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Barriers and facilitators for physical activity in rheumatic and musculoskeletal disease: a European-based survey

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Abstract

Physical activity (PA) is a key strategy for improving symptoms in people with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to investigate and rank the importance of known barriers and facilitators for engaging in PA, from the perspective of people living with RMD. Five hundred thirty-three people with RMD responded to a survey (nine questions) disseminated by the People with Arthritis and Rheumatism (PARE) network of the European Alliance of Associations for Rheumatology (EULAR). The survey required participants to rank — based on their perceived importance — known PA barriers and facilitators from the literature, and specifically RMD symptoms as well as healthcare and community factors that may affect PA participation. Of the participants, 58% reported rheumatoid arthritis as their primary diagnosis, 89% were female, and 59% were between 51 and 70 years of age. Overall, participants reported fatigue (61.4%), pain (53.6%) and painful/swollen joints (50.6%) as the highest ranked barriers for engaging in PA. Conversely, less fatigue (66.8%) and pain (63.6%), and being able to do daily activities more easy (56.3%) were identified as the most important facilitators to PA. Three literature identified PA barriers, i.e., general health (78.8%), fitness (75.3%) and mental health (68.1%), were also ranked as being the most important for PA engagement. Symptoms of RMDs, such as pain and fatigue, seem to be considered the predominant barriers to PA by people with RMD; the same barriers are also the ones that they want to improve through increasing PA, suggesting a bi-directional relationship between these factors.

Key Points

• Symptoms of rheumatic and musculoskeletal disease (RMD) are the predominant barriers for lack of physical activity engagement.

• RMD symptoms are the factors that people with RMDs want to improve when engaging in PA.

• The barriers that stop people living with RMDs to do more PA are the ones that can be significantly improved through PA engagement.

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References

  1. Metsios GS, Moe RH, Kitas GD (2020) Exercise and inflammation. Best Pract Res Clin Rheumatol 34(2):101504

    Article  PubMed  Google Scholar 

  2. Metsios GS, Moe RH, van der Esch M, van Zanten J, Fenton SAM, Koutedakis Y et al (2019) The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis. Rheumatol Int 40(3):347–357. https://doi.org/10.1007/s00296-019-04483-6

  3. Rausch Osthoff AK, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H et al (2018) 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 77:1251–1260

  4. Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ et al (2017) EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 76(1):17–28

    Article  CAS  PubMed  Google Scholar 

  5. Veldhuijzen van Zanten JJ, Rouse PC, Hale ED, Ntoumanis N, Metsios GS, Duda JL et al (2015) Perceived barriers, facilitators and benefits for regular physical activity and exercise in patients with rheumatoid arthritis: a review of the literature. Sports Med 45(10):1401–12

    Article  PubMed  PubMed Central  Google Scholar 

  6. Niedermann K, Nast I, Ciurea A, Vliet Vlieland T, van Bodegom-Vos L (2019) Barriers and facilitators of vigorous cardiorespiratory training in axial spondyloarthritis: surveys among patients, physiotherapists, and rheumatologists. Arthritis Care Res (Hoboken) 71(6):839–851

    Article  PubMed  Google Scholar 

  7. Harb S, Pelaez S, Carrier ME, Kwakkenbos L, Bartlett SJ, Hudson M, et al (2021) Barriers and facilitators to physical activity for people with scleroderma: a scleroderma patient-centered intervention network cohort study. Arthritis Care Res (Hoboken)

  8. Metsios GS, Koutedakis Y, Veldhuijzen van Zanten JJ, Stavropoulos-Kalinoglou A, Vitalis P, Duda JL et al (2015) Cardiorespiratory fitness levels and their association with cardiovascular profile in patients with rheumatoid arthritis: a cross-sectional study. Rheumatology (Oxford) 54(12):2215–20

    PubMed  Google Scholar 

  9. Sobejana M, van den Hoek J, Metsios GS, Kitas GD, Jorstad HT, van der Leeden M et al (2021) Cardiorespiratory fitness and physical activity in people who have rheumatoid arthritis at an increased risk of cardiovascular disease: a cross-sectional study. Rheumatol Int 41(12):2177–2183

    Article  CAS  PubMed  Google Scholar 

  10. Metsios GS, Fenton SAM, Moe HR, van der Esch M, Veldhuijzen van Zanten JJCS, Koutedakis Y et al (2019) Implementation of physical activity into routine clinical practice in rheumatic musculoskeletal disease: the IMPACT-RMD study protocol and rationale. Mediterr J Rheumatol 30(4):231–6

