EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis: 2025 update
Annals of the Rheumatic Diseases, vol. 85, pp. 1026–1038
Abstract
OBJECTIVES: The 2018 European Alliance of Associations for Rheumatology (EULAR) recommendations for physical activity (PA) in people with inflammatory arthritis (IA) and osteoarthritis (OA) required revision as new studies have been published on interventions using technology and/or the combination of educational and behavioural strategies to promote PA or reduce sedentary behaviour (SB). Moreover, the World Health Organisation released updated general PA guidelines in 2020 with an emphasis on reducing SB. This work aimed to update the 2018 EULAR recommendations for PA in IA and OA. METHODS: The EULAR Standardised Operating Procedures for developing recommendations were followed. A multidisciplinary task force (TF) was established. Systematic literature searches related to 13 research questions were conducted in August 2024. Recommendations were updated, and the TF members rated their level of agreement and estimated impact and implementability (0-10 scale, with 10 highest). RESULTS: The revised recommendations include 4 overarching principles and 11 recommendations on PA and SB including inter alia PA promotion as standard care, measurements of PA, and intervention modalities considering dose, adaptations and the application of (technology-based) behaviour change techniques. The mean level of agreement for the recommendations ranged from 9.0 to 9.8, the mean impact between 8.3 and 9.2, and the mean feasibility of implementation between 7.2 and 8.5. In addition, quality indicators, research and educational agendas were defined. CONCLUSIONS: The updated EULAR recommendations for PA should guide the development, conduct and evaluation of PA interventions and promotion, including the reduction of SB, in people with IA and OA. These recommendations should be implemented with consideration of individual needs, environmental conditions, and the broader national health care context.
Authors 26
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Anne-Kathrin Rausch Osthoff corresponding
Affiliation as printed
Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland. Electronic address: anne-kathrin.rausch@zhaw.ch
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Leiden University Medical Center
Affiliation as printed
Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands; Department of Physical Therapy, Leiden University of Applied Sciences, Health Faculty, Leiden, The Netherlands
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University of Lisbon · Unidade Local de Saúde de Coimbra · Escola Superior de Enfermagem da Universidade de Lisboa · Nursing Research, Innovation and Development Centre of Lisbon
Affiliation as printed
Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEUL), Universidade de Lisboa, Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Rheumatology Department, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
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Homerton University Hospital · Homerton University Hospital NHS Foundation Trust
Affiliation as printed
Sport and Exercise Medicine Department, Homerton University Hospital NHS Foundation Trust, London, UK
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Affiliation as printed
School of Health and Society, Centre for Human Movement and Rehabilitation, University of Salford, Salford, Greater Manchester, UK
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Affiliation as printed
Department of Physical Therapy, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Arthritis Research Canada, Vancouver, BC, Canada
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Medical University of Sofia · University Hospital St. Ivan Rilski
Affiliation as printed
University Hospital "St. Iv. Rilski" - Clinic of Rheumatology, Medical University Sofia, Sofia, Bulgaria
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Danderyds sjukhus · Karolinska Institutet
Affiliation as printed
Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden; Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
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Affiliation as printed
Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
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Université Paris Cité · Centre de Recherche Épidémiologie et Statistique
Affiliation as printed
Team METHODS, CRESS UMR1153, University of Paris Cité, Paris, France
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Affiliation as printed
Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Türkiye
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University of Copenhagen · Glostrup Hospital · Rigshospitalet
Affiliation as printed
Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Affiliation as printed
Center for Treatment of Rheumatic and Musculoskeletal Disease (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Affiliation as printed
Department of Orthopaedic Surgery, University Hospital and Faculty of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
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Affiliation as printed
Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium
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University of Copenhagen · University of Southern Denmark · Gentofte Hospital
Affiliation as printed
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark
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Affiliation as printed
University of Limerick, School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, Limerick, Ireland
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Rheumazentrum Ruhrgebiet · Ruhr University Bochum
Affiliation as printed
Rheumazentrum Ruhrgebiet, Herne, Germany; Ruhr University, Bochum, Germany
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Affiliation as printed
University of Jyväskylä, Faculty of Sport and Health Sciences, Jyväskylä, Finland
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Affiliation as printed
Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Thesssaly, Greece
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Affiliation as printed
Amsterdam Rheumatology and immunology Center, Reade Amsterdam, The Netherlands
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Affiliation as printed
Patient Research Partner EULAR, Spain
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Universitair Ziekenhuis Leuven
Affiliation as printed
Department of Quality Management, Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
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University of Copenhagen · Frederiksberg Hospital · Bispebjerg Hospital · Glostrup Hospital · Rigshospitalet · Center for Clinical Research and Prevention
Affiliation as printed
Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Affiliation as printed
Keele University, Primary Health Care Sciences, Keele, UK
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ZHAW Zurich University of Applied Sciences
Affiliation as printed
Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy, Winterthur, Switzerland
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