Background & Purpose


Additional Resources

Barriers and Facilitators to Physical Activity

The barriers and facilitators to physical activity for adults with arthritis are both perceived and objective. An understanding of these barriers and facilitators can shape environmental and policy strategies to increase physical activity for persons with arthritis. It can also help identify existing policies that might serve as models for new policies specific to arthritis.

BarriersFacilitators

Physical Barriers

  • Pain – including occurrence of pain preventing exercise, pain experienced during exercise, and pain experienced after exercise
  • Fatigue – including fatigue related to medication, insomnia, and depression
  • Mobility – impaired mobility is a major challenge to exercise
  • Comorbid conditions – including conditions ranging from musculoskeletal to cardiovascular ailments

Physical Facilitators

  • Symptom management – including reduction of pain, stiffness and fatigue
  • Mobility and function – increased ability to move and function due to exercise
  • Strength and flexibility – including increased flexibility from yoga and being more limber from swimming
  • Weight loss – benefits for persons with arthritis due to exercise

 

Psychological Barriers

  • Attitudes and beliefs – including lack of time, motivation, and enjoyment of exercise
  • Fear – including fear of experiencing or worsening pain and fear of water preventing participation in water aerobics
  • Perceived negative outcomes – including negative outcomes that might result from pushing beyond one’s limits

 

Psychological Facilitators

  • Independence related reasons as motivators to exercise – including not having to be in a wheelchair, not having to go to a nursing home, and being able to remain “self-sufficient”
  • Attitudes and beliefs – including self-confidence, feeling of accomplishment, and an overall improved attitude towards the disease
  • Emotional benefits – including stress relief, relaxation, improved mood, and helping to forget about pain
  • Enjoyment – including liking exercise and having fun while exercising
  • Behavioral facilitator – including being internally motivated to exercise

Social Barriers

  • Lack of support – including not having support from family, friends, and health care providers (failure to mention exercise, not referring patients to helpful exercise programs, or not instructing patients how to exercise properly)
  • No one to exercise with – without exercise partners, frequency of exercise decreased
  • Competing role responsibilities – including feelings of responsibility to one’s family

Social Facilitators

  • Social interaction – including “the enjoyment of exercising with others and the positive social interaction of being around others who exercise”
  • Support from health care providers – if training and assistance is provided to health care providers (to provide guidance in prescribing exercise), they could provide support to persons with arthritis through exercise recommendations and specific referrals

Environmental Barriers

  • Lack of programs or facilities – including few programs or facilities that meet specific needs and lack of qualified instructors
  • Environmental conditions – including hot and cold weather, rain, congested parking, concrete surfaces, and presence of dogs
  • Cost –for both current exercisers and non-exercisers
  • Transportation – including lack of transportation to facilities or programs
  • Exercise facility barriers – including lack of curb cuts, inaccessible access routes, lack of elevators, slippery floors, absence of hand rails on stairs, lack of adaptive and/or accessible equipment, paying the same membership even though the facility is not fully accessible, and poor equipment maintenance
  • Park and recreational center barriers – lack of accessibility due to “challenge of complying with ADA guidelines while preserving the natural surroundings of parks and trails”
  • Public space barriers – including no safe curb cuts, damaged sidewalks, no sidewalks, terrain too steep a grade or slope, unsafe neighborhoods, poor weather causing slippery or impassible sidewalks, insufficient number of benches along a trail for people who need frequent rest periods, and poorly designated signage

Environmental Facilitators

  • Instructors and availability of programs – instructors who understand issues related to arthritis and the availability of exercise programs that are safe and accessible for people with arthritis, including water-based exercise
  • Tailoring of programs – incorporating pain management skills into an exercise program and teaching people how to modify their exercise routines according to their symptoms
  • Exercise facility facilitators – including non-slip mats in locker rooms, adequate number of accessible parking spaces, push-button operated doors, zero-depth entry pools, and family changing rooms
  • Exercise equipment facilitators – including Velcro straps to allow individuals with disabilities to grip exercise equipment, pool water chairs, and upper-body aerobic exercise equipment

 

References

Factors that influence exercise among adults with arthritis in three activity levels. Prev Chronic Dis 2006

Arthritis care: comparison of physicians' and patients' views. Semin Arthritis Rheum 2000

Accessibility of health clubs for people with mobility disabilities and visual impairments. Am J Public Health 2005

Physical activity participation among persons with disabilities: barriers and facilitators. Am J Prev Med 2004

Perceived exercise barriers, enablers, and benefits among exercising and nonexercising adults with arthritis: results from a qualitative study. Arthritis Rheum 2006

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