Archives of Osteoporosis

, 13:7 | Cite as

“We get them up, moving, and out the door. How do we get them to do what is recommended?” Using behaviour change theory to put exercise evidence into action for rehabilitation professionals

  • Caitlin McArthurEmail author
  • Christina Ziebart
  • Alexandra Papaioannou
  • Angela M. Cheung
  • Judi Laprade
  • Linda Lee
  • Ravi Jain
  • Lora M. Giangregorio
Original Article



Recommendations suggest a multicomponent exercise for people with osteoporosis. We identified rehabilitation professionals’ barriers and facilitators to implementing exercise recommendations with people with osteoporosis, and used those to make suggestions for targeted knowledge translation interventions. Future work will report on development and evaluation of the interventions informed by our study.


Rehabilitation professionals can help people with osteoporosis to engage in a multicomponent exercise program and perform activities of daily living safely. However, rehabilitation professional face barriers to implementing exercise evidence, especially for specific disease conditions like osteoporosis. We performed a behavioural analysis and identified rehabilitation professionals’ barriers to and facilitators of implementing disease-specific physical activity and exercise recommendations (Too Fit to Fracture recommendations), and used the Behaviour Change Wheel to select interventions.


Semi-structured interviews and focus groups were conducted with rehabilitation professionals, including physical therapists, kinesiologists, and occupational therapists, 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 relevant interventions were identified.


Ninety-four rehabilitation professionals (mean age 40.5 years, 88.3% female) participated. Identified barriers were as follows: capability—lack of training in behaviour change, how to modify recommendations for physical and cognitive impairments; opportunity—lack of resources, time, and team work; motivation—lack of trust between providers, fear in providing interventions that may cause harm. Interventions selected were as follows: education, training, enablement, modelling and persuasion. Policy categories are communication/marketing, guidelines, service provision and environmental/social planning.


Key barriers to implementing the recommendations are rehabilitation professionals’ ability to use behaviour change techniques, to modify the recommendations for physical and cognitive limitations and to feel comfortable with delivering challenging but safe interventions for people with osteoporosis, and lacking trust and team work across sectors. Future work will report on development and evaluation of knowledge translation interventions informed by our study.


Physical activity Physical therapy Osteoporosis Health care provider Guidelines Knowledge translation Implementation science 



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

Conflict of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Caitlin McArthur
    • 1
    • 2
    • 3
    Email author
  • Christina Ziebart
    • 1
  • Alexandra Papaioannou
    • 2
    • 3
  • Angela M. Cheung
    • 4
  • Judi Laprade
    • 4
    • 5
  • Linda Lee
    • 6
  • Ravi Jain
    • 5
  • Lora M. Giangregorio
    • 1
    • 2
    • 7
    • 8
  1. 1.Department of KinesiologyUniversity of WaterlooWaterlooCanada
  2. 2.Geriatric Education and Research in Aging Sciences CentreHamiltonCanada
  3. 3.McMaster UniversityHamiltonCanada
  4. 4.University of TorontoTorontoCanada
  5. 5.Ontario Osteoporosis Strategy & Osteoporosis CanadaTorontoCanada
  6. 6.Centre for Family MedicineKitchenerCanada
  7. 7.Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
  8. 8.Schlegel - UW Research Institute for AgingWaterlooCanada

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