Background/Purpose: Exercise is an established treatment to improve pain and physical function in adults with knee osteoarthritis (KOA), which is a leading cause of disability affecting 14 million adults. Most adults with KOA do not adhere to long-term exercise, abating benefits. The literature lacks well-controlled studies evaluating approaches to improve long-term exercise adherence. We conducted a randomized controlled trial (RCT) in people with KOA where both groups received the same evidence based exercise protocol and differed only in adherence interventions. Two-year adherence was the primary outcome. The intervention group received theoretically informed automated interactive telephone calls to coach and motivate subjects to adhere to the exercise protocol; both control and intervention arms received recorded telephone reminders to continue with the exercise protocol. Here we report on an ancillary study to this RCT that explored experiences, feelings and perspectives of subjects related to long-term adherence to exercise and use of technology

Methods: Qualitative design informed by grounded theory using semi-structured interviews.Consecutive participants of the RCT were purposely recruited and enrolled. Participants were >50 years with knee pain, self-report doctor diagnosed KOA, and not strength training for previous 6 months. Data collection: Post the RCT final assessment, 1-1 interviews were conducted (n=25, mean age 67 and BMI 31, 77% female) using guiding questions to elicit participants’ views on exercise experiences and impressions of technology to foster adherence to exercise. Participants were categorized into low-, or high- adherence groups according to a self-assessment questionnaire. Data analysis: constant comparative methods. Initial coding related to participants’ experiences on adherence to exercise and use of technology. Focus coding explored the meaning of data represented in the initial codes that more deeply reflected participants’ experiences regarding motivation toward exercise and home exercise abilities. Third level of coding compared high-adherence data to low-adherence at 2 years, and intervention compared to control groups.

Results: Three themes were identified: monitoring, knowledge of exercise, and beliefs about benefits of exercise. Participants with high-adherence appeared self-determined with a sense of self-efficacy. Participants with low-adherence expressed ambivalence about the benefits of exercise and desired more social support. Figure 1 provides more details. These results were independent of group assignment.

Conclusion: This study provides new evidence that promoting self-determination may improve long-term exercise adherence among adults with KOA. In addition, subjects valued monitoring provided by the group exercise approach and automated telephone technology.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/exercise-and-adherence-over-two-years-beliefs-of-adults-with-knee-osteoarthritis/