Skip to main content

Research Repository

Advanced Search

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

Kanavaki, Archontissa M; Rushton, Alison; Efstathiou, Nikolaos; Alrushud, Asma; Klocke, Rainer; Abhishek, Abhishek; Duda, Joan L


Archontissa M Kanavaki

Alison Rushton

Nikolaos Efstathiou

Asma Alrushud

Rainer Klocke

Joan L Duda


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: The primary aim of this study is to conduct a systematic review of the existing qualitative evidence on barriers and facilitators of PA for patients with hip or knee OA. Secondary objective is to explore differences in barriers and facilitators between (1) lifestyle PA and exercise and (2) PA uptake and maintenance.

Methods: Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Scopus, Grey literature and qualitative journals were searched. Critical Appraisal Skills Programme—Qualitative checklist and Lincoln and 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 healthcare 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 coexercisers 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 individualised patient education, psychological interventions or social policy change to promote exercise engagement and lifestyle PA in individuals with lower limb OA is required.


Kanavaki, A. M., Rushton, A., Efstathiou, N., Alrushud, A., Klocke, R., Abhishek, A., & Duda, J. L. (2017). Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence. BMJ Open, 7(12), Article e017042.

Journal Article Type Article
Acceptance Date Jul 31, 2017
Online Publication Date Dec 26, 2017
Publication Date 2017-12
Deposit Date Dec 6, 2018
Publicly Available Date Dec 6, 2018
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 7
Issue 12
Article Number e017042
Public URL
Publisher URL