Co-design and Qualitative Evaluation of the “Just One Move” Toolkit to Support Physical Activity Promotion in Rheumatology Care

For millions of people living with inflammatory arthritis, a group of conditions that causes painful swelling and stiffness in the joints, the path to feeling better involves a paradox. Medical guidelines strongly recommend regular physical activity to manage pain, reduce inflammation, and improve overall health. Yet, the very symptoms that make movement difficult—fluctuating pain, exhaustion, and the fear that exercise might worsen the condition—often keep patients sedentary. Healthcare providers, the doctors and nurses who treat these patients, are in a unique position to help. They are trusted sources of medical advice, and patients often look to them for guidance on how to stay active. However, the reality of modern medical practice often gets in the way. Appointments are frequently short, lasting only fifteen to twenty minutes, and are dominated by the urgent need to manage medications and monitor disease progression. In this rush, conversations about movement and exercise often fall by the wayside, leaving patients without the support they need to navigate their daily lives.

A team of researchers from universities across Canada set out to solve this disconnect. They wanted to create a practical set of tools to help healthcare providers weave physical activity advice into their routine visits without adding to their already heavy workload. Instead of designing these tools in a quiet office and handing them to doctors, the researchers used a method called co-design. This approach treats the people who will actually use the tools—the doctors, nurses, and physical therapists—as partners in the creation process. By working directly with them, the team aimed to build resources that fit seamlessly into the chaotic, time-pressed reality of a rheumatology clinic. The result was the "Just One Move" toolkit, a collection of posters, conversation guides, and planning sheets designed to make the first step toward activity feel small, safe, and achievable.

The development of this toolkit began with a clear understanding of the barriers. The researchers knew that providers often felt they lacked the time, the specific knowledge, or the confidence to give advice on exercise. They also knew that patients often felt overwhelmed by complex instructions or feared that moving too much would hurt their joints. To address these issues, the research team brought together a group of rheumatology specialists, including doctors, physical therapists, and nurses, for a series of brainstorming and design sessions. They worked with a professional design consultant to turn ideas into tangible prototypes. The goal was to create a sequence of resources that would guide a patient from the moment they walked into the clinic until they left with a plan.

The final toolkit consists of four main parts that work together like a relay race. First, there are posters for the waiting room. One poster, titled "Waiting Room Moves," encourages patients to try simple, low-impact movements like ankle pumps or leg marches while they wait for their appointment. This serves a dual purpose: it gets patients moving immediately and signals that movement is a normal part of the clinic experience. A second poster, "Ask Your Doctor," prompts patients to think about questions they want to ask regarding exercise and directs them to fill out a planning sheet. This sheet, called the Physical Activity Action Planner, is the third component. It is a simple form where patients can write down their own goals and the barriers they expect to face, turning a vague intention to "get active" into a concrete plan. The fourth piece is a conversation guide for the healthcare provider. This is a concise, two-page handout that offers prompts and scripts to help the doctor or nurse start a discussion about physical activity, regardless of how much time they have left in the appointment. It offers different paths for patients who are eager to start versus those who are hesitant or in pain.

To see if these tools actually worked, the researchers gathered fourteen healthcare providers from various clinics across Canada for a series of focus group discussions. They showed the participants the posters, the guide, and the planner, asking for honest feedback on how they would feel using them in a real clinic. The response was largely positive. The providers felt that the materials were clear, inclusive, and respectful of the patients' diverse backgrounds and abilities. They appreciated that the language was gentle and avoided confusing medical jargon. The idea of having a simple, ready-made way to start a conversation about exercise was seen as a major help, especially for providers who felt unsure about where to begin or worried about giving advice that might be unsafe.

However, the evaluation also revealed significant hurdles that no amount of clever design could completely erase. The most consistent and emphatic barrier identified by the providers was time. Even with a helpful guide, the reality of a fifteen-minute appointment meant that adding a new topic to the agenda felt like a heavy burden. Providers worried that if they started a conversation about exercise, they might not have enough time to answer follow-up questions or address the patient's immediate pain concerns. There was also a sense of uncertainty about who should be responsible for this task. Some doctors felt that prescribing exercise was outside their specific role, while others worried about liability if a patient got hurt. They questioned whether they should be the ones to give the advice or if it should be delegated to nurses or physical therapists, though they noted that not all clinics have the staff to make that delegation work.

Another challenge was the lack of local resources. Providers expressed frustration that they often did not know what exercise programs were available in their specific communities. A doctor in a large city might know of several local gyms or classes, but a provider seeing patients from a wide geographic area, including remote towns, had no way of knowing which programs were safe or accessible for their patients. This gap meant that even if a provider wanted to refer a patient to a local class, they often could not do so without spending time searching for information they did not have.

Despite these structural challenges, the study concluded that the "Just One Move" toolkit was a feasible and practical resource. The researchers found that the tools successfully lowered the threshold for starting a conversation. By using the waiting room posters to prime patients and the action planner to give them a voice, the toolkit shifted some of the initiative to the patient, making the interaction feel more like a partnership. The conversation guide provided a safety net for providers, giving them the words they needed to feel confident in their advice. The study suggests that for these tools to be truly effective in the long run, they need to be part of a larger system. This includes integrating the tools into electronic medical records so they appear automatically during a visit, and ensuring that clinics have the staff and local connections to support the referrals that providers make.

The research team emphasized that while the toolkit is a promising step forward, it is not a magic solution that will instantly fix the problem of inactivity in arthritis care. The study did not measure whether patients actually exercised more after using the tools, nor did it prove that the tools changed the behavior of the doctors. Instead, the findings are based on what the providers said they would do and how they felt about the resources. The researchers are clear that the next step is to test the toolkit in real-world settings to see if it can sustainably increase the frequency of physical activity conversations and improve patient outcomes. Until then, the "Just One Move" toolkit stands as a carefully crafted attempt to bridge the gap between medical guidelines and the daily reality of the clinic, offering a simple, structured way to remind patients that even a single move can be a step toward better health.