Osteoporosis International

, Volume 28, Issue 6, pp 1953–1963 | Cite as

“I do not have time. Is there a handout I can use?”: combining physicians’ needs and behavior change theory to put physical activity evidence into practice

  • R. E. Clark
  • C. McArthur
  • A. Papaioannou
  • A. M. Cheung
  • J. Laprade
  • L. Lee
  • R. Jain
  • L. M. Giangregorio
Original Article



Guidelines for physical activity exist and following them would improve health. Physicians can advise patients on physical activity. We found barriers related to physicians’ knowledge, a lack of tools and of physician incentives, and competing demands for limited time with a patient. We discuss interventions that could reduce these barriers.


Uptake of physical activity (PA) guidelines would improve health and reduce mortality in older adults. However, physicians face barriers in guideline implementation, particularly when faced with needing to tailor recommendations in the presence of chronic disease. We performed a behavioral analysis of physician barriers to PA guideline implementation and to identify interventions. The Too Fit To Fracture physical activity recommendations were used as an example of disease-specific PA guidelines.


Focus groups and semi-structured interviews were conducted with physicians and nurse practitioners in Ontario, stratified by type of physician, geographic area, and urban/rural, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the behavior change wheel framework, themes were categorized into capability, opportunity and motivation, and interventions were identified.


Fifty-nine family physicians, specialists, and nurse practitioners participated. Barriers were as follows: Capability–lack of exercise knowledge or where to refer; Opportunity–pragmatic tools, fit within existing workflow, available programs that meet patients’ needs, physical activity literacy and cultural practices; Motivation–lack of incentives, not in their scope of practice or professional identity, competing priorities, outcome expectancies. Interventions selected: education, environmental restructuring, enablement, persuasion. Policy categories: communications/marketing, service provision, guidelines.


Key barriers to PA guideline implementation among physicians include knowledge on where to refer or what to say, access to pragmatic programs or resources, and things that influence motivation, such as competing priorities or lack of incentives. Future work will report on the development and evaluation of knowledge translation interventions informed by the barriers.


Guidelines Healthcare provider Implementation science Knowledge translation Osteoporosis Physical activity 



The research was funded by an Ontario Ministry of Health and Long Term Care Health Research System Fund Capacity Award. Dr. Giangregorio received funding from an Ontario Ministry of Health Research and Innovation–Early Researcher Award, CIHR New Investigator Award, and Canadian Foundation for Innovation. Dr. Cheung is supported by a Tier 1 Canada Research Chair in Musculoskeletal and Postmenopausal Health.

Compliance with ethical standards

Informed consent was obtained from all individual participants included in the study, which was approved by the Office of Research Ethics at the University of Waterloo and the McMaster University Research Ethics Board.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of interest

L. Giangregorio has consulted for ICON on behalf of Eli Lilly. No other conflicts of interest relevant to this work.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • R. E. Clark
    • 1
  • C. McArthur
    • 1
  • A. Papaioannou
    • 2
    • 3
  • A. M. Cheung
    • 4
  • J. Laprade
    • 4
    • 5
  • L. Lee
    • 2
    • 6
    • 7
  • R. Jain
    • 5
  • L. M. Giangregorio
    • 1
    • 3
    • 7
    • 8
  1. 1.University of WaterlooWaterlooCanada
  2. 2.McMaster UniversityHamiltonCanada
  3. 3.Geriatric Education and Research in Aging Sciences CentreHamiltonCanada
  4. 4.University of TorontoTorontoCanada
  5. 5.Ontario Osteoporosis Strategy & Osteoporosis CanadaTorontoCanada
  6. 6.Centre for Family MedicineKitchenerCanada
  7. 7.Schlegel-UW Research Institute for AgingWaterlooCanada
  8. 8.Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada

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