The attitudes towards, and beliefs about, physical activity in people with osteoarthritis and comorbidity: A qualitative investigation

Abstract

Objective: To investigate the attitudes towards, and beliefs about, physical activity (PA) in older adults with osteoarthritis (OA) and comorbidity to understand experiences and seek ways to improve PA participation.Methods: Semi-structured interviews with adults aged ≥45, with self-reported OA and comorbidity (N = 17). Face-to-face interviews explored participant perspectives regarding; (1) attitudes and beliefs about PA in the context of OA and comorbidity and (2) how people with OA and comorbidity could be encouraged to improve and maintain PA levels. Data were transcribed verbatim and inductive thematic analysis was undertaken using a framework approach. Results: Participants did not conceptualise multiple long-term conditions (LTCs) together and instead self-prioritised OA over other LTCs. Barriers to PA included uncertainty about both the general management of individual LTCs and the effectiveness of PA for their LTCs; and, negative perceptions about their health, ageing and PA. Participants experienced dynamic and co-existing barriers to PA, and problematized this as a multi-level process, identifying a barrier, then a solution, followed by a new barrier. Facilitators of PA included social support and support from knowledgeable healthcare professionals (HCPs), together with PA adapted for OA and comorbidity and daily life. PA levels could be increased through targeted interventions to increase self-efficacy for managing OA alongside other LTCs and self-efficacy for PA. Conclusion: People with OA and comorbidity experience complicated PA barriers. To increase PA levels, tailored PA interventions could include HCP and social support to anticipate and overcome multi-level PA barriers and target increased self-efficacy for LTC management and PA.

Peoples' beliefs about their chronic hip pain and its care: a systematic review of qualitative studies. “I'm just getting old and breaking down”

“…122 Most often people who attributed their hip pain to wear and tear, degeneration, overuse, or age avoided activities and nonsurgical treatments (see theme 3). 59,84,103,114,115 People attributing biomedical causes to their hip pain were concerned that physical activity and exercise may worsen their hip joint (eg, worsen "degeneration" and "wear and tear") or that physical activity and exercise were unlikely to benefit them because their hip pain was due to "getting old" and would thus inevitably deteriorate. 59,84,103,114,115 Subtheme 1: Scary pathoanatomical labels "All that stuff was going on in that area.…”

“…Hip pain made it difficult to move, exercise, walk, work, rest, and remain independent, including to self-care (eg, dressing) and to drive. 10,14,24,42,59,[82][83][84]96,105,107,109,114,115 Hip pain hindered people from spending time with family and friends and made them rely on family for self-care. 10,14,24,82,84,96,105,109,114,115,119 Difficulties with moving, activities, and relationships fomented low self-confidence, depression, anxiety, and distress.…”

“…People often coped with their hip pain by resting and avoiding or modifying activities, such as exercise, sport, and leisure (eg, travel). 14,42,59,83,84,109,114,115,119,120 Labels of hip pain (eg, damaged) and beliefs about the causes of hip pain (eg, age and wear and tear) informed peoples' belief that they should avoid activity and rest. 59,84 People often avoided exercise because they feared exacerbating their hip pain (during and after exercise), and they equated hip pain during exercise with damaging their joints further.…”

“…59,114,115,120 Finally, people who feared falling or were embarrassed about their walking ability also avoided activities, such as walking, sport, and gardening. 82,84,96,119,120 Except for one example, 42 it seemed that avoiding or modifying activities and resting failed to provide adequate pain relief, reinforcing peoples' frustration and distress. 13,59,96 4.…”

“…14,70,83,106,115,120,122 Subtheme 3: Information and support were helpful: "I was pleased that there were other options of my osteoarthritis, other options and not having a hip replacement" Healthcare professionals improved people's satisfaction with care and their confidence and motivation to adopt nonsurgical treatments, when they care to a person's circumstances and values, informed people about treatments for hip pain (including what exercises they should do), assessed progress and provided feedback, and communicated with empathy and professionalism. 14,70,82,84,106,115,120 People were also more likely to maintain exercise if they enjoyed physical activity, viewed pain as a normal part of exercise, had clear goals and intentions (eg, wanting to avoid surgery), valued the health benefits of exercise (eg, mental health benefits), and felt supported by family and friends or by exercising in a group. 59,70,84,115,120 These findings were represented across studies of people from hospital, 106,120 orthopaedic, 14,59,82 general practice, 14,115 and physiotherapy care, 70,106 and from the community.…”