1043 - Perceptions, Barriers, and Preferences for Exercise Among Adults With Knee Osteoarthritis Following a Clinical Intervention

Knee osteoarthritis (KOA) is a leading cause of chronic pain and functional limitations. Although exercise is an effective non-pharmacologic treatment, long-term adherence remains low. Weight off-loading walking therapies, such as lower-body positive-pressure (LBPP) treadmill and aquatic walking, may reduce joint loading and improve exercise tolerance. Our objective was to evaluate perceptions, barriers, and preferences for exercise among adults with KOA following participation in a weight off-loading walking intervention, and to assess durability of benefits, current exercise behaviors, and factors influencing future program design.

Design: Cross-sectional, mixed-methods quality improvement study of 22 adults (mean age 69.2 ± 8.0 years; mean BMI 29.4 ± 6.2; 73% female) with KOA who had completed an 8-week randomized exercise trial (LBPP treadmill, n=7; aquatic walking, n=7; control, n=8). A structured survey assessed exercise behaviors, motivation, barriers, and preferences. Quantitative data were analyzed descriptively, and qualitative responses were coded thematically.

Results: Thirty-two percent of all participants reported both improved perceptions of exercise and adoption of new exercise habits. Walking was the most common activity, typically performed 3–5+ days per week for 30–60 minutes. Participants cited pain reduction, increased mobility, and improved balance as key benefits of the LBPP treadmill and aquatic interventions, with minimal drawbacks. Most expressed willingness to continue using the LBPP treadmill if available, identifying cost and accessibility as primary barriers. Routine, motivation, and social support were emphasized as important facilitators of sustained exercise.

Conclusions: LBPP treadmill use shows promise for supporting long-term exercise engagement in adults with KOA. Programs that integrate walking, strength training, supervision, and accountability may improve adherence, although cost and accessibility remain key barriers. Future interventions should prioritize adaptability, convenience, and responsiveness to individual needs to maximize effectiveness and sustainability.