'I saw it as a marriage-You can't have one without the other': A qualitative study of patient and physiotherapist experiences with a therapeutic combined strength and aerobic physical activity exercise programme for hip osteoarthritis.

INTRODUCTION: To explore physiotherapist and patient experiences with, and acceptability of, a 12-week physiotherapist-guided combined strength and aerobic physical activity exercise programme for hip osteoarthritis (OA).

METHODS: A qualitative study using semi-structured interviews with 13 people with hip OA and four physiotherapists. Patients underwent a 12-week home exercise programme customised by weekly visits with one of the four physiotherapists. The programme aimed for patients to participate in 150 min of moderate-intensity aerobic physical activity, and 20-30 min of strengthening exercise 2-3 times per week in concordance with American College of Sports Medicine (ACSM) dosage guidelines. Following the programme, patients and physiotherapists participated in individual semi-structured interviews to explore the acceptability of the exercise programme and barriers and facilitators to participation. Data were audio-recorded, transcribed and analysed using a thematic approach.

RESULTS: Five over-arching themes (supporting subthemes) were identified from both patient and physiotherapist interviews: (i) positive outcomes (functional improvements, pain relief, empowerment through experience, commitment to continue); (ii) combined benefits of aerobic and strength exercises (complimentary effects, strengthening exercises key); (iii) valuing support from the physiotherapist (personalised care, skill performance feedback, coach effect, accountability); (iv) motivation and opportunity for exercise (positive symptom loop, integration into daily routine, prior exercise experience, Fitbit motivation); and (v) time-consuming commitment (physiotherapy visit frequency, travel inconvenience, time for exercise).

CONCLUSIONS: Experiences of participants in this study indicate that, although time-consuming, a combined aerobic physical activity and strengthening programme prescribed at ACSM dosage guidelines is acceptable and confers positive outcomes in individuals with hip OA.