Participant Experiences in Using a Telehealth Mindful Exercise Program for Knee Osteoarthritis: A Qualitative Study

Objective: To explore the acceptability of an 8-week, telehealth, group-based, mindful exercise intervention in individuals with knee osteoarthritis (OA). Methods: This qualitative study was nested within a randomized controlled trial (N = 40) comparing a mindful exercise intervention to an exercise-only control group. Thirteen participants from the mindful exercise arm were individually interviewed remotely using HIPAA-compliant Zoom. Interviews were guided by the Theoretical Framework of Acceptability (TFA). The transcripts were analyzed using an inductive thematic approach, and the identified themes were mapped onto TFA constructs to determine factors related to the intervention's acceptability. Results: Eight key themes were identified as follows: (1) Openness to Alternative Treatments for Knee Pain, (2) Challenges with Exercise and Equipment, (3) Varied Perceptions of Mindfulness, (4) Mindfulness was Enjoyable but Challenging, (5) Integration of Mindfulness with Exercise Varied by Exercise Type, (6) Perceived Impact of Intervention was Physical and Psychological, (7) Group Telehealth Format Enhanced Intervention Acceptability, and (8) 2-H Time Commitment was Challenging. Mapping these themes onto the constructs of the TFA highlighted factors that influenced the acceptability of the mindful exercise intervention. These included enjoyment in practicing mindfulness especially when integrated with familiar exercises, the 8-week intervention length, and convenience of the group and telehealth aspects of the intervention. Participants encountered challenges with the 2-h weekly time, exercise equipment, learning and practicing mindfulness independently, and absence of alternative formats (e.g., hybrid or self-guided options). Conclusion: The mindful exercise intervention was generally acceptable to people with knee OA. However, to enhance acceptability, modifications may be needed, such as adjusting the exercise types and equipment, providing additional support for learning and practicing mindfulness, and offering greater flexibility in session format, timing, and duration. These insights are valuable for developing more effective, patient-centered, mindfulness-based exercise interventions for individuals with knee OA.