RSS-Feed abonnieren
DOI: 10.1055/s-0031-1277185
© Georg Thieme Verlag KG Stuttgart · New York
Körperliche Aktivität nach der Rehabilitationsbehandlung: Die subjektive Beeinträchtigung durch Schmerzen als Barriere oder Motivation
Physical Activity after Rehabilitation Treatment: The Subjective Influence of Pain in Terms of Barrier or MotivationPublikationsverlauf
Publikationsdatum:
05. Oktober 2011 (online)
![](https://www.thieme-connect.de/media/rehabilitation/201204/lookinside/thumbnails/10.1055-s-0031-1277185-1.jpg)
Zusammenfassung
Ziel der Studie: Es soll geklärt werden, inwieweit körperliche Aktivität langfristig durch subjektive Beeinträchtigung aufgrund von Schmerzen sowie durch Intentionen und Planung vorhergesagt werden kann.
Methodik: Es wurde eine Befragungsstudie mit Rehabilitationspatienten über einen Zeitraum von über 3 Jahren durchgeführt. Die Datenanalyse erfolgte mittels binärer logistischer Regressionen.
Ergebnisse: Nach Kontrolle von sozial-kognitiven Variablen war die subjektive Beeinträchtigung durch Schmerzen am Anfang der Rehabilitation ein positiver Prädiktor für gesteigerte körperliche Aktivitäten nach der Rehabilitation. Wer jedoch 6 Monate nach der Rehabilitation Schmerzen berichtete, war mit einer geringeren Wahrscheinlichkeit körperlich aktiv.
Schlussfolgerung: Für die Rehabilitationspraxis erscheint die Berücksichtigung der subjektiven Beeinträchtigung durch Schmerzen bei der Motivierung von Patienten empfehlenswert, z. B. durch die Antizipation von Schmerzen und die Information über Möglichkeiten zu deren Linderung bzw. durch Bewältigungsplanung, wie man angesichts von Schmerzen körperlich aktiv sein kann. Insbesondere die Nachsorge stellt Potenzial dar, mit Schmerzen besser umzugehen.
Abstract
Purpose of this study: To examine the impact of the subjective health impairment due to pain, intention and planning on long-term physical activity.
Method: A longitudinal questionnaire study with rehabilitation patients was performed over a time-span of more than 3 years. Data analyses were performed with binary logistic regressions.
Results: After controlling for social-cognitive variables subjective health impairment due to pain at the beginning of rehabilitation was a significant positive predictor of increased physical activity after rehabilitation. However, subjective health impairment due to pain 6 months after discharge was significantly negatively correlated with physical activity 3 years after rehabilitation.
Conclusion: These findings suggest that subjective impairment due to pain should be considered when motivating people, e. g. by anticipating pain and possibilities for its improvement, respectively, or by coping planning on how to be physically active even in the face of pain. Especially during the time after rehabilitation patients may benefit from more help to manage pain.
Schlüsselwörter
Intention - Planung - Schmerzen - Aktivität - Rehabilitation
Key words
intention - planning - pain - activity - rehabilitation
Literatur
- 1 Briggs AM, Straker LM, Wark JD. Bone health and back pain: What do we know and where should we go?. Osteoporos Int. 2009; 20 209-219
- 2 Rejeski WJ, Focht BC, Messier SP. et al . Obese, older adults with knee osteoarthritis: Weight loss, exercise, and quality of life. Health Psychol. 2002; 21 419-426
- 3 Mensink G. Movement and circulation. Population studies on physical activity and cardiovascular risk. Wageningen: Ponsen & Looijen BV; 1997
- 4 Mensink G. Bundes-Gesundheitssurvey: Körperliche Aktivität. Beiträge zur Gesundheitsberichterstattung des Bundes. Berlin: RKI; 2003
- 5 Sallis JF, Owen N. Physical activity and behavioral medicine. Thousand Oaks: Sage; 1998
- 6 Ziegelmann JP, Lippke S. Selbstregulation in der Gesundheitsverhaltensänderung: Strategienutzung und Bewältigungsplanung bei Erwachsenen im jungen, mittleren und höheren Alter. Zeitschrift für Gesundheitspsychologie. 2006; 14 82-90
- 7 Mensink G. Körperliche Aktivität. Gesundheitswesen. 1999; 61 126-131
- 8 Wurm S, Lampert T, Menning S. Subjektive Gesundheit. In: Böhm K, Tesch-Römer C, Ziese T, Hrsg. Beiträge zur Gesundheitsberichterstattung des Bundes Gesundheit und Krankheit im Alter. Berlin: RKI; 2009: 80-92
- 9 Rütten A, Abu-Omar K, Lampert T, Ziese T. Gesundheitsberichterstattung des Bundes. Heft 26. Körperliche Aktivität Berlin: RKI; 2005
- 10 Phillips M, Flemming N, Tsintzas K. An exploratory study of physical activity and perceived barriers to exercise in ambulant people with neuromuscular disease compared with unaffected controls. Clin Rehabil. 2009; 23 746-755
