Patients' perceptions of diet and exercise interventions for knee osteoarthritis and barriers to optimal treatment

BACKGROUND: Changing diet and exercise behaviors are first-line lifestyle interventions to treat knee osteoarthritis (OA), but many patients fail to adhere to recommended guidelines. OBJECTIVE: To determine the perceptions, trends and barriers related to healthy diet and exercise engagement in an urban cohort of individuals with knee OA. METHODS: Cross-sectional survey study of a convenience sample of individuals with knee OA (n = 100). The survey assessed current diet and exercise behaviors, perceptions of diet and exercise, barriers to optimal diet and exercise behaviors, and self-efficacy. RESULTS: A majority of patients believed exercise and diet are important to improving knee OA symptoms (82% and 72%, respectively) and were interested in exercising more (84%) and eating a healthier diet (77%). The most prevalent barrier to exercise was knee pain (46.4%), and the most prevalent barriers to a healthy diet were lack of health care guidance (28.6%), uncertainty of foods to eat (26%), and time (23.4%). Individuals of non-White racial identity were more likely to report lack of health care guidance and pain as barriers to exercise participation (p = .02). Respondents who lived in a zip code with a lower median household income were more likely to report inadequate health care guidance about exercise (p = .01) and were less confident about which foods to incorporate into their diet (p = .04). CONCLUSION: Our cohort of individuals living in a large urban city with knee OA valued the importance of exercise and healthy diet. Predominant barriers to engagement were pain and lack of knowledge due to perceived lack of health care guidance. Non-White individuals and those dwelling in areas of lower socioeconomic status are at increased risk of experiencing these barriers. Barriers identified by this needs assessment can inform future research on the most effective, community-based, educational interventions to promote healthy lifestyle behaviors.