Implementation of physical activity recommendations for patients with rheumatic and musculoskeletal diseases

EULAR (European Union of Rheumatists) has made recommendations aimed at promoting health-enhancing physical activity, but despite the proven benefits of physical activity and exercise interventions, such as improving overall health, reducing symptoms, improving quality of life, and positively influencing cardiometabolic biomarkers, challenges remain and there is a significant gap between research findings and implementation in clinical practice.

The HPR Abstracts Session at the 2024 EULAR Congress specifically looked at harnessing the benefits of exercise in rheumatic and musculoskeletal diseases (RMDs) and the challenges in its implementation.

Mohamed Saadi presented a systematic review investigating barriers and facilitators influencing adherence to EULAR physical activity recommendations. From the 68 selected articles, 29 different themes were identified: 9 social, 16 environmental, and 4 systemic. The five most frequent themes were the presence of supportive family and friends, supportive health professionals, followed by cost, and access or proximity to adapted and supervised programs.

Importantly, there may be country-level differences in these three key factors. Social considerations include the level of support available, whether people feel social pressure or body criticism, and whether social physical activity is embedded in everyday life, such as walking the dog or playing with children. System differences may be evident in costs and financial support. Environmental factors consider aspects such as weather, safety, and the transportation needed to get to places to engage in physical activity. Each of these will influence adoption of recommendations at an individual level.

Further research is needed to understand these differences and develop tailored strategies for each country. As a next step in the project, the researchers plan to develop a questionnaire for use in the four European countries, which will allow them to further identify barriers and facilitators to physical activity adoption and adherence, in line with the EULAR recommendations on physical activity.

A similar qualitative study has already been conducted elsewhere, collecting information about facilitators and inhibitors in four rheumatology outpatient clinics in Denmark. This involved 10 days of observation in clinical practice, observing patients’ daily consultations with doctors and nurses.

In addition, 12 semi-structured individual interviews were conducted with doctors, nurses and clinical leaders. Tanja Thomsen, first author and presenter of the study at the EULAR conference, personally conducted all observations and interviews. A theoretical domain framework including psychological and organisational domains relevant to clinical behaviour change and template analysis was used to process and interpret the data.

The barriers cited by nurses and physicians were particularly related to the areas of skills, competencies, and professional role and identity, highlighting the need for targeted training to enable healthcare professionals to provide adequate instruction on physical activity. They also highlighted the sense of responsibility when discussing physical activity with patients.

The main barriers described by clinical management were related to the environmental context and resources, essentially a possible lack of physical and clinical resources to provide appropriate instruction. Mutual facilitators among informants were related to optimism, revealing a shared belief about the feasibility and potential of implementing physical activity instruction as part of routine rheumatology practice.

Together, these two studies provide valuable knowledge regarding factors that should be addressed when implementing physical activity guidance for patients with RMD.

Courtesy of the European Union of League Against Rheumatism (EULAR)