Original research| Volume 19, ISSUE 6, P454-458, June 2016

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Mental toughness as a moderator of the intention–behaviour gap in the rehabilitation of knee pain



      The purpose of this study was to investigate the role of mental toughness in maximising the effect of intentions to perform rehabilitative exercises on behaviour among a sample of people with knee pain.


      Cross-sectional survey, with a 2-week time-lagged assessment of exercise behaviour.


      In total, 193 individuals (nfemale = 107, nmale = 84) aged between 18 and 69 years (M = 30.79, SD = 9.39) participated, with 136 (70.5%) retained at both assessment points. At time 1, participants completed an online, multisection survey that encompassed measures of demographic details, severity of problems associated with the knee (e.g., pain, symptoms), past behaviour, mental toughness, and the theory of planned behaviour constructs (TPB; attitudes, subjective norms, perceived behavioural, intentions). Two weeks later, participants retrospectively reported their exercise behaviour for the past 14 days using an online survey.


      Moderated regression analyses indicated that mental toughness and its interaction with intention accounted for an additional 3% and 4% of the variance in exercise behaviour, respectively. Past behaviour, attitudes, and mental toughness all had direct effects on behaviour, alongside a meaningful interaction between intentions and mental toughness. Specifically, intentions had a stronger effect on exercise behaviour among those individuals high in mental toughness compared to those low in this personal resource.


      The results of this study shed new light on the intention–behaviour gap by indicating that mental toughness increases the likelihood that intention is translated into action.


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        • Zhang W.
        • Moskowitz R.W.
        • Nuki G.
        • et al.
        OARSI recommendations for the management of hip and knee osteoarthritis. Part II: OARSI evidence-based, expert consensus guidelines.
        Osteoarthritis Cartilage. 2008; 16: 137-162
        • Knols R.
        • Aaronson N.K.
        • Uebelhart D.
        • et al.
        Physical exercise in cancer patients during and after medical treatment: a systematic review of randomised and controlled clinical trials.
        J Clin Oncol. 2005; 23: 3830-3842
        • Saunders D.H.
        • Greig C.A.
        • Mead G.E.
        Physical activity and exercise after stroke: review of multiple meaningful benefits.
        Stroke. 2014; 45: 3742-3747
        • Naci H.
        • Ioannidis H.P.A.
        Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study.
        BMJ. 2013; 347: f5577
        • World Health Organization
        Adherence to long-term therapies: evidence for action.
        WHO Library, Geneva, Switzerland2003
        • Michie S.
        • van Stralen M.M.
        • West R.
        The behaviour change wheel: a new method for characterising and designing behaviour change interventions.
        Implement Sci. 2011; 6: 42
        • Michie S.
        • Abraham C.
        Interventions to change health behaviours: evidence-based or evidence-inspired?.
        Psychol. Health. 2004; 19: 29-49
        • Ajzen I.
        The theory of planned behaviour.
        Organ Behav Hum Decis. 1991; 50: 179-211
        • McEachan R.R.C.
        • Conner M.T.
        • Taylor N.
        • et al.
        Prospective prediction of health-related behaviours with the theory of planned behaviour: a meta-analysis.
        Health Psychol Rev. 2011; 5: 97-144
        • Hagger M.
        • Chatzisarantis N.L.D.
        • Biddle S.J.H.
        A meta-analytic review of the theories of reasoned action and planned behaviour in physical activity: predictive validity and the contribution of additional variables.
        J Sport Exerc Psychol. 2002; 24: 1-12
        • Rhodes R.E.
        • Dickau L.
        Meta-analysis of experimental evidence for the intention–behaviour relationship in the physical activity domain.
        Health Psychol. 2012; 31: 724-727
        • Rhodes R.E.
        • Dickau L.
        Moderators of the intention–behaviour relationship in the physical activity domain: a systematic review.
        Br J Sport Med. 2013; 47: 215-225
        • Carraro N.
        • Gaudreau P.
        Spontaneous and experimentally induced action planning and coping planning for physical activity: a meta-analysis.
        Psychol Sport Exerc. 2013; 14: 228-248
        • Sniehotta F.F.
        Towards a theory of intentional behaviour change: plans, planning, and self-regulation.
        Br J Health Psychol. 2009; 14: 261-273
        • Gucciardi D.F.
        • Hanton S.
        • Gordon S.
        • et al.
        The concept of mental toughness: tests of dimensionality, nomological network, and traitness.
        J Pers. 2015; 83: 26-44
        • Bell J.J.
        • Hardy L.
        • Beattie S.
        Enhancing mental toughness and performance under pressure in elite young cricketers: a 2-year longitudinal intervention.
        Sport Exerc Perform Psychol. 2014; 2: 281-297
        • Gucciardi D.F.
        • Peeling P.
        • Ducker K.
        • et al.
        When the going gets tough: mental toughness and its relationship with behavioural perseverance.
        J Sci Med Sport. 2014; (in press)
        • Gucciardi D.F.
        • Gordon S.
        • Dimmock J.A.
        Towards an understanding of mental toughness in Australian football.
        J Appl Sport Psychol. 2008; 20: 261-281
        • Jones G.
        • Hanton S.
        • Connaughton D.
        A framework of mental toughness in the world's best performers.
        Sport Psychol. 2007; 21: 243-264
        • Øiestad B.E.
        • Østeras N.
        • Frobell R.
        • et al.
        Efficacy of strength and aerobic exercise on patient-reported outcomes and structural changes in patients with knee osteoarthritis: study protocol for a randomized controlled trial.
        BMC Musculoskel Dis. 2013; 14: 266
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • et al.
        Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28: 88-96
        • Azjen I.
        Constructing a TpB questionnaire: conceptual and methodological considerations.
        2006 (Retrieved from 〈〉)
        • Hagger M.S.
        • Chatzisarantis N.L.D.
        • Barkoukis V.
        • et al.
        Cross-cultural generalizability of the Theory of Planned Behaviour among young people in a physical activity context.
        J Sport Exerc Psychol. 2007; 29: 1-20
        • Gucciardi D.F.
        • Jackson B.
        Understanding sport continuation: an integration of the theories of planned behaviour and basic psychological needs.
        J Sci Med Sport. 2015; 18: 31-36
        • Ziegelmann J.P.
        • Lippke S.
        • Schwarzer R.
        Adoption and maintenance of physical activity: planning interventions in young, middle-aged, and older adults.
        Psychol Health. 2006; 21: 145-216
        • Dawson J.F.
        Moderation in management research: what, why, when and how.
        J Bus Psychol. 2014; 29: 1-19
        • Steiger J.H.
        Beyond the F test: effect size confidence intervals and tests of close fit in the analysis of variance and contrast analysis.
        Psychol Methods. 2004; 9: 164-182
        • Poitras S.
        • Rossignol M.
        • Avouac J.
        • et al.
        Management recommendations for knee osteoarthritis: how usable are they?.
        Joint Bone Spine. 2010; 77: 458-465
        • Fishbein M.
        • Ajzen I.
        Predicting and changing behaviour: the reasoned action approach.
        Psychology Press, New York, NY2010