- 11 Barlow JH. Understanding exercise in the context of chronic disease. Percept Mot Skills. 1998; 87 439-446
- 12 Centers for Disease Control and Prevention (CDC) . Arthritis as a potential barrier to physical activity among adults with heart disease. MMWR. 2009; 58 165-169
- 13 Williams NH, Amoakwa E, Burton K. et al . Activity Increase Despite Arthritis (AIDA): Design of a Phase II randomised controlled trial evaluating an active management booklet for hip and knee osteoarthritis. BMC Fam Pract. 2009; 10 62-70
- 14 Brosseau L, MacLeay L, Robinson VA. et al . Intensity of exercise for the treatment of osteoarthritis. Cochrane Database Syst Rev. 2003; CD004259
- 15 Hernandez-Molina G, Reichenbach S, Zhang B. et al . Effect of therapeutic exercise for hip osteoarthritis: Results of a meta-analysis. Arthritis Rheum. 2008; 59 1221-1228
- 16 McCarthy C, Oldham J. The effectiveness of exercise in the treatment of osteoarthritic knees: A critical review. Phys Ther. 1999; 4 241-250
- 17 van Baar ME, Assendelft WJ, Oostendorp RA, Bijlsnd JW. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review of randomized clinical trials. Arthritis Rheum. 1999; 42 1361-1369
- 18 Schaefer U, Bischoff C. Qualitative Analyse subjektiver Krankheitskonzepte. Erstellung und Validierung eines Kategoriensystems für den Fragebogen zum Krankheitskonzept (Bischoff, Husen, Schaefer und Reichel). Psychother Psychosom Med Psychol. 2002; 52 398-407
- 19 Schwarzer R. Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. J Appl Psychol;. 57 1-29
- 20 Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology. 2006; 38 68-119
- 21 Scholz U, Schüz B, Ziegelmann JP. et al . Beyond behavioural intentions: Planning mediates between intentions and physical activity. Br J Health Psychol. 2008; 13 479-494
- 22 Glasgow RE, Eakin EG. Issues in diabetes self-management. In: Shumaker SA, Schron EB, Ockene JK, McBee WL , Hrsg. The handbook of health behavior change New York: Springer; 1998: 435-461
- 23 Conner M, Norman P. The role of social cognitions in predicting health behaviors. In: Conner M, Norman P , Hrsg. Predicting health behavior Buckingham, UK: Open University Press; 1996: 1-22
- 24 Gollwitzer PM. Implementation intentions: Strong effects of simple plans. Am Psychol. 1999; 54 493-503
- 25 Webb TL, Sheeran P. Integrating concepts from goal theories to understand the achievement of personal goals. European Journal of Social Psychology. 2005; 35 69-96
- 26 Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? A meta-analyis of the experimental evidence. Psychol Bull. 2006; 132 249-268
- 27 Ajzen I. From intentions to actions: A theory of planned behavior. In: Kuhl J, Beckman J, Hrsg. Action–control: From cognition to behavior Heidelberg: Springer; 1985: 11-39
- 28 Schwarzer R. Self-efficacy in the adoption and maintenance of health behaviors: Theoretical approaches and a new model. In: Schwarzer R, Hrsg. Self-efficacy: Thought control of action Washington, DC: Hemisphere; 1992: 217-243
- 29 Biddle SJH, Hagger MS, Chatzisarantis NLD, Lippke S. Theoretical frameworks in exercise psychology. In: Tenenbaum G, Eklund RC, Hrsg. Handbook of sport psychology 3. Aufl. New York: Wiley; 2007: 537-559
- 30 Göhner W, Fuchs R. Änderung des Gesundheitsverhaltens. MoVo-Gruppenprogramme für körperliche Aktivität und gesunde Ernährung. Göttingen: Hogrefe; 2007
- 31 Lippke S, Ziegelmann JP. Theory-based health behavior change: Developing, testing, and applying theories for evidence-based interventions. J Appl Psychol. 2008; 57 698-716
- 32 Fleig L, Lippke S, Wiedemann AU. et al . Förderung von körperlicher Aktivität im betrieblichen Kontext. Ein randomisiertes Kontrollgruppen-Design zur Untersuchung von stadienspezifischen Interventionseffekten. Zeitschrift für Gesundheitspsychologie. 2010; 18 69-78
- 33 Campbell M, Fitzpatrick R, Haines A. et al . Framework for design and evaluation of complex interventions to improve health. BMJ. 2000; 321 694-696
- 34 Craig P, Dieppe P, Macintyre S. et al . Developing and evaluating complex interventions: The new Medical Research council guidance. BMJ. 2008; 337 979-983
- 35 Dombrowski SU, Sniehotta FF, Avenell S. Towards a cumulative science of behaviour change: Do current conduct and reporting of behaviourial interventions fall short of good practice?. Psychology and Health. 2007; 22 869-874
- 36 Noar SM, Zimmermann RS. Health behavior theory and cumulative knowledge regarding health behaviors: Are we moving in the right direction?. Health Educ Res. 2005; 20 275-290
- 37 Weinstein ND, Rothman AJ, Sutton SR. Stage theories of health behavior: Conceptual and methodological issues. Health Psychol. 1998; 17 290-299
