Predicting planned physical activity of individuals with arthritis: A self-regulatory perspective

Abstract

Few individuals with arthritis are sufficiently active. We surveyed a convenience sample of exercisers (N = 134) to examine the utility of social cognitive theory variables, namely, self-regulatory efficacy, negative outcome expectations, and pain acceptance for predicting planned physical activity according to Weinstein’s two prediction suggestions. Logistic regression revealed, after controlling for pain intensity, self-regulatory efficacy, negative outcome expectations, and pain acceptance distinguished groups achieving/not achieving planned physical activity, p < 0.001 (28% variance). A second model adding past physical activity also predicted the groups, p < 0.001 (57% variance). This is one of the first arthritis studies examining planned physical activity relative to Weinstein’s recommendations.

Keywords

arthritis negative outcome expectations pain acceptance physical activity theory

Recommended physical activity levels for arthritis management

Individuals with arthritis can encounter numerous challenges that can impede their daily activities such as arthritis symptoms. Regular physical activity can help to manage these symptoms. Public health agencies have recommended that individuals with arthritis accumulate at least 150 minutes of moderate to vigorous physical activity (MVPA) per week in order to obtain health benefits (Centers for Disease Control and Prevention [CDC], 2011). Some physical activity is recommended for all individuals with arthritis, regardless of arthritis type, even during flare experiences when symptoms are exacerbated (CDC, 2011). However, fewer than half of individuals with arthritis are active at the health benefit level (Barbour et al., 2013; Public Health Agency of Canada, Centre for Chronic Disease Prevention and Control and Chronic Disease Surveillance Division, 2010).

Initial studies have examined questions about motivational psychological factors linked to exercise adherence among individuals with arthritis (e.g. Gyurcsik et al., 2011). Determining the psychological factors that can predict individuals’ activity levels may yield clues about modifiable self-regulatory factors that could be improved for better adherence.

Theory-based predictors of planned physical activity

Social cognitive theory (Bandura, 1997) has been used as a framework to conduct investigations that examine adherence to planned physical activity (Marks et al., 2005a) and has been consistently employed to examine the self-regulation of planned physical activity as part of chronic disease self-management (Clark, 2003; Rejeski et al., 2008a). According to this theory, self-regulatory efficacy (SRE) beliefs are critical in fostering adherence to motivated behaviors such as regular, planned physical activity. These beliefs concern an individual’s confidence in his or her ability to perform behaviors required to regularly manage his or her physical activity, such as planning and scheduling and overcoming barriers. SRE beliefs exert their primary influence when individuals are challenged in their efforts to adhere to activity behavior (Bandura, 1997).

A second necessary motivational component of the agency aspect of this theory is outcome expectations (OEs). OEs motivate adherence by virtue of individuals’ beliefs about potential positive outcomes obtained or negative outcomes avoided through involvement in regular behavior. Positive OEs, such as improved fitness or stronger joints, can serve as incentive to take part in day-to-day pursuits related to behaviors like planned physical activity. In contrast, negative OEs, such as increased soreness and fatigue, can cause an individual distress in anticipation of performing daily behaviors and lead to abstaining from them (Bandura, 1997).

Arthritis research and physical activity

In past arthritis research, there is a demonstrated relationship between adherence-related social cognitions and physical activity (Marks et al., 2005b). For example, a recent study conducted among 80 women with arthritis reported a significant positive association between individuals’ SRE for overcoming exercise barriers, arthritis barriers, and their physical activity (Gyurcsik et al., 2009, 2011).

Most recently, these variables were examined in relation to an arthritis flare, which is an exacerbation of arthritis symptoms, and is particularly challenging for individuals with arthritis. In this study, a positive association between volume of planned 20-minute bouts of MVPA and SRE beliefs to overcome arthritis barriers and to schedule and plan activity was detected (Gyurcsik et al., 2013).

Relative to OEs, a review in arthritis supports their link to activity (Wilcox et al., 2005) but these initial studies focused upon positive OEs. Negative OEs are less frequently examined relative to exercise adherence among individuals with arthritis (Williams et al., 2005). Given the possible implications of negative effects for chronic arthritis, it is important to understand individuals’ negative OEs as they relate to planned physical activity.

