New insights into physical activity adoption in rheumatoid arthritis patients

The HPR Abstracts Session at the 2024 EULAR Congress focused specifically on 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, and 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 integrated into daily life, such as walking dogs or playing with children. Systematic differences may be evident in costs and financial support. Environmental factors consider aspects such as weather, safety, and the transport needed to get to places to do physical activity. Each of these will affect the adoption of recommendations at an individual level. Further research is needed to understand these differences and tailor strategies for each country. As the next phase of the project, the researchers plan to develop a questionnaire for use in four European countries. This will further identify barriers and facilitators to uptake and adherence to physical activity according to the EULAR recommendations on physical activity.

Similar qualitative studies have already been carried out elsewhere, collecting information on facilitators and inhibitors in four rheumatology outpatient clinics in Denmark. This included 10 days of clinical practice observation, observing patients’ daily consultations with doctors and nurses. In addition, 12 individual semi-structured interviews with doctors, nurses and clinical leaders were conducted. Tanja Thomsen, first author and presenter of the study at the EULAR conference, personally conducted all observations and interviews. A theoretical domain framework and template analysis, including psychological and organisational domains relevant for clinical behaviour change, were used to process and interpret the data.

The barriers mentioned by nurses and physicians were especially related to the areas of skills, competencies and professional role or identity. This highlights the need for targeted training to enable healthcare professionals to provide adequate instruction on physical activity. They also highlighted a sense of responsibility when discussing physical activity with patients. The main barriers mentioned by clinical management were related to environmental circumstances and resources, basically a possible lack of physical and clinical resources to provide adequate instruction. Mutual facilitators among informants were related to optimism, revealing a shared belief about the possibility and potential of physical activity instruction as part of routine practice in rheumatology.

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