EULAR Recommendations for Physical Activity in Arthritis Save

• Regular PA and reduced sedentary behaviour are essential for health-related quality of life in people with IA and OA — this is not aspirational language but a clinical mandate.
• Reducing sedentary behaviour confers health benefits independent of whether a person meets PA targets. A patient who exercises for 150 minutes per week but is otherwise sedentary still requires intervention on prolonged sitting.
• All four PA domains — cardiorespiratory fitness, muscular strength, flexibility, and neuromotor performance — are evidence-based, feasible, and safe for people with IA and OA, including during periods of active disease.
• Effective PA promotion requires shared decision-making, incorporating individual preferences, capabilities, disease status, and available resources.

Recommendations

1. PA promotion, aligned with general WHO PA recommendations, should be an integral part of standard care throughout the entire disease course. All healthcare professionals involved in the care of people with IA or OA share responsibility for this promotion — not solely physiotherapists or exercise specialists.

2. People with IA and OA should aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week, or an equivalent combination, plus muscle-strengthening activities on two or more days per week. Short bouts of intermittent activity throughout the day are valid and accumulate meaningfully, lowering barriers for patients with pain, fatigue, or functional limitation.

3. A dedicated recommendation addresses sedentary behaviour explicitly for the first time. Breaking up prolonged sitting with brief movement intervals, and targeting overall daily sitting time, should be discussed alongside exercise prescription in every clinical encounter. Sedentary behaviour and physical inactivity are distinct constructs requiring separate interventions.

4. A comprehensive assessment of current PA levels, sedentary patterns, individual barriers, facilitators, and disease-specific factors should precede any PA prescription. The previous separate recommendation on contraindications has been integrated here: rather than listing reasons to withhold PA, clinicians are directed to assess and adapt — a conceptual shift from risk avoidance to individualised enablement.

5. A formally new recommendation endorses behaviour change techniques (BCTs) — including goal-setting, self-monitoring, action planning, and motivational interviewing — ideally combined with educational strategies, to improve long-term PA adherence. Wearable activity trackers (pedometers, smartwatches, accelerometers) and other digital technologies (apps, telehealth platforms) are specifically endorsed as effective delivery tools for PA promotion, reflecting the now substantial evidence base in this area.

6. PA interventions may be delivered in-person (individual or group), remotely (digital, telephone), or via hybrid models. Supervised sessions are beneficial, particularly at initiation, but unsupervised home-based programmes augmented by technology are evidence-based alternatives where access is limited. Dose, intensity, and modality should be adapted to individual capacity and disease phase.

7. Task force members rated feasibility of implementation at 7.2–8.5 — notably lower than impact ratings (8.3–9.2) and level of agreement (9.0–9.8). This gap reflects real-world barriers: time constraints in clinical consultations, inadequate provider training in PA counselling, variable patient access to exercise facilities, and health system funding structures that do not routinely support PA prescription. The task force explicitly calls for quality indicators, educational programmes for health professionals, and health system-level investment to close this implementation gap.

8. People with IA and OA are consistently less active than healthy controls, and provider hesitancy — particularly the unfounded fear that exercise will cause flares or joint damage — remains a documented obstacle. This update reinforces unequivocally that PA is safe and that hesitancy is not evidence-based.

The 2025 EULAR PA update delivers a strengthened evidence-based framework. Its most consequential advances are the explicit treatment of sedentary behaviour as an independent therapeutic target, the formal endorsement of digital technologies, and rethinking the assessment process from contraindication screening to individualised enablement. 

For the practising rheumatologist, the central message is clear: PA promotion — in all its forms — must be a routine, proactive, and shared clinical conversation at every patient encounter, from diagnosis onwards.