Pain acceptance

Pain has frequently been reported by individuals with arthritis as a disease-related reason for not engaging in exercise. Focht et al. (2002) examined the validity of this notion by using an experience sampling procedure to examine the arthritis pain individuals perceived on exercise and non-exercise days. This longitudinal investigation revealed that pain on exercise days was no different than the pain on non-exercise days. The results of this study suggest that perceived pain could not be attributed as a reason to avoid exercise.

Interestingly, the association between social cognitions about exercising in the face of arthritis symptoms like pain varies among people who differ in pain acceptance. There is an individual difference such that some individuals accept pain and are willing to engage in activities despite pain (cf. McCracken and Vowles, 2006), while others are less accepting. In the arthritis and exercise literature, Gyurcsik et al. (2011) examined exercising individuals with arthritis who expressed different levels of pain acceptance. They found that individuals more willing to act despite their arthritis pain were also more confident in their ability to exercise for bouts of 20 minutes or more of planned MVPA and engaged in a greater volume of MVPA. Subsequently, Gyurcsik et al. (2013) linked pain acceptance and SRE to greater physical activity adherence.

These pain acceptance studies are consistent with other pain acceptance research among symptomatic samples (e.g. peripheral artery disease; Rejeski et al., 2008b). Rejeski et al. (2014) recently illustrated that pain acceptance could be changed and that increases paralleled self-efficacy for functional performance. Following a 6-month intervention, these cognitions were linked to better physical activity adherence.

Taken together, the foregoing evidence indicates that SRE, positive OEs, and pain acceptance are associated with the level of individuals’ physical activity and with functional performance. What has not been described by previous research is (a) the utility of SRE, negative OEs, and pain acceptance in predicting activity level and (b) the association between pain intensity, negative OEs, and pain acceptance among individuals with arthritis engaging in planned exercise. These objectives were one focus of this study.

Issues in predicting health behavior

In his article about health behavior research, Weinstein (2007) addressed an important issue about the conduct and implications of theory-based exercise research. He raised the point that health researchers frequently fail to consider individuals’ past behaviors in their investigations. This is a potential oversight given that past activity can directly affect (a) future activity and (b) related social cognitions about engaging in future physical activity. Weinstein (2007) argued convincingly that in predicting future behavior, the social cognitions of individuals who have some experience engaging in exercise may not account for as much variance when determinants of such social cognitive predictors are taken into account (i.e. past exercise). Although psychological factors continue to motivate people, Weinstein noted that their strong relation to past behavior may limit their ability to capture additional variance in a predictive model. He also pointed out that failure to take past behavior into account may result in the effects of social cognitive predictors being overestimated and thus can be misleading. However, Weinstein reminds us that simply controlling for past behavior does not completely alleviate interpretation issues about a variable’s predictive utility, as this control is conservative and may lead to underestimating a relationship. To address this quandary, Weinstein (2007) recommended conducting and presenting both analyses (prediction with and without past behavior).

Study purposes and hypotheses

The overall purpose of this study was threefold. First, we aimed to examine social cognitions linked to individuals’ adherence to bouts of planned MVPA. Planned bouts of MVPA require conscious self-regulation to result in regular exercise. Specifically, individuals’ SRE, negative OEs, and pain acceptance were examined relative to study participants achieving a criterion of 150 minutes per week of planned MVPA in which bouts were 20 minutes or more. Our rationale was that self-regulatory capabilities (i.e. self-monitoring, goal-setting) are needed to engage in regular, planned bouts of activity of moderate to vigorous intensity. Unplanned, spontaneous activity is not characterized by such self-regulatory actions and was not our focus. Second, we aimed to explore unexamined associations between pain intensity, negative OEs, and pain acceptance. Third, we followed Weinstein’s (2007) suggestions to estimate the contribution of the study variables, including past physical activity, in the prediction of exercising individuals’ adherence to levels of planned activity.

First, we hypothesized that (a) SRE beliefs, (b) negative OEs, and (c) pain acceptance would reliably distinguish those individuals categorized as achieving 150 minutes of planned MVPA from those not achieving this benchmark. Second, we hypothesized that a positive relationship would be found between pain intensity and negative OEs and negative associations would be found between pain acceptance and each of pain intensity and negative OEs. Individuals reporting more intense pain would be expected to report more distressing negative OEs about exercising. Individuals more willing to complete exercise despite their pain should perceive lower pain intensity and less distressing negative OEs about exercising.

