Barriers and Facilitators to Exercise Participation in People with Hip and/or Knee Osteoarthritis

Abstract

Exercise is recommended for hip and knee osteoarthritis (OA). Patient initiation of, and adherence to, exercise is key to the success of managing symptoms. This study aimed to (1) identify modifiable barriers and facilitators to participation in intentional exercise in hip and/or knee OA, and (2) synthesize findings using behavior change theory. A scoping review with systematic searches was conducted through March 2015. Two reviewers screened studies for eligibility. Barriers and facilitators were extracted and synthesized according to the Theoretical Domains Framework (TDF) by two independent reviewers. Twenty-three studies (total of 4633 participants) were included. The greatest number of unique barriers and facilitators mapped to the Environmental Context and Resources domain. Many barriers were related to Beliefs about Consequences and Beliefs about Capabilities, whereas many facilitators were related to Reinforcement. Clinicians should take a proactive role in facilitating exercise uptake and adherence, rather than trusting patients to independently overcome barriers to exercise. Strategies that may be useful include a personalized approach to exercise prescription, considering environmental context and available resources, personalized education about beneficial consequences of exercise and reassurance about exercise capability, and use of reinforcement strategies. Future research should investigate the effectiveness of behavior change interventions that specifically target these factors.

Mindfulness Is Associated With Treatment Response From Nonpharmacologic Exercise Interventions in Knee Osteoarthritis

“…Because exercise interventions require active patient participation, psychological factors may influence treatment efficacy through its behavioral effect on adherence 11,12 . One prior study found that absence of depressive symptoms predicted symptomatic response from exercise rehabilitation in OA 7 .…”

“…Among the general population, mindfulness is associated with greater physical activity and greater weight loss from exercise 21–24 . Investigating the association between mindfulness and exercise treatment outcomes is warranted because poor adherence and low pain-coping skills are both major barriers to exercise in OA 11,12 . To date, no study has examined longitudinal associations of mindfulness on treatment outcomes among these patients.…”

Knee osteoarthritis and aquatic cycling

“…7 Addition of these elements might prevent monotony especially in multiple session programmes 75 and results from supportive literature suggest that a full spectrum aquatic cycling programme is effective in patients with musculoskeletal disorders. 76 This scoping review has identified a number of areas for further research. Most of the included studies have a cross over design with few cycling sessions and investigated the exercise response in young healthy males, because gender, body mass and morphology are known to affect the response to aquatic cycling.…”

“…While interpreting our results, the study setting and supervision should be taken into account since both may have influenced adherence and the lasting effects observed. 76 According to Dobson et al, 76 the environmental context influences participation and adherence. The intervention programme was free of cost, conducted in a small hospital therapy pool with individual shower and changing facilities and the location was easily reachable either by bus or car.…”

“…However, to ensure safe and beneficial exercise participation it is important that fitness professionals are educated with regard to musculoskeletal pathology. 76 This dissertation provides insight into different training set ups for patient populations (chapter 2 4), and based on these findings a well educated aquatic fitness professional should be able to adjust training sessions to meet the needs of a participant with knee OA. By contrast, patients need to be able to participate in community based exercise classes.…”