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hurkmans E, Giesenvander FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC (2009) Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev 2009(4):CD006853

    PubMed  PubMed Central  Google Scholar 

  12. Rongen-van Dartel SA, Repping-Wuts H, Flendrie M, Bleijenberg G, Metsios GS, van den Hout WB et al (2015) Effect of aerobic exercise training on fatigue in rheumatoid arthritis: a meta-analysis. Arthritis Care Res (Hoboken) 67(8):1054–1062

    Article  CAS  PubMed  Google Scholar 

  13. O’Brien CM, Ntoumanis N, Duda JL, Kitas GD, Veldhuijzen van Zanten J, Metsios GS et al (2021) Pain and fatigue are longitudinally and bi-directionally associated with more sedentary time and less standing time in rheumatoid arthritis. Rheumatology (Oxford) 60(10):4548–57

    Article  PubMed  Google Scholar 

  14. Metsios GS, Kitas GD (2020) Should patients with rheumatic diseases take pain medication in order to engage in exercise? Expert Rev Clin Immunol 16(3):235–237

    Article  CAS  PubMed  Google Scholar 

  15. Davergne T, Tekaya R, Sellam J, Tournadre A, Mitrovic S, Ruyssen-Witrand A et al (2021) Influence of perceived barriers and facilitators for physical activity on physical activity levels in patients with rheumatoid arthritis or spondyloarthritis: a cross-sectional study of 150 patients. BMC Musculoskelet Disord 22(1):915

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by the European Alliance of Associations for Rheumatology (EULAR Project number: HPR043).

Author information

Authors and Affiliations

  1. School of Physical Education, Sport Science and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132, Trikala, Greece

    George S. Metsios

  2. Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK

    George S. Metsios & G. D. Kitas

  3. School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK

    S. A. M. Fenton, J. J. C. S. Veldhuijzen van Zanten & G. D. Kitas

  4. Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK

    K. Tzika & Y. Koutedakis

  5. National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

    R. H. Moe

  6. Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK

    G. E. Fragoulis

  7. Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands

    T. P. M. Vliet Vlieland

  8. Rheumatology Department, King’s College Hospital, London, UK

    E. Nikiphorou

  9. Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands

    C. H. M. Van den Ende

  10. Department of Physical Education and Sport Science, University of Thessaly, Karies, Trikala, Greece

    I. Fatouros & Y. Koutedakis

  11. ACHIEVE-Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands

    M. van der Esch

  12. School of Health Sciences, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland

    K. Niedermann

  13. Centre for Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds, UK

    A. Stavropoulos-Kalinoglou

  14. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden

    N. Brodin & C. Bostrom

  15. School of Psychology, University of Surrey, Guildford, UK

    C. M. O’Brien

  16. School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland

    N. Kennedy

  17. Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium

    T. W. Swinnen

Authors
  1. George S. Metsios
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  2. S. A. M. Fenton
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  3. K. Tzika
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  4. R. H. Moe
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  5. G. E. Fragoulis
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  6. T. P. M. Vliet Vlieland
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  7. E. Nikiphorou
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  8. C. H. M. Van den Ende
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  9. I. Fatouros
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  10. M. van der Esch
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  11. K. Niedermann
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  12. A. Stavropoulos-Kalinoglou
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  13. J. J. C. S. Veldhuijzen van Zanten
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  14. N. Brodin
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  15. C. M. O’Brien
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  16. Y. Koutedakis
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  17. N. Kennedy
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  18. T. W. Swinnen
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  19. C. Bostrom
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  20. G. D. Kitas
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Consortia

The IMPACT-RMD Consortium

Corresponding author

Correspondence to George S. Metsios.

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Conflict of interest

EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius and holds research grants from Pfizer and Lilly.

GEF has received honoraria/speaker fees from Abbvie, Novartis, Pfizer, UCB, AEnorasis, Genesis.

All other authors have nothing to declare.

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Metsios, G.S., Fenton, S.A.M., Tzika, K. et al. Barriers and facilitators for physical activity in rheumatic and musculoskeletal disease: a European-based survey. Clin Rheumatol 42, 1897–1902 (2023). https://doi.org/10.1007/s10067-023-06518-7

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  • DOI: https://doi.org/10.1007/s10067-023-06518-7

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