Background: The 2018 EULAR recommendations for physical activity (PA) in people with inflammatory arthritis (IA) and osteoarthritis (OA) [1] required an update, as the World Health Organisation released updated guidelines for PA and sedentary behavior in 2020 [2]. Moreover, many new interventional studies related to PA in IA and OA have been published, including interventions targeting sedentary behavior reduction, specific exercise interventions, and interventions using technology and/or the combination of educational and behavioral strategies in people with IA or OA.

Objectives: To perform a systematic literature review and update the 2018 EULAR recommendations for PA in people with IA and OA.

Methods: The EULAR Standardised Operating Procedures for developing recommendations were followed [3]. A task force (TF) (six rheumatologists, one orthopaedic surgeon, eleven physiotherapists, one occupational therapist, one nurse, one exercise physiologist, one patient representative, and two methodologists) from 17 countries met twice. During the first meeting in February 2024 (online), the TF agreed on 13 research questions associated with the original four overarching principles (OAP) and ten recommendations and updated the three related PICOS’s (population, intervention, control, outcome, study). Systematic literature searches were conducted for literature published from 1 ^st April 2017 until 1 ^st August 2024 to identify new evidence since the 2018 PA recommendations. The retrieved evidence and consequences for the recommendations were discussed in four online subgroup meetings and presented to all TF members during the second meeting for all TF members (in-person meeting) meeting in November 2024. The recommendations were revised during this second in-person meeting based on the new evidence and the subgroup discussions. The TF voted on each proposed recommendation, updated or not, to reach a consensus (defined a priori > 75% in favor). After the meeting, the TF completed a web-based survey to 1) ascertain the Level of Agreement (LoA) (0-10, 10=totally agree) with each OAP or recommendation and 2) rate both the impact and feasibility (0-10, 10=highest) of each recommendation to facilitate the development of quality indicators for future implementation.

Results: Based on updated evidence from 59 systematic reviews, 35 randomized controlled trials, and 25 qualitative studies, the TF agreed to rephrase or adapt three OAPs and eight original recommendations. Adaptations included, among others, the emphasis on the reduction of sedentary behavior. Additionally, one recommendation on contraindications was incorporated into a recommendation on assessment. Further, one new recommendation supporting wearable activity trackers and other digital technologies for PA promotion was added. One OPA and two recommendations remained unchanged. All 26 TF members participated in the voting. The mean LoA ranged from 9.0 to 9.8 across all OAPs and recommendations, the mean impact of all recommendations was rated between 8.3 to 9.2, and the mean feasibility of implementation was rated somewhat lower between 7.2 to 8.5. The highest rated recommendation 1 (‘PA promotion consistent with general PA recommendations should be an integral part of standard care throughout the course of disease in people with IA and OA’) reached a mean LoA of 9.8, mean impact of 9.2 and mean feasibility of 8.5. Finally, the TF agreed to update related research and education agendas.

Conclusion: An updated set of three overarching principles and eleven recommendations regarding PA in patients with IA and OA was developed, based on evidence and discussion by an international multi-professional TF. A plan for dissemination and implementation including quality indicators that take the ratings of impact and feasibility into account will be developed.

REFERENCES: [1] Rausch Osthoff AK, Niedermann K et al. doi: 10.1136/annrheumdis-2018-213585.

[2] Bull FC, et al. doi: 10.1136/bjsports-2020-102955.

[3] EULAR SOPs standard operating procedures for task forces https://www .eular.org/recommendations/points-to-consider-task-forces-project-applications

Acknowledgements: We thank the librarian Mr Jan W Schoones, Walaeus Library, Leiden University Medical Center, the Netherlands, for supporting our literature search.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.