Third, following Weinstein’s reasoning for individuals having experience with a health behavior, we expected that while our first hypothesis would be supported, this prediction would change with more of the variance being accounted for by past behavior and less from the psychological predictors (Weinstein, 2007).

Method

Design and procedures

After approval by the University’s Behavioral Research Ethics Board, participants were recruited via web-based study announcements that were made to internet-based arthritis chat groups, arthritis organizations in the United States and Canada, and select organizations’ Facebook pages.

The inclusion criteria were as follows: (a) having self-reported medically diagnosed arthritis, (b) being 18 years or older, (c) residing in the United States or Canada, and (d) being English speaking. Information about arthritis type was not requested given that individuals lack knowledge about and/or fail to accurately recall their arthritis type (CDC, 2011). Individuals who met the criteria completed the informed consent and online survey, which took approximately 20 to 30 minutes to complete. In order for predictor measures to have some basis in direct experience, all participants were required to have plans to exercise in the next 2 weeks. Individuals who had not engaged in exercise were not the focus of our research questions. The study design was prospective, where participants’ MVPA was assessed at two time points (baseline and 2 weeks later).

Measures

The following measures have previously been used in published research, and have, at minimum, face validity. Internal consistencies for past research and present data are offered throughout.

Pain intensity

Four items were used to assess participants’ arthritis pain in various instances. For example, one item asks participants to rate their arthritis pain at the present moment. Responses were on a 0 (no pain) to 10 (extreme pain) scale. The measure followed recommendations for assessing chronic pain (Hadjistavropoulos et al., 2007) and has been used in previous physical activity research with arthritic samples, where an acceptable internal consistency was demonstrated (e.g. Cronbach’s alphas ⩾ 0.89; Gyurcsik et al., 2009, 2011). In this study, this scale was internally consistent (Cronbach’s alpha = 0.88; Tabachnick and Fidell, 2012).

SRE for exercise

To assess participants’ confidence in their ability to manage their exercise bouts, participants responded to a 9-item measure pertaining to behaviors necessary to self-regulate planned physical activity over the next 2 weeks, such as scheduling and planning their exercise. An example item from this scale is, “Over the next 2 weeks (14 days), how confident are you that you can rearrange your schedule so that you can fit your planned exercise into your day?” Items were assessed using a 0 (not at all confident) to 10 (entirely confident) confidence scale and were in accordance with recommendations in the literature (Bandura, 1997; McAuley and Mihalko, 1998; Woodgate et al., 2005). These items have been used previously in exercise-related research with both asymptomatic and symptomatic populations, in which internal consistencies ranged from 0.84 to 0.93 (e.g. Woodgate and Brawley, 2008). This scale was internally consistent (Cronbach’s alpha = 0.94; Tabachnick and Fidell, 2012).

Negative OEs

Negative disease-related reactions anticipated as a consequence of engaging in physical activity were assessed in terms of how distressing (1 = not at all distressing to me; 9 = very distressing to me) each outcome would be as a result of doing exercise. Six items were prefaced with the statement, “Moderate to vigorous activity will …” Example items include the following: “make your arthritis pain worse” and “make your arthritic joints more stiff.” Items were derived from previous arthritis research showing that adults frequently reported these negative outcomes as barriers to being active (Gyurcsik et al., 2009, 2011). This measure followed suggestions for assessment of OEs (e.g. Bandura, 1986; French and Hankins, 2003). This scale was internally consistent in this study (Cronbach’s alpha = 0.92; Tabachnick and Fidell, 2012).

Pain acceptance

The 20-item Chronic Pain Acceptance Questionnaire (CPAQ; McCracken et al., 2004) is a reliable and valid measure comprising two subscales. The activities engagement subscale consists of 11 items to assess the extent to which one pursues life activities despite having pain. Example items include the following: “I am getting on with the business of living no matter what” and “It’s OK to experience arthritis pain.” The pain willingness subscale consists of nine items to assess one’s willingness to experience pain without attempting to control it. Example items include the following: “Keeping my arthritis pain under control takes first priority whenever I’m doing something” and “I have to struggle to do things when I have arthritis pain.” Participants rated each item relative to their arthritis pain on a 0 (never true) to 6 (always true) scale. A total pain acceptance score was used in the analyses. The total possible response range was 0–120, with higher scores representing greater pain acceptance. Both subscales were internally consistent (Cronbach’s alphas = 0.91 [activities engagement], and 0.79 [pain willingness]; Tabachnick and Fidell, 2012).

