Barriers to and facilitators of maintaining physical activity for people with hip and knee osteoarthritis: a mixed-methods systematic review

Increasing physical activity (PA) is an important recommendation for the management of hip and knee osteoarthritis (OA), under which components of therapeutic exercise can be embedded. However, maintaining PA behaviour (≥ 6-months) following the cessation of structured exercise interventions remains challenging and under-explored. This mixed-methods systematic literature review aimed to identify the barriers to and facilitators of maintaining PA behaviour for those living with hip and/or knee OA. Electronic databases were searched for peer-reviewed studies examining PA behaviour maintenance (defined as at least six-months post-intervention) for those with hip and/or knee OA. Data were extracted, appraised using the Mixed-methods Appraisal Tool (MMAT), and synthesised narratively. Sixteen studies (n = 1,486; 73.7% female) were included: six quantitative, five qualitative and five mixed-methods. The most frequently cited TDF domains were beliefs about capabilities (e.g. confidence reinforced by intervention skills), environmental context and resources (e.g. competing priorities), and memory, attention and decisional processes (e.g. memory recall - forgetting). Quantitative evidence supported these domains highlighting that correlates such as self-efficacy, energy levels, social support and resource availability strongly influenced PA behaviour maintenance. Integrated findings informed the Physical Activity Maintenance for osteoArthritis (PAMA) conceptual map, illustrating the dynamic interactions between individual, social and environmental factors. This review revealed that maintaining PA behaviour is multifactorial and influenced by individual, social and environmental factors. Further research should consider these interactions in the design of future interventions and in healthcare practice to foster and support the maintenance of PA behaviour for those living with hip and knee OA. PROSPERO registration: CRD42024591820 .