title: Facilitators and barriers to exercise adherence in patients with osteopenia and osteoporosis: a systematic review.
abstract: The aim of this study was to categorize the facilitators and barriers of exercise and identify methods to promote exercise adherence in the osteoporosis population. Despite the fair methodological quality of included randomized controlled trials (RCTs), less than 75 % identified facilitators and barriers to exercise. Methods to promote and measure exercise adherence were poorly reported.
  
  
  
  Several studies have shown exercise to be successful in maintaining or increasing BMD in individuals with low bone mass. Yet, adherence to exercise is poor, with 50 % of those registered in an exercise program dropping out within the first 6 months, lack of time being the number one barrier in many populations. However, in the osteoporosis population, the main facilitator and barrier to exercise is still unclear. The aim of this study is to examine the extent to which RCTs reported the facilitators and the barriers to exercise and identified methods to promote adherence to an exercise program.
  
  
  
  PubMed, CINHAL, EMBASE, and the Cochrane Review were queried using a predefined search criterion, and the resulting citations were imported into DistillerSR. Screening was carried out by two independent reviewers, and articles were included in the analysis by consensus. The methodological quality of included studies was assessed using the PEDro scale.
  
  
  
  Fifty-four RCTs examining exercise interventions in patients with osteopenia or osteoporosis were included. A spectrum of facilitators and barriers to exercise for osteoporotic patients were identified; however, no one facilitator was more frequently reported than the other. The most commonly reported barriers were lack of time and transportation. In most RCTs, methods to promote and measure exercise adherence were unsatisfactory. Of the 54 papers, 72 % reported an adherence rate to an exercise program; the lowest reported rate was 51.7 %, and the highest 100 %.
  
  
  
  Most RCTs found were of fair quality; however, less than three quarters identified facilitators and barriers to exercise. Reporting of methods to promote and measure exercise adherence were low. Future work should be directed toward identifying major facilitators and barriers to exercise adherence within RCTs. Only then can methods be identified to leverage facilitators and overcome barriers, thus strengthening the evidence for efficacy of optimal interventional exercise programs. This review has been registered in PROSPERO under registration number CRD42016039941.
authors.affiliation: McMaster University School of Rehabilitation Science, 1280 Main Street W, IAHS 308, Hamilton, ON, L8S 4K1, Canada. rodrigib@mcmaster.ca.
authors.forename: I B
authors.initials: IB
authors.lastname: Rodrigues
authors.affiliation: Schulich School of Medicine and Dentistry, 101-460 Wellington St., London, ON, N6A 3P8, Canada.
authors.forename: J J
authors.initials: JJ
authors.lastname: Armstrong
authors.affiliation: McMaster University Department of Medicine St. Joseph's Healthcare Hamilton, 25 Charlton Ave. E Room 501, Hamilton, ON, L8N 1Y2, Canada.
authors.forename: J D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: Hand and Upper Limb Center Clinical Research Lab, 930 Richmond St., London, ON, N6A 3J4, Canada.
authors.forename: J C
authors.initials: JC
authors.lastname: MacDermid
mesh_terms: D015982:Bias; D001851:Bone Diseases, Metabolic / Q000534:rehabilitation*; D015444:Exercise; D005081:Exercise Therapy; D006801:Humans; D010024:Osteoporosis / Q000534:rehabilitation; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000379:methods
keywords: Barriers; Exercise; Facilitators; Osteopenia; Osteoporosis; Physical activity; Randomized control trial