Exercise volume and level categorization

Participants reported their total weekly volume (frequency × duration) of planned moderate and vigorous activity (i.e. 20-minute bouts or more), which was based upon international recommendations and previous research among adults with arthritis (Gyurcsik et al., 2009, 2011). Shorter bouts of activity may be unplanned and, therefore, may not call for self-regulatory actions such as goal-setting and self-monitoring to be completed. Moderate and vigorous exercises were defined as follows: Moderate exercise “… makes your heart beat faster and makes you breathe a little harder. You can talk easily while doing moderate activity, but you may not be able to sing comfortably. On a scale from 0 to 10, where sitting is 0 and the highest level of effort possible is 10, moderate exercise is a 5 or 6”; Vigorous exercise “… makes your heart beat much faster. You may not be able to talk comfortably without stopping to catch your breath. On a scale of 0 to 10, vigorous activity is a 7 or 8” (Nelson et al., 2007; United States Department of Health and Human Services, 2008). Participants were instructed to only report planned bouts that lasted a minimum of 20 minutes. The instructions given to participants about their recall was based upon a threefold rationale that took into account (a) the self-regulation of planned bouts of activity (i.e. requiring conscious efforts to plan, schedule, and carry out), (b) that planned exercise bouts of longer duration are more apt to be recalled and self-reported with accuracy compared to short bouts of unplanned activity (Cust et al., 2008), and (c) stronger associations between self-reported MVPA and objective measures (Matthews et al., 2005). Exercise volume was measured at two time points, first with all other measures and then 2 weeks later. The exercise volume associated with planned bouts of MVPA (Time 2) was then used to determine which individuals were adhering to 150 minutes of planned, self-regulated activity and which were not. Given our interest in self-regulated MVPA and prediction, we did not include unplanned incidental activity. Our classification of individuals to physical activity levels only considers self-regulated, planned MVPA consisting of bouts of 20 minutes or more. While appropriate for our research question, it is important to recognize that it is not identical to the chronic disease recommendations for arthritis which also includes accumulation of unplanned minutes of MVPA.

Statistical analysis

To accomplish our first and third study purposes, we conducted two logistic regressions. Based on social cognitive theory and past arthritis research in exercise, in our first logistic regression, we first controlled for pain intensity and then entered SRE, OEs, and pain acceptance as predictors to determine their utility for prediction. In our second logistic regression, following the recommendations of Weinstein (2007), we controlled for past planned MVPA in the first step before entering the predictors in subsequent steps. In both models, the dependent variable was planned physical activity level in the two subsequent weeks. Individuals who were meeting the planned 150-minute self-regulated MVPA level were classified as more systematically adherent, while individuals who were not achieving this level were classified as less systematically adherent. Thus, activity level was a dichotomous variable. Prior to conducting the regressions, multicollinearity among the predictors was examined and was not problematic. Standardized residuals were also examined in order to identify and potential outliers were checked and none were detected. Finally, correlations were examined to describe the relations outlined between pain intensity, negative OEs, and pain acceptance (i.e. our second study purpose).

Results

Demographics of study participants

Mean age of the 134 participants was 49.55 ± 13.78 years, where women made up 88 percent of the sample. The majority of participants were White (94%), married (58%) or divorced (11%), and employed full time (36%), retired (20%), or on disability (18%). The sample had a mean self-reported body mass index of 28.10 ± 7.15 kg/m². In regard to arthritis demographics, participants reported a varied length of time since being diagnosed with arthritis, ranging from less than 1 year to over 20 years. Means and standard deviations for the main study variables are reported in Table 1.

Table 1.

Descriptive statistics for key study variables.

Variable	Activity level groups
	Less adherent		More adherent
	M	SD	M	SD
Pain intensity	5.05	1.93	4.70	1.96
Self-regulatory efficacy	6.04	2.17	8.30	1.61
Negative outcome expectations	4.18	2.14	3.37	2.02
Pain acceptance	62.00	17.34	72.67	17.80
MVPA	84.25	36.73	343.34	201.04

SD: standard deviation; MVPA: moderate to vigorous physical activity.

MVPA refers to total weekly volume of planned MVPA (i.e. 20-minute bouts or more). Classification of individuals to physical activity groups considers only self-regulated, planned MVPA consisting of bouts of 20 minutes or more. Scale ranges are as follows: pain intensity (0–10), self-regulatory efficacy (0–10), negative outcome expectations (1–9), and pain acceptance (0–120).

