Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis

synthesis of the literature using behavior change theory

Fiona Dobson*, Kim L. Bennell, Simon D. French, Philippa J.A. Nicolson, Remco N. Klaasman, Melanie A. Holden, Lou Atkins, Rana S. Hinman

*Corresponding author for this work

Research output: Contribution to journalReview article

72 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)372-389
Number of pages18
JournalAmerican Journal of Physical Medicine and Rehabilitation
Issue number5
Publication statusPublished - 1 May 2016
Externally publishedYes


  • Barriers
  • Exercise
  • Facilitators
  • Osteoarthritis

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