Knee pain in older adults is common and often disabling, with the majority of knee pain in adults over the age of 45 being attributed to osteoarthritis (OA). Regular physical activity and exercise are recommended for all older adults with knee pain and are associated with reduced pain and improved function. However, physical activity levels are low in this population and there is uncertainty regarding its long-term safety, whether change in physical activity level is associated with future pain and function, and the relationship between attitudes and beliefs about physical activity and physical activity level. This thesis addressed these research questions.
A systematic review of safety outcomes from 49 published studies found exercise was safe for the majority of older adults with knee pain, although most evidence related to low impact, moderate cardiovascular intensity exercise.
Secondary data analysis of an exercise randomised controlled trial for older adults with knee pain (n=514) did not find an association between change in physical activity level between baseline and three months and clinical outcome at either three or six months.
Secondary cross-sectional data analysis, using baseline data from the same trial and a community survey of older adults with knee pain (n=611), found that a number of scales measuring attitudes and beliefs about physical activity were associated with physical activity level in multivariable models. Positive outcome expectations, self-efficacy for exercise, kinesiophobia and a composite scale measuring physical activity attitude themes were associated with physical activity level.
Further longitudinal analysis from the trial showed that positive outcome expectations and self-efficacy for exercise remained associated with future physical activity level at three and six months within multivariable models whilst negative outcome expectations were not.
The original thesis findings have contributed to a better understanding of attitudes, beliefs and physical activity in older adults with knee pain