In the first logistic regression analysis, after controlling for pain intensity, the predictors of SRE, negative OEs, and pain acceptance were examined relative to their relationship to planned activity level (−2 Log Likelihood = 150.802, χ²(4) = 31.333, p < 0.001). The model correctly classified 69 percent of the cases. Approximately 28 percent of the variance in the prediction of levels of exercise in the subsequent 2 weeks was accounted for by the four predictors (pain intensity, SRE, negative OEs, and pain acceptance). Wald statistics indicate that after controlling for pain intensity, SRE and pain acceptance significantly predicted the association of individuals to more adherent and less adherent activity level groups, p < 0.01; however, negative OEs did not. Pain intensity did not contribute significantly to the overall model prediction and thus was not utilized in the second regression analysis (Cohen, 1992). The correlation coefficients between pain intensity and exercise levels at both time points were low, negative, and non-significant (r = −0.09 and r = −0.14).

In the second logistic regression analysis, we controlled for past planned activity and entered SRE, negative OEs, and pain acceptance as predictors. The overall model was statistically reliable in distinguishing between more adherent and less adherent activity level groups (−2 Log Likelihood = 107.536, χ²(4) = 74.599, p < 0.001). The model correctly classified 81 percent of the cases. The variables accounted for 57 percent of the variance. Wald statistics indicate that past exercise and pain acceptance significantly predicted the more and less adherent planned physical activity level groups, ps < 0.05; however, SRE and negative OEs did not. The values for B, Wald, df, and level of significance for models 1 and 2 are reported in Table 2.

Table 2.

Regression coefficients.

	B	Wald	df	p
Model 1
Pain intensity	−0.07	0.33	1	0.57
Self-regulatory efficacy	0.37	12.59	1	0.00**
Negative outcome expectations	0.10	0.73	1	0.39
Pain acceptance	0.04	7.62	1	0.01**
Constant	−4.93	11.68	1	0.00
Model 2
Past planned MVPA	3.17	32.23	1	0.00**
Self-regulatory efficacy	0.11	0.74	1	0.39
Negative outcome expectations	0.10	0.52	1	0.47
Pain acceptance	0.04	4.43	1	0.03*
Constant	−7.71	19.34	1	0.00

MVPA: moderate to vigorous physical activity.

Consistent with logistic regression procedures, the dependent variable is categorical, where more adherent is ≥150 minutes of planned MVPA and less adherent is <150 minutes of planned MVPA.

p < 0.05; **p ⩽ 0.01.

Hypotheses about relationships between pain intensity, negative OEs about exercising, and pain acceptance were supported (i.e. ps < 0.001). Pain intensity and pain acceptance were inversely related (r = −0.31) and negative OEs and pain acceptance were inversely related (r = −0.49). Pain intensity and negative OEs were positively related (r = 0.47). Correlations between study variables are reported in a supplementary file (See Supplementary Material online).

Discussion

This study examined adherence-related exercise social cognitions and pain acceptance relative to planned, self-regulated physical activity levels reported by people with arthritis. We also examined Weinstein’s suggestions for estimating the predictive utility of psychological predictors in conjunction with the predictor of past behavior. Finally, we explored associations between pain intensity, negative OEs, and pain acceptance, which had not been done in the physical activity and arthritis literature.

Two separate analyses were conducted to meet the predictive aims. In support of the first hypothesis, the regression model containing SRE beliefs, negative OEs, and pain acceptance as predictors reliably distinguished people more adherent to planned physical activity of 150 minutes from people less adherent to this criteria. SRE and pain acceptance contributed the most to this prediction. The second regression analysis illustrated that when past planned activity was also considered, the contribution of SRE, negative OEs, and pain acceptance was lower in comparison to the first regression model without its inclusion. As expected, past behavior accounted for a substantial portion of the variance in subsequent activity.

In accordance with arguments made by Weinstein (2007) about individuals who have some experience with exercise, the contributions of exercise social cognitions in the prediction of activity levels differed when past activity was taken into account. This approach offers a more careful interpretation of results than the frequent reporting of social predictors without controlling for previous planned activity experience.

