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Background: Inflammatory joint disease (IJD), including rheumatoid arthritis (RA) and spondyloarthritis (SpA), is associated with an increased risk of cardiovascular (CV) disease. Exercise therapy is recommended by the European Alliance of Associations for Rheumatology (EULAR) as a key strategy to manage this risk. High-intensity interval training (HIIT) has been shown to be safe and effective in improving cardiorespiratory fitness and enhancing health-related quality of life in people with IJD. Research shows that HIIT does not adversely affect disease activity and may even reduce it. Evidence further suggests that exercise benefits may be dose-dependent, with higher-intensity training providing greater effects than lower-intensity approaches. Despite these benefits, individuals with IJD generally report low levels of physical activity and reduced cardiorespiratory fitness. Moreover, limited knowledge exists regarding how patients with IJD perceive and experience HIIT, and how motivation and sustainability develop over time.
Objectives: To explore how patients with IJD and increased CV risk perceive and experience participation in a 12-week supervised HIIT intervention, with a particular focus on motivation, engagement, and sustainability.
Methods: This qualitative study was embedded within the intervention arm of the ExeHeart randomized controlled trial (NCT04922840). Between January 2022 and February 2023, we conducted semi-structured individual interviews with ten adults with rheumatoid arthritis or spondyloarthritis who had completed a 12-week HIIT programme. The intervention was delivered in a primary care setting and comprised two weekly physiotherapist-supervised HIIT sessions and one recommended unsupervised session. We audio-recorded the interviews, transcribed them verbatim, and analysed the data using thematic analysis. We first applied an inductive approach, followed by a deductive interpretation guided by Self-Determination Theory (SDT).
Results: Through our analysis, we identified four main themes:
Starting out, external motivation as driving force: The offer of being included in the training program/study was experienced as a “gift package” a safe entry into exercise, that also entailed a commitment to attend and provided structure.
From pain and effort to achievement: Exercising with chronic illness was demanding, yet over time participants reported less discomfort, growing body awareness, and emerging courage to test limits.
Relatedness and sense of security: The physiotherapist’s role was pivotal for initiation, motivation, and adherence, providing expertise, reassurance and trust that enabled perseverance while safely pushing personal limits.
Vulnerability to external barriers: Motivation alone wasn’t sufficient; time and logistics, along with health prerequisites (being injury-free, low disease activity, and feeling well enough on a given day), and contextual demands (work, family, travel distance, health fluctuations) shaped the integration and sustainability of exercise in daily life.
Conclusions: A structured and physiotherapy-supported HIIT programme can facilitate a shift from externally regulated participation toward more autonomous and sustainable exercise behaviour in patients with IJD and elevated CV risk. Addressing (psychological) needs for competence, autonomy, and a sense of relatedness appears essential for successful implementation and long-term adherence to high-intensity exercise in this population.
REFERENCES: NIL.
Acknowledgments: NIL.
Disclosure of Interests: None declared.