More than a prescription: The need for behavioral theory to guide exercise interventions for osteoarthritis - A narrative review

OBJECTIVE: Many clinical exercise trials show that participation in exercise, such as strength training and aerobic walking, reduce osteoarthritis (OA)-related pain and functional limitation. This has led to exercise being one of the most commonly prescribed treatments for OA. However, little attention is given to the complex behavior elements of exercise, that is exercise is an activity that adults need to choose to engage in regularly, which is necessary to ensure exercise can have long-term efficacy to address pain. The purpose of this review is to highlight the behavioral aspects of exercise. DESIGN: Narrative review RESULTS: Limitations of previous clinical exercise trials in OA and why and how behavioral theories should be used to guide exercise interventions are highlighted. Three behavioral theories commonly used for exercise and physical activity interventions in other populations are reviewed. An overview of choosing a behavioral theory, building a conceptual model, and linking behavior change techniques to theoretical constructs is provided. Finally, in order to make the results more generalizable and comparable across studies, a standardized approach to quantify exercise behaviors is recommended. CONCLUSION: In conclusion, a shift to view exercise more as a behavior than a treatment is recommended. The use of behavioral theories is encouraged to guide interventions for clinical and research use to more effectively change exercise behaviors and reduce OA-related pain and functional limitations for the long-term.