Relative to our second study purpose and describing the uninvestigated relationships between pain intensity, negative exercise OEs, and pain acceptance, the significant correlations were as hypothesized. A positive relationship was found between pain intensity and negative OEs, illustrating that individuals reporting more intense pain reported more distressing negative OEs about exercising. Conversely, negative or inverse relationships were observed between pain acceptance and each of pain intensity and negative OEs, where individuals with greater willingness to complete exercise despite pain reported lower pain intensity and less distressing negative OEs about exercising.

Pain acceptance was linked to planned physical activity. Acceptance of arthritis pain predicted adherence to planned activity level, where individuals with greater pain acceptance were also most adherent to the 150 minutes of planned bouts of activity of 20 minutes or more. This finding was consistent with exercise research for arthritis and other chronic conditions (Gyurcsik et al., 2013; Rejeski et al., 2014). The relative importance of pain acceptance in this study and past research suggests that efforts should continue to consider individuals’ acceptance of their pain.

Contrary to the hypothesis, negative OEs did not significantly predict MVPA adherence level in either of the two regression analyses. Given that the mean of distressing negative OEs was relatively low (3.85 and 3.39 out of 9 for both activity levels), perhaps this was not a surprising result. Both groups of exercisers did not perceive these situations to be particularly distressing.

Research contributions

A contribution of this work to the activity and arthritis literature is the examination of negative OEs. The paucity of negative OEs research in exercise has been acknowledged in a review (Williams et al., 2005), and other than this study, only one other arthritis study associating negative OEs and physical activity has been reported (Gyurcsik et al., 2015).

A second contribution of this work is the examination of Weinstein’s recommendations to estimate the contribution of study variables with appropriate statistical adjustment (Weinstein, 2007). This is one of the first arthritis studies about planned physical activity to examine theoretical relationships taking into account these recommendations.

A third contribution is that the study was based upon a theoretical foundation of social cognitive theory to drive hypotheses. As Painter and colleagues have noted, there is a surprising paucity of the use of theory in regard to health behavior research; they stress its importance in advancing future work (Painter et al., 2008).

The limitations of this study also need to be considered. First, generalizability of the findings is limited due to the convenience sampling of volunteers through online data collection methods. Given that participants were required to have plans to exercise in the next 2 weeks, findings are not generalizable to individuals who did not plan to be active. These findings cannot be extended to less educated and/or less affluent individuals with arthritis who exercise but do not have access to this form of responding. Another possible limitation is that bouts of planned physical activity were self-reported, although numerous steps were taken to minimize criticisms of this method as described in the “Measures” section.

While not a limitation per se, readers should not confuse our prediction of planned activity levels (i.e. greater or less than 150 minutes of planned MVPA consisting of bouts of 20 minutes or more) as being the same as predicting the CDC’s recommended level of 150 minutes MVPA to achieve health benefits. The latter public health recommendation is an accumulation of both incidental activity and bouts of longer duration of MVPA. By contrast, our interest was only in planned, regular, self-regulated MVPA.

Future directions

While our research, and that of others, has considered the predictor variables that may characterize the extent of adherence to physical activity recommendations for individuals with arthritis, it is important to recognize that recommendations are a general guide. If more specific needs of individuals are taken into account, the predictor variables may continue to have utility in forecasting adherence but the amount of physical activity recommended could be less. A clear example would be the case of individuals with knee osteoarthritis (KOA), where bone-on-bone contact contributes to differential pain experiences with activity than for individuals with systemic types of arthritis. In this case, recommendations for planned activity may require different self-regulatory strategies to be adherent. In a recent review linking self-efficacy to studies of treatment for KOA, Marks (2012) stresses that greater consideration of individual symptom and tailoring of interventions may promote adherence as opposed to a one-size-fits-all approach. Future predictive research within an exercising KOA population may be useful in determining whether KOA-specific social cognitive predictors (e.g. SRE, negative OEs) offer improved predictive utility.

Finally, taking into account Weinstein’s ideas about when and for whom social cognitive predictors would have greater predictive utility, a future research direction should be the examination of individuals starting or reinitiating exercise (e.g. individuals with KOA). As he notes, the contribution of predictors drawn from theories such as social cognitive theory as well as disease-related predictors (SRE, negative OEs, pain, pain acceptance) would be anticipated to be greater in the prediction of planned MVPA for individuals starting or reinitiating.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Canadian Institutes of Health Research and the Regional Partnership Program with the Saskatchewan Health Research Foundation.

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