Challenges With Strengthening Exercises for Individuals With Knee Osteoarthritis and Comorbid Obesity: A Qualitative Study With Patients and Physical Therapists

To explore challenges associated with implementing a home-based strengthening exercise program for individuals with knee osteoarthritis and comorbid obesity.This is a qualitative study embedded within a randomized controlled trial comparing 2 home-based strengthening programs (weight-bearing functional exercise versus non-weight-bearing quadriceps strengthening exercise) for individuals with knee osteoarthritis and comorbid obesity. Patients in both exercise programs attended 5 consultations with a physical therapist and undertook a home-based exercise program for 12 weeks. After trial completion, semistructured individual telephone interviews were conducted with 22 patients and all 7 physical therapists who delivered trial interventions. Interviews were recorded, transcribed verbatim, and thematically analyzed using an inductive approach.Three themes arose: 1) psychological challenges (false assumptions about exercise; fear of pain; disliking exercise; mental effort of the weight-bearing functional program; underestimating capability); 2) physical challenges (complexity of the weight-bearing functional program; cuff weights and straight leg raise being problematic in non-weight-bearing quadriceps program; other health conditions); and 3) overcoming challenges (incentives to exercise; accountability; education and reassurance; tailoring the exercise program).Patients and physical therapists experienced numerous psychological and physical challenges to exercise, including a fear of pain, having false assumptions about exercise, difficulties with exercise performance, application of cuff weights, and adverse impacts of other health conditions.