Perceived barriers and facilitators to increasing physical activity among people with musculoskeletal disorders: a qualitative investigation to inform intervention development

Figures & data

Table 1 Demographic information for all participants

Clinical and demographic characteristics	All respondents n=217
Mean (standard deviation) age in years	53 (15)
Sex – male (%)	113 (52.1%)
Body mass index (derived from self-report)
Underweight (>18.5)	3 (1.4%)
Normal weight (18.5–25)	74 (34.1%)
Overweight (25–30)	49 (22.6%)
Obese (30–35)	62 (28.6%)
Severely obese (40–45)	15 (6.9%)
Very severely obese (≥45)	14 (6.5%)
Primary reason for clinic attendance
Back condition	83 (38.2%)
Shoulder condition	37 (17.1%)
Knee condition	19 (8.8%)
Neck condition	17 (7.8%)
Elbow, wrist, or hand condition	12 (5.5%)
Ankle condition	10 (4.6%)
Hip condition	7 (3.2%)
Weight loss	1 (0.5%)
Other condition	31 (14.3%)
Comorbidity (not primary reason for clinic attendance)
Other musculoskeletal disorders
Back condition	25 (11.5%)
Shoulder condition	33 (15.2%)
Neck condition	41 (18.9%)
Knee condition	36 (16.6%)
Hip condition	25 (11.5%)
Elbow, wrist, or hand condition	18 (8.3%)
Ankle condition	14 (6.5%)
Osteoporosis	18 (8.3%)
Osteoarthritis (multiple joints affected)	38 (17.5%)
Other health conditions
Depression	41 (18.9%)
Hypertension	39 (18.0%)
Diabetes	38 (17.5%)
Heart condition	25 (11.5%)
Eye or vision problems	23 (10.6%)
Asthma	23 (10.6%)
Cancer	22 (10.1%)
Digestive problems	10 (4.6%)
Kidney disease	9 (4.1%)
Hay fever/allergies	8 (3.7%)
Fibromyalgia	4 (1.8%)
Epilepsy	4 (1.8%)
Stroke (past)	4 (1.8%)
Other conditions	37 (17.1%)

Table 2 Perceived barriers to undertaking physical activity

Health conditions	Time restrictions	Poor physical condition	Emotional, social, and psychological	Access to exercise opportunities
1. Musculoskeletal conditions (n=108)	1. Work (n=22)	1. Movement restriction (n=31)	1. Lack of motivation (n=17)	1. Lack of money (n=9)
2. Pain (n=72)	2. Being a caregiver(n=22)	2. Lack of flexibility and/or strength (n=19)	2. Depression (n=10)	2. Difficulty with transport (n=6)
3. Comorbid conditions (n=51)	3. Unspecified time restrictions (n=19)	3. Breathing difficulties (n=8)	3. Fear and anxiety (n=6)	3. Weather-related concerns (n=3)
4. Specific medication effects (n=2)	4. Domestic duties (n=4)	4. L ack of energy or stamina/feeling tired (n=8)	4. L ack of social support (n=4)	4. L ack of people to exercise with (n=3)
	5. Study (n=3)	5. Overweight (n=6)		5. Lack of skills to use local exercise facilities (n=3)
	6. Lack of physical activity routine (n=3)	6. Age-related frailty/poor balance (n=4)		6. Distance (n=2)

Table 3 Quote excerpts illustrating patient-perceived barriers to undertaking physical activity

Health conditions	Time restrictions	Poor physical condition	Emotional, social, and psychological	Access to exercise opportunities
“I have spinal damage, so I can’t do most exercise” (1)	“I’m a mother of two children; I’m always behind with my work” (1, 2)	“I have a poor sleeping pattern that leaves me very tired” (4)	“I’m not really motivated at the moment” (1)	“I don’t drive, so I can’t easily go to a gym” (2)
“I have heart failure; it’s hard to do any activity” (3)	“I’m not allocating enough time to do exercise” (6)	“I’m feeling weak recovering from surgery and radiation” (2)	“I’m not feeling good mentally” (due to depression) (2)	“It’s too cold to swim in an unheated pool” (3)
“I can’t exercise because of the pain in my arms and back” (2)	“Working and commuting leaves me little time for exercising” (1)	“I get short of breath when I walk uphill” (3)	“Just laziness” (1)	“Going to the pool is too expensive” (1)

Note: Category numbers from each theme in parentheses.

Table 4 Facilitators to undertaking physical activity as perceived by participants

Improved health state	Social, emotional, and behavior supports	Access to exercise environment	Opportunities for physical activity	Time availability
1. Health-condition intervention(s) (n=39)	1. Motivation (n=19)	1. Access to suitable exercise facilities or locations (n=17)	1. Physiotherapy (including aquatic physiotherapy) (n=29)	1. Free time (n=16)
2. Pain relief (n=26)	2. People to exercise with (n=17)	2. Equipment (n=11)	2. Getting from place to place (n=8)	2. Work flexibility (n=5)
3. Being well rested (n=9)	3. Assistance (n=15)	3. Weather (n=8)	3. Activities of daily living (including domestic tasks) (n=8)	3. Time management (n=4)
4. Optimizing posture and movement (n=8)	4. Mood and exercise enjoyment (n=9)		4. Children (n=7)
5. Improved fitness (n=7)	5. Encouragement and emotional support (n=5)		5. Pets (n=7)
6. Weight loss (n=5)			6. Active work (n=3)

Table 5 Quote excerpts illustrating perceived facilitators to undertaking physical activity

Improved health state	Social, emotional, and behavior supports	Access to exercise environment	Opportunities for physical activity	Time availability
“Not having my knee problem would make it easier to be active” (1)	“Having company makes it more fun to do, and you’re kept accountable” (1, 2, 4)	“My gym has a crèche, so I can take my children there” (1)	“Doing my basic physiotherapy exercises makes a big difference” (1)	“Making more time available for exercise” (1)
“Medication for pain relief makes moving around a lot easier” (2)	“My husband accompanies me on walks and helps when it is painful” (2, 3)	“Proximity to an open space with walking tracks” (1)	“When I take my kids to their training, I go for a run when I’m down there” (4)	“I’m a sole trader, which means freedom from regular work hours” (2)
“Stretching regularly to keep my muscles from becoming too tight” (5)	“Having someone to go exercise with” (2)	“I have a treadmill in case of rain” (2)	“I ride a bike from my front door” (2)	“Having an organized daily schedule helps me” (3)

Note: Category numbers from each theme in parentheses.