BACKGROUND: Exercise is an established treatment to alleviate pain and improve function among adults with knee osteoarthritis (KOA). However, long-term adherence to exercise is poor and effective approaches to support adherence are limited. The objective of this dissertation was to 'gain a new look' into long-term exercise adherence. With study #1, the experiences of participants in the Boston Overcoming Osteoarthritis through Strength Training (BOOST) study, were explored to identify participants' experiences, feelings and perspectives with exercise over 2-years and factors that influenced adherence to a prescribed exercise program after 2 years. With study #2, we examined if kinesiophobia: i) was associated with physical performance measures, ii) improved after a 6-week exercise program and iii) change was associated with change in pain and function among adults with KOA. METHODS: Participants of both studies completed a 6-week exercise program. For study #1 all participants received an automated telephone reminder to continue with their exercises and complete their logs, in addition, those randomized into the intervention group received a motivational computer adaptive telephone program. Participants were purposively sampled and in-depth interviews were conducted at the 2-year assessment. For study #2, data analysis was conducted prior to randomization with a sample of participants who completed the Tampa Scale of Kinesiophobia (TSK) questionnaire. Additional data included stair negotiation, 5 and 10 time sit-to-stand, and timed-up-and go tests. RESULTS: Study #1: Three themes were identified describing beliefs about exercise: i) monitoring, ii) knowledge of how to manage exercise behaviors, and iii) benefits of exercise. Those who reported high-adherence exhibited self-determination and self-efficacy, those who reported low-adherence expressed ambivalence about the benefits of exercise and a desire for more social support. Participants valued monitoring by peers and instructors during the exercise class and telephone technology. Study #2: Higher TSK was associated with slower stair and 5 time sit-to-stand times. TSK decreased after the exercise class but did not attain statistical significance. Change in TSK was associated with change in self-report physical function. CONCLUSIONS: Future research on the use of telephone technology and importance of self-determination and kinesiophobia on exercise adherence among adults with KOA is warranted.