Jinks et al. BMC Public Health 2010, 10:148 http://www.biomedcentral.com/1471-2458/10/148 to judge when and at what level costs would become a barrier. The culture of work was mentioned by some people as a barrier, such as office jobs leading to a sedentary life- style, or the fact that work routines appeared to domi- nate everyday life: “I mean, even at your age, you could look at some of the activities going on ‘round you and you could think “well, I wished I could do, I wished I was doing that or not could do it, I wished I was doing it. Then you look at all your commitments. You say, I haven’t got time.” (6545) This person saw work commitments determining how time was spent, and thereby reinforced the culture of work and its impact on people’s choices. Yet, another person gave an example of how people could become empowered to challenge this: “There’s still people with busy lifestyles who build some exercise into it. Erm, like my daughter and her partner, her husband, go both out to work full time, but they do exercise. But they have a routine, they build it into their life.” (5969) Without explicitly referring to will power, the ele- ments of personal choice and determination were impli- cit in this account, and the impact that individual behaviour might make on the environment was men- tioned when concluding: “I think that people are slowly being made aware of it.” An important barrier to prevention was the actual image of knee pain itself as most people thought that “nothing could be done”. As highlighted in previous stu- dies [21,22] this perception was associated with ageing and inevitable ‘wear and tear’ of joints. We will not repeat the arguments from the literature here, but suf- fice with stating that in our sample considering knee pain as part and parcel of becoming older was interna- lised, and thus created a barrier to prevention. The fact that the health service and health professionals tended not to offer active interventions (apart from knee repla- cements in extreme cases) could be perceived as a struc- tural (organisational) problem. When broadening out the concept of gym-based exer- cise to staying active in a variety of ways, more than half of the participants mentioned the benefits of swimming, walking, cycling or dancing. The main facilitating factor in taking up activities appeared to be the social aspect: “We do a lot of dancing at parties and that sort of thing, you know. I mean, well, I don’t dance particu- larly well, but I hold this girl while she does, you Page 7 of 9 know, what I mean. I’m daft and that, like we do a lot, I do enjoy that, you know and she does, because she’s a dancer.” (6900) This gentleman emphasised his enjoyment of dancing, and the pleasure he derived from the dance partnership. The contacts with others in the parties made the activity of dancing a shared experience. Similarly, the lady who joined in with an over-60s gym club emphasised the social interaction: “They’re all the same as me. They’re overweight and they’ve all got health problems [...]. We giggle, yeah, we giggle, you know. You know, sort of, I don’t know, you even, we just say, you know: “How’s your leg today?” “Oh, it’s been awful this weekend, how’s yours?” (968) The important additional factor for her was the fact that she identified with her fellow club members in terms of health and mobility. They could ask each other about problems, be supportive and at the same time downplay issues through the use of humour. Thus, par- ticipation was stimulated by a combination of factors, and not just by the knowledge that activity would help with reducing pain and disability. The contribution of social networks, trust and support in maintaining health and well-being have been highlighted in the literature on social capital [23-25]. Similar results [26] have been documented in relation to coping with pain and the above accounts reflect these findings. A further important facilitator was the issue whether activity could be integrated within everyday life, such as using stairs rather than lifts, walking instead of taking the car or the daily walk with the dog: “That’s what my specialist once said to me when I went. He said: “Have you got a dog, Mr.S?” I said “yes”. He said: “Make sure he gets plenty of exer- cise.” Ha, I thought, that’s a nice way of putting it.” (6150) The facilitating factors clearly underlined the impor- tance of context, and that taking up and maintaining an active lifestyle was dependent on social networks, access to facilities (for walking, cycling etc) and finally whether health policy supported healthy behaviours: “Smoking has changed. Now, what’s the difference between allowing, or taking action, of advertising and everything else to do with smoking, and yet, on the other hand the same government will then extend the licensing laws and allow alcohol to be drunk 24 hours a day.” (5228)