Maintaining activity in arthritis: a qualitative exploration of barriers, facilitators and strategies following a physiotherapy-led exercise programme

Abstract Background Physical activity (PA) is central to arthritis management, yet gains from structured exercise programmes are often not maintained long-term. Limited evidence exists on factors influencing PA maintenance after exercise programme completion in this population. This study aimed to (1) explore understandings of PA maintenance; (2) identify barriers and facilitators to maintaining PA; and (3) examine suggested strategies to support PA maintenance among people living with arthritis following completion of a physiotherapy-led exercise programme. Methods A qualitative descriptive study using online focus groups with adults living with arthritis following completion of a physiotherapy-led exercise programme, “Be Active with Arthritis” (BAWA). Discussions were recorded, transcribed, and analysed in two stages (1), framework analysis using the Theoretical Domains Framework (TDF) to identify barriers and facilitators to PA maintenance; and (2) qualitative descriptive analysis to explore participants’ understanding of PA maintenance, and suggested strategies. Results Three focus groups were hosted ( n = 5, n = 6, n = 7). Participants valued PA for health and arthritis management but commonly conceptualised PA maintenance as continued participation in structured, arthritis-specific exercise rather than broader everyday activity, shaping how barriers, facilitators, and strategies were discussed. Participants identified multiple interacting barriers and facilitators across all 14 TDF domains, with the richest data concentrated within five key domains. (1) Beliefs about capabilities, (2) Beliefs about consequences, (3) Environmental context and resources, (4) Social Influences and (5) Emotion. Social support was a key facilitator, while fluctuating health status, psychological burden of living with arthritis, and environmental factors (e.g., cost, weather) posed significant barriers. Participants suggested multiple strategies including “booster” sessions, peer support and knowing how to adapt activities. Conclusions Findings highlight the need for co-developed interventions that move beyond structured exercise to support long-term integration of PA into daily life for people living with arthritis. It provides a theory-informed foundation, suggesting that intervention development should incorporate social support and address fluctuating symptoms, psychological challenges, and practical barriers. It should also prioritise confidence building, foster social connection, support emotional adjustment, promote habit formation, and reframe PA beyond rehabilitation towards flexible, self-directed everyday movement.