Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence

Physical activity (PA) including engagement in structured exercise, has a key role in the management of hip and knee osteoarthritis (OA), however maintaining a physically active lifestyle is a challenge for people with OA. PA determinants in this population need to be understood better so that they can be optimised by public health or healthcare interventions and social policy changes. Objectives: To conduct a systematic review of the existing qualitative evidence on barriers and facilitators of PA for patients with hip or knee OA. Secondary objectives, to explore differences in barriers and facilitators between (i)lifestyle PA and exercise; (ii)PA uptake and maintenance. Methods: MEDLINE, EMBASE, Web of Science, CINAHL, SPORTDiscus, Scopus, Grey literature and qualitative journals were searched. CASP-Qualitative checklist and Lincoln &Guba’s criteria were used for quality appraisal. Thematic synthesis was applied. Findings: Ten studies were included, seven focusing on exercise regimes, three on overall PA. The findings showed a good fit with the biopsychosocial model of health. Aiming at symptom relief and mobility, positive exercise experiences and beliefs, knowledge, a “keep going” attitude, adjusting and prioritising PA, having health-care professionals’ and social support emerged as PA facilitators. Pain and physical limitations; non-positive PA experiences, beliefs and information; OA-related distress; a resigned attitude; lack of motivation, behavioural regulation, professional support; and negative social comparison with co-exercisers were PA barriers. All themes were supported by high and medium quality studies. Paucity of data did not allow for the secondary objectives to be explored. Conclusion: Our findings reveal a complex interplay among physical, personal including psychological, and social-environmental factors corresponding to the facilitation and hindrance of PA, particularly exercise, engagement. Further research on the efficacy of individualized patient education, psychological interventions, or social policy change to promote exercise engagement and lifestyle PA in individuals with lower limb OA is required.