- 38 Scholz U, Sniehotta FF, Schwarzer R. Predicting physical exercise in cardiac rehabilitation: The role of phase-specific self-efficacy beliefs. Journal of Sport and Exercise. 2005; 27 135-151
- 39 Luszczynska A, Schwarzer R. Planning and self-efficacy in the adoption and maintenance of breast self-examination: A longitudinal study on self-regulatory cognitions. Psychology and Health. 2003; 18 93-108
- 40 Schwarzer R, Schüz B, Ziegelmann JP. et al . Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity. Ann Behav Med. 2007; 33 156-166
- 41 Renner B, Schwarzer R. The motivation to eat a healthy diet: How intenders and nonintenders differ in terms of risk-perception, outcome expectancies, self-efficacy, and nutrition behavior. Polish Psychological Bulletin. 2005; 36 7-15
- 42 Schwarzer R, Renner B. Social-cognitive predictors of health behavior: Action self-efficacy and coping self-efficacy. Health Psychol. 2000; 19 487-495
- 43 Schüz B, Sniehotta FF, Mallach N. et al . Predicting transitions from preintentional, intentional and actional stages of change. Health Educ Res. 2009; 24 64-75
- 44 Michalski D, Zweynert U, Kittel J, Hinz A. Schmerzempfinden und -verhalten während der orthopädischen Rehabilitation. Schmerz. 2009; 23 360-369
- 45 Pfingsten M. Psychologische Faktoren. In: Hildebrandt J, Müller G, Pfingsten M, Hrsg. Lendenwirbelsäule. Ursachen, Diagnostik und Therapie von Rückenschmerzen München: Elsevier; 2005: 26-40
- 46 Thomas JS, France CR. Pain-related fear is associated with avoidance of spinal motion during recovery from low back pain. Spine. 2007; 32 460-466
- 47 Lippke S, Ziegelmann JP, Schwarzer R. Initiation and maintenance of physical exercise: Stage-specific effects of a planning intervention. Reseach in Sports Medicine. 2004; 12 221-240
- 48 Lippke S, Ziegelmann JP. Understanding and Modeling Health Behavior. The Multi-Stage-Model of Health Behavior Change. J Health Psychol. 2006; 11 37-50
- 49 Lippke S, Ziegelmann JP, Schwarzer R. Stage-specific adoption and maintenance of physical activity: testing a three-stage model. Psychology of Sport and Exercise. 2005; 6 585-603
- 50 Lippke S, Ziegelmann JP, Schwarzer R, Velicer WF. Validity of stage assessment in the adoption and maintenance of physical activity and fruit and vegetable consumption. Health Psychol. 2009; 28 183-193
- 51 Lippke S, Ziegelmann JP, Schwarzer R. Behavioral intentions and action plans promote physical exercise: A longitudinal study with orthopedic rehabilitation patients. Journal of Sport and Exercise Psychologie. 2004; 26 470-483
- 52 Schwarzer R, Luszczynska A, Ziegelmann JP. et al . Social-cognitive predictors of physical exercise adherence: Three longitudinal studies in rehabilitation. Health Psychol. 2008; 27 54-63
- 53 Bullinger M, Kirchberger I. SF-36. Fragebogen zum Gesundheitszustand. Göttingen: Hogrefe; 1998
- 54 Lippke S, Wiedemann A, Ziegelmann JP. et al . Self-efficacy moderates the mediation of intentions into behavior via plans. Am J Health Behav. 2009; 33 521-529
- 55 Lippke S, Plotnikoff RC. The protection motivation theory within the stages of the transtheoretical model – stage-specific interplay of variables and prediction of exercise stage transitions. Br J Health Psychol. 2009; 14 211-229
- 56 Reuter T, Ziegelmann JP, Lippke S, Schwarzer R. Long-term relations between intentions, planning, and exercise: A 3-year-longitudinal study after orthopedic rehabilitation. Rehabilitation Psychology. 2009; 54 363-371
- 57 Dombrowski S, Luszczynska A. The interplay between conscious and automatic self-regulation and adolescents’ physical activity: The role of planning, intentions, and lack of awareness. Appl Psychol. 2009; 58 257-273
- 58 Norman P, Conner M. The Theory of Planned Behavior and exercise: Evidence for the mediating and moderating roles of planning on intention-behavior relationships. Journal of Sport and Exercise Psychology. 2005; 27 488-504
- 59 Aspinwall LG. The psychology of future-oriented thinking: From achievement to proactive coping, adaption and aging. Motivation and Emotion. 2005; 29 203-234
- 60 Bode C, De Ridder DT, Bensing JM. Preparing for aging: Development, feasibility and preliminary results of an educational program for midlife and older based on proactive coping theory. Patient Educ Couns. 2006; 61 272-278
Korrespondenzadresse
Juliane Paech
Freie Universität Berlin
Erziehungswissenschaften und
Psychologie
Arbeitsbereich
Gesundheitspsychologie
Habelschwerdter Allee 45
(PF 10)
14195 Berlin
eMail: jpaech@zedat.fu-berlin.de