Osteoporosis International

, Volume 29, Issue 5, pp 1081–1091 | Cite as

“Left to my own devices, I don’t know”: using theory and patient-reported barriers to move from physical activity recommendations to practice

  • C. Ziebart
  • C. McArthur
  • L. Lee
  • A. Papaioannou
  • J. Laprade
  • A. M. Cheung
  • R. Jain
  • L. Giangregorio
Original Article



Knowledge exchange with community-dwelling individuals across Ontario revealed barriers to implementation of physical activity recommendations that reflected capability, opportunity, and motivation; barriers unique to individuals with osteoporosis include fear of fracturing, trust in providers, and knowledge of exercise terminology. Using the Behaviour Change Wheel, we identified interventions (training, education, modeling) and policy categories (communication/marketing, guidelines, service provision).


Physical activity recommendations exist for individuals with osteoporosis; however, to change behavior, we must address barriers and facilitators to their implementation. The purposes of this project are (1) to identify barriers to and facilitators of uptake of disease-specific physical activity recommendations (2) to use the findings to identify behavior change strategies using the Behaviour Change Wheel (BCW).


Focus groups and semi-structured interviews were conducted with community-dwelling individuals attending osteoporosis-related programs or education sessions in Ontario. They were stratified by geographic area, urban/rural, and gender, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and interventions were identified.


Two hundred forty community-dwelling individuals across Ontario participated (mean ± SD age = 72 ± 8.28). Barriers were as follows: capability: disease-related symptoms hinder exercise and physical activity participation, lack of exercise-related knowledge, low exercise self-efficacy; opportunity: access to exercise programs that meet needs and preferences, limited resources and time, physical activity norms and preferences; motivation: incentives to exercise, fear of fracturing, trust in exercise providers. Interventions selected were training, education, and modeling. Policy categories selected were communication/marketing, guidelines, and service provision.


Barriers unique to individuals with osteoporosis included the following: lack of knowledge on key exercise concepts, fear of fracturing, and trust in providers. Behavior change techniques may need tailoring to gender, age, or presence of comorbid conditions.


Barriers Behavior change Exercise Osteoporosis Physical activity 



We gratefully acknowledge Sospeter Gatobu, Ruchit Patel, Rebecca Clark, and Jaylyn Leighton for their assistance with data collection and transcription.

Funding information

The research was funded by an Ontario Ministry of Health and Long Term Care Health Research System Fund Capacity Award. Dr. Giangregorio received funding from an Ontario Ministry of Health Research and Innovation–Early Researcher Award, CIHR New Investigator Award, and Canadian Foundation for Innovation. Dr. Cheung is supported by a Tier 1 Canada Research Chair in Musculoskeletal and Postmenopausal Health.

Compliance with ethical standards

Informed consent was obtained from all individual participants included in the study, which was approved by the Office of Research Ethics at the University of Waterloo and the McMaster University Research Ethics Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of interest


Supplementary material

198_2018_4390_MOESM1_ESM.docx (116 kb)
ESM 1 (DOCX 116 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • C. Ziebart
    • 1
  • C. McArthur
    • 1
  • L. Lee
    • 2
    • 3
  • A. Papaioannou
    • 4
    • 5
  • J. Laprade
    • 6
    • 7
    • 8
  • A. M. Cheung
    • 9
  • R. Jain
    • 7
    • 8
  • L. Giangregorio
    • 1
    • 9
    • 10
  1. 1.Department of KinesiologyUniversity of WaterlooWaterlooCanada
  2. 2.Centre for Family Medicine Family Health TeamKitchenerCanada
  3. 3.Department of Family MedicineMcMaster UniversityHamiltonCanada
  4. 4.Department of Health and Research Methods, Evidence and ImpactMcMaster UniversityHamiltonCanada
  5. 5.Department of MedicineMcMaster UniversityHamiltonCanada
  6. 6.Division of AnatomyUniversity of TorontoTorontoCanada
  7. 7.Ontario Osteoporosis StrategyTorontoCanada
  8. 8.Osteoporosis CanadaTorontoCanada
  9. 9.University Health NetworkTorontoCanada
  10. 10.Schlegel-UW Research Institute for AgingWaterlooCanada

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