The 2018 EULAR recommendations for physical activity (PA) in people with inflammatory arthritis (IA) and osteoarthritis (OA) have been modified to align with the 2020 World Health Organization (WHO) PA guidelines2; however, these modifications had not yet been formally published at the time of writing.
The updated EULAR recommendations were developed following the EULAR Standard Operating Procedures (SOP) through multiple expert meetings and a comprehensive literature review.
A total of 13 research questions guided the development process using the PICOS framework (Population, Intervention, Comparison, Outcome, and Study design). The most critical question addressed the effectiveness, safety, and feasibility of promoting PA and reducing sedentary behaviour in IA and OA, including digital interventions. Other key questions explored barriers and facilitators to PA, and behaviour change techniques to support sustainable engagement.
The updated recommendations emphasise that PA should be an integral part of standard care for all patients with IA and OA. Interventions should be delivered by healthcare professionals and tailored to patients’ preferences, abilities, and resources through shared decision-making. Regular PA and reduced sedentary behaviour are essential to improving health-related quality of life in people with IA and OA, and reducing sedentary time provides benefits independently of overall PA levels. The recommended PA domains—including cardiorespiratory fitness, muscle strength, flexibility, and neuromotor performance—are feasible and safe for these patients. The use of digital tools, such as wearable activity trackers, is also encouraged to enhance motivation, self-monitoring, and adherence, reinforcing the importance of collaboration and shared decision-making between patients and healthcare providers.
The recommendations further highlight the importance of addressing individual, socioeconomic, and physiological barriers to PA through goal setting, follow-up, and tailored interventions. Standardised methods are advised for defining and evaluating PA frequency, intensity, and outcomes over time.
Finally, the update introduces new recommendations related to digital technologies and the evaluation of PA interventions, while refining previous statements for greater precision and applicability. The accompanying research agenda prioritises the assessment of combined exercise and pharmacological strategies, and the education agenda focuses on enhancing healthcare professionals’ capacity to assess PA and apply effective behaviour change techniques.
Bibliography
- Niedermann K. Update of the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. European Congress of Rheumatology: EULAR 2025; 2025 Jun 11-14, Barcelona, Spain.
- World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020.