The Importance of Physical Activity for Individuals with Rheumatic and Musculoskeletal Diseases

Physical activity is being increasingly advocated for individuals with rheumatic and musculoskeletal diseases (RMD) alongside the general population. The European Alliance of Associations for Rheumatology (EULAR) has established guidelines that emphasize the significance of physical activity for those suffering from inflammatory arthritis and osteoarthritis.

At EULAR's 2025 annual congress held in Barcelona, various sessions highlighted the benefits of physical activity for individuals with diverse forms of RMD, as well as the challenges faced in implementing these programs effectively. Previous studies indicate that personalized supervised exercise therapy has proven more beneficial than standard care over a one-year period for patients with severe functional limitations caused by rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA).

Researchers, including David Ueckert and his team, investigated the long-term impact of this intervention on physical function and overall quality of life. Initially, patients were scheduled for 64 sessions in the first year, with the possibility of an additional 14 sessions if necessary. From the second year onwards, the frequency of sessions was tailored based on consultations between the physical therapist and the patient, extending up to 42 months.

After two years, significant improvements were recorded across all outcome measures for both RA and axSpA patients, except for the mental component score of the SF-36. Notably, between the first and second years, most functional and quality-of-life measures remained stable, with the only exception being a marked improvement in the distance achieved in the six-minute walk test among the axSpA group.

These results underscore the long-term benefits of personalized exercise therapy, where functional improvements and quality of life enhancements were maintained despite a decrease in the frequency of supervised sessions in the second year.

In another study presented by Nienke Bakker, the effectiveness and cost-utility of a multimodal, physiotherapist-led vocational intervention were examined among 140 adults with RA or axSpA experiencing reduced work capacity. This intervention comprised 10 to 21 sessions over a year, which included essential components such as work-oriented assessments, patient education, exercise therapy, and optional modalities like workplace evaluations or self-management courses. Findings suggested that this intervention was generally superior in terms of quality-adjusted life years compared to standard care, with reduced overall societal costs.

Fatigue management remains a critical concern for both patients and healthcare providers. Research indicates a correlation between higher levels of physical activity and reduced fatigue, yet the implications of sedentary behavior are not as clearly understood. In a study led by Sally Fenton, researchers explored how physical activity levels (measured by stepping time and intensity) and sedentary behavior patterns varied throughout the day and their relationship with various dimensions of fatigue in 104 individuals with RA. Results demonstrated similar activity levels in the morning and afternoon, with a notable decline in the evening when sedentary behavior increased. A significant negative correlation was found between physical activity levels and overall fatigue and motivation, though no association was observed for mental fatigue.

Moreover, a study presented by Alexandros Mitropoulos revealed that combined exercise programs, which include both aerobic and resistance training, can yield significant benefits for individuals with systemic sclerosis (SSc). In this multi-center clinical trial, 170 participants were randomly assigned to either an exercise or control group. The exercise group engaged in a tailored program that featured high-intensity interval training and upper body resistance exercises alongside standard care. The results indicated notable improvements in fatigue, pain, depression, quality of life, and overall fitness in the exercise group compared to the control group.

Despite the demonstrated benefits of physical activity, numerous barriers persist. Previous research has identified common obstacles across various populations; however, these challenges can vary significantly across European nations due to differences in healthcare systems, cultural norms, climate, urban planning, and economic conditions. A study conducted by Özgül Öztürk highlighted these differences by analyzing responses from 602 individuals with RA, axSpA, or osteoarthritis across Turkey, Switzerland, France, and the Netherlands. Participants reported a median of only 60 minutes of physical activity per week, which falls short of the 150 minutes recommended by EULAR for general health and specifically for individuals with inflammatory arthritis. Key barriers identified included adverse weather conditions, high costs associated with gym memberships or equipment, and work obligations. In contrast, effective facilitators included scheduled exercise, professional support, adequate knowledge and fitness for performing the exercises, and proximity to sports facilities.

In a related effort, Annabelle Iken discussed the identification of facilitators and barriers to the implementation of personalized exercise therapy for patients with RA and axSpA facing severe functional limitations. This qualitative study, which involved interviews with 18 patients, healthcare professionals, and insurers, identified strong communication and collaboration as essential to successful referrals. However, barriers included vague eligibility criteria, limited knowledge about the therapy's effectiveness, and a lack of awareness regarding qualified therapists. Participants emphasized that accessible and tailored exercise programs could enhance adherence, and that ongoing education and resource availability are crucial for sustaining long-term exercise therapy.

Collectively, the studies presented in Barcelona highlight the complex relationship between physical activity and exercise therapy for individuals with RMD. They underscore the urgent need to raise awareness, improve education, streamline referral processes, enhance accessibility, and address cost-related issues to promote physical activity as an integral part of care for this population.