Motivators and barriers for physical activity in elderly with osteoarthritis: a qualitative survey.

Background: Physical activity is recognized as an important tool in the prevention and treatment of osteoarthritis (OA). However, one on two Belgian citizens attains a minimum of 2.5 hours of moderate physical activity/week, and this proportion decreases to one on five in those aged >74 years. The promotion of physical activity in elderly OA-patients should target those factors that motivate or hinder physical activity in these persons. Aim of the study: to identify the motivators and barriers for physical activity in elderly OA-patients. Methods: First, Pubmed, Web of Science and Psychinfo were systematically screened using the keywords "Arthritis / osteoarthritis, physical activity / movement / exercise, motivation / adherence / barrier". Next, supplementary items were generated by a panel composed by a rheumatologist, a general practitioner, two physical therapist, two occupational therapists, a master in gerontology, a senior's sports coordinator (all showing clinical expertise in working with OA-patients) and a representative of the Flemish rheumatologic association. Finally, 17 elderly persons (10 female, 7 male, aged 65-80 years) suffering from osteoarthritis of the hip and/or knee participated in a semi-structured interview. Data obtained from literature search, panel discussion and interviews were analyzed from a qualitative approach by screening for motivators and barriers for physical activity. The Health Belief Model (Becker, 1974) was used as a theoretical framework for classifying the items. Results: Literature search resulted in 8 relevant articles (from which 2 reviews), generating 48 motivators and 69 barriers for physical activity in OA-patients. The expert panel discussion and semi-structured interviews generated respectively 117 and 97 motivators and 146 and 89 barriers for physical activity, which were either confirmatory or complementary to the items found in the literature. The items covered a wide range of physical, social and psychological motivators and barriers for physical activity. In addition, structural factors such as lifestyle and environmental factors such as 'the weather' were mentioned to influence the extent of physical activity. Apathy for exercise, depression, competitive social roles, pain, stiffness, low fitness-level, long-lasting sedentary life style, fatigue and co-morbidity were mentioned as barriers for physical activity. Common motivators were extrinsic motivation, social support, a good communication with the general practitioner and the autonomy to decide and/or choose. In literature, the expert panel and the interviews, an improved well-being, a better feeling and an improved health feeling were mentioned as motivators for physical activity. The role of the media was only emphasized by the experts and the elderly. Finally, the interviews demonstrate that elderly OA-patients are not equally informed concerning the purpose and benefits of physical activity. Conclusions: This study added supplementary motivators and barriers for physical activity in elderly OA-patients to those described in the literature, which are important to target when promoting physical activity in these patients. Based on the items generated in our study, a structured questionnaire will be developed and the relative importance of the different motivators and barriers for physical activity will be assessed on a large sample of OA-patients.