Exercise therapy shows long-term benefits for people with rheumatic diseases

Regular physical activity is increasingly promoted for people with rheumatic and musculoskeletal diseases (RMD) as well as the general population. EULAR - The European Alliance of Associations for Rheumatology - has published recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. There are also points to consider on helping people participate in healthy and sustainable paid work.

Several sessions at the 2025 annual congress of EULAR, which took place in Barcelona, focused on the value of physical activity for people with a variety of RMD - as well as the potential barriers to implementing these programs in the real world.

Previous trials have demonstrated that long-standing, personalised supervised exercise therapy is more effective than usual care after 1 year in people with severe functional limitations due to rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). David Ueckert and colleagues set out to evaluate the long-term effects of this intervention on physical function and quality of life in this population. During the first year, the planned number of sessions was 64 (plus an extra 14 if needed); from Year 2 onwards continuation and frequency was determined by the physiotherapist and patient for up to 42 months. At 2 years, statistically significant improvements were seen for all outcome measures in both RA and axSpA, with the exception of the mental component score in the SF-36. Between 1 and 2 years, there was no significant further change for most functional and quality of life outcome measures, indicating that effects were sustained; the only exception was a significant improvement in the distance covered in the 6-minute walk test in the axSpA group. These findings highlight the favourable effects of this long-standing personalised exercise therapy, with functional and quality of life benefits preserved despite declining usage of the supervised therapy in the second year.

Effectiveness on work-related outcomes and the cost-utility of a multimodal, physiotherapist-led, vocational or work-oriented intervention compared to usual care in 140 adults with RA or axSpA and reduced work ability was explored in an abstract presented by Nienke Bakker. The intervention consisted of 10-21 sessions over 12 months, including mandatory modalities such as work-oriented assessment, patient education, exercise therapy, referral-roadmap of work-related professionals, plus optional modalities including workplace examination or a self-management course. Findings showed that the intervention tended to be superior with respect to quality-adjusted life years - but not with respect to work-related outcomes. Total costs to society were also lower in the intervention group, leading the authors to conclude that these types of programs are likely to be cost-effective compared to usual care.

Fatigue management is a priority for both patients and healthcare professionals. Higher levels of physical activity are reported to be associated with lower levels of fatigue, but the role of sedentary behaviour is less well understood. Sally Fenton and colleagues aimed to examine how patterns of physical activity (stepping time and intensity) and sedentary behaviour vary throughout the day, and whether these diurnal patterns were associated with multi-dimensional aspects of fatigue in 104 people with RA. Results indicated similar time and intensity of physical activity in the morning and afternoon, but lower levels in the evening, when sitting time was significantly higher. Time and intensity of physical activity was also significantly negatively related to general fatigue, physical fatigue, reduced activity, and reduced motivation. But no associations were found for mental fatigue. Significant interaction effects indicated that physical activity in the evening was positively associated with general and physical fatigue. These patterns should be considered when designing fatigue management interventions for people with RA.

There is evidence that combined exercise programs that incorporate both aerobic and resistance training can be beneficial for people with systemic sclerosis (SSc). Alexandros Mitropoulos from LENI Research Group at Sheffield Hallam University in the UK shared the findings from a multi-centre clinical trial in 170 people with SSc who were randomly allocated to either exercise or control group. The exercise group performed a twice-weekly supervised individualised programme for 12 weeks - with 30 minutes of high-intensity interval training (30s at 100% of peak power output and 30s passive recovery) plus three circuits of five main muscle upper body resistance training exercises - in addition to usual care. Both fatigue and pain were significantly better at 12 weeks for the exercise compared to the control group; similar results were seen for depression, quality of life, cardiorespiratory and musculoskeletal fitness. While the exercise group demonstrated improvements both within and between groups at 12 weeks, the control group demonstrated a slight worsening - suggesting a protective effect of exercise. Exercise may serve as an effective non-pharmacological intervention adjunct to pharmacotherapy to manage SSc symptoms and potentially prevent worsening of symptoms.

Several barriers to physical activity exist, and previous studies have revealed similar determinants across populations. But within Europe countries differ in many aspects such as healthcare systems, cultural norms, weather conditions, urban design, and income. özgül öztürk presented a questionnaire-based study exploring these differences and potential barriers or facilitators for physical activity across Turkey, Switzerland, France, and the Netherlands, with 602 people with RA, axSpA, or osteoarthritis submitting their responses. The median duration of physical activity taken weekly was 60 minutes - well below the 150 minutes recommended for general health, and endorsed by EULAR for people with inflammatory arthritis. The top barriers were weather conditions, costs for memberships to sport facilities or equipment, and work-related duties. The best facilitators included scheduled exercises, support from healthcare professionals, having the knowledge and fitness to perform exercises, and shorter travel to sport facilities. Cross-country comparisons revealed significant differences, with weather conditions being the main barrier in Turkey, compared to membership costs in the Netherlands. Additionally significant differences were observed for having a dog, living close to nature, access to tailored exercise programs, guidance or supervision from experts in RMD, and environmental living conditions. This study highlights the need for tailored, country-specific interventions to address the unique barriers and facilitators in different populations.

A similar exercise was undertaken in the Netherlands. Annabelle Iken explained how key facilitators and barriers for the implementation of long-standing, personalised exercise therapy for people with RA and axSpA with severe functional limitations was undertaken at a national level, using a qualitative study with 18 semi-structured interviews in patients, healthcare professionals, and insurers. When considering referral to such programs, facilitators included strong communication and collaboration between healthcare providers and patients, ensuring clear explanations of benefits, eligibility criteria, and addressing concerns about exercise. Key barriers to referral included unclear eligibility criteria, limited knowledge about the effectiveness of the exercise, lack of awareness about where to find qualified therapists, and time constraints during consultations. Respondents indicated that tailored exercise programs that are accessible and convenient can improve adherence, and that access to continuing education and resources facilitates long-standing exercise therapy. Motivated patients who understand their condition and actively participate in care are more likely to benefit from long-standing exercise therapy.

Taken together, these new studies presented in Barcelona highlight the multifaceted nature of physical activity and exercise therapy for people with RMD, and underscore the need for increased awareness and education, clearer referral pathways, improved access, and strategies to address cost concerns and support patient motivation. By addressing these challenges, healthcare providers can ensure that physical activity becomes a standard part of care for people with an RMD.