title: Barriers and Facilitators to Exercise Participation in People with Hip and/or Knee Osteoarthritis: Synthesis of the Literature Using Behavior Change Theory.
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.
authors.affiliation: From the Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia (FD, KLB, SDF, PJAN, RSH); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada (SDF); Faculty of Healthcare, University of Applied Sciences Utrecht, Utrecht, The Netherlands (RNK); Arthritis Research UK Primary Care Centre, Keele University, Keele, UK (MAH); and Research Department of Clinical, Education and Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, London, UK (LA).
authors.forename: Fiona
authors.initials: F
authors.lastname: Dobson
authors.forename: Kim L
authors.initials: KL
authors.lastname: Bennell
authors.forename: Simon D
authors.initials: SD
authors.lastname: French
authors.forename: Philippa J A
authors.initials: PJ
authors.lastname: Nicolson
authors.forename: Remco N
authors.initials: RN
authors.lastname: Klaasman
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Holden
authors.forename: Lou
authors.initials: L
authors.lastname: Atkins
authors.forename: Rana S
authors.initials: RS
authors.lastname: Hinman
mesh_terms: D001288:Attention; D001294:Attitude to Health; D004644:Emotions; D005081:Exercise Therapy / Q000523:psychology*; D006040:Goals; D015438:Health Behavior; D006801:Humans; D015207:Osteoarthritis, Hip / Q000503:physiopathology*; D020370:Osteoarthritis, Knee / Q000503:physiopathology*; D010358:Patient Participation / Q000523:psychology*; D011582:Psychological Theory; D020377:Self Efficacy; D012931:Social Environment