 28(7): 532-41.
33. Kim KH, Park JG (2009). Examining the structural model of perceived autonomy support, basic needs, and motivational orientations among collegiate athletes. Ko-rean J Sport Psychol, 20(3): 33-48.
34. Stoeckel K., Kasser SL (2020) Spousal sup-port underlying self-determined physical activity in adults with multiple sclero-sis. Disabil & Rehabil. Available from: https://doi.org/10.1080/09638288.2020.1792564
35. Cho H, Hussain RSB, Kang HK (2020). The role of social support and its influence on exercise participation: the perspective of self-determination theory and the theory of planned behavior. Soc Sci J. Available from: https://doi.org/10.1080/03623319.2020.1756176
36. Chan DK, Lonsdale C, Ho PY, Yung PS, Chan KM (2009). Patient motivation and adherence to post-surgery rehabilitation exercise recommendations: the influence of physiotherapists' autonomy-supportive behaviors. Arc Phys Med Re-habil, 90(12): 1977-82.
37. Ren Z, Hu L, Yu JJ, et al (2020). the influ-ence of social support on physical activity in Chinese adolescents: the mediating role of exercise self-efficacy. Children, 7(23): 1-11.
38. McNeill LH, Wyrwich KW, Brownson RC, Clark EM, Kreuter MW (2006). Individu-al, social environmental, and physical en-vironmental influences on physical activi-ty among black and white adults: a struc-tural equation analysis. Ann Behav Med, 31(1): 36-44.
39. Ryan RM (1982). Control and information in the intrapersonal sphere: an extension of cognitive evaluation theory. J Pers Soc Psychol, 43: 450-61.
40. Koponen AM, Simonsen N, Suominen S (2017). Determinants of physical activity among patients with type 2 diabetes: the role of perceived autonomy support, au-tonomous motivation and self-care com-petence. Psychol Health & Med, 22(3): 332-344.
41. Ng JY, Ntoumanis N, Thøgersen-Ntoumani C, Deci EL, Ryan RM, Duda JL, Williams GC (2012). Self-determination theory applied to health contexts: a meta-analysis. Perspect Psychol Sci, 7(4): 325-40.
42. Sweet SN, Fortier MS, Strachan SM, Blanchard CM (2012). Testing and inte-grating self-determination theory and self-efficacy theory in a physical activity context. Can Psychol, 53(4): 319-27.
IssueVol 49 No 9 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v49i9.4083
Exercise behavior Rheumatoid arthritis Self-determination Self-efficacy

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How to Cite
HAN E-S, KWEON Y-R. Construction of Exercise Behavior Model in Patients with Rheumatoid Arthritis. Iran J Public Health. 49(9):1666-1674.