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2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis
  1. Anne-Kathrin Rausch Osthoff1,2,
  2. Karin Niedermann1,
  3. Jürgen Braun3,4,
  4. Jo Adams5,
  5. Nina Brodin6,7,
  6. Hanne Dagfinrud8,
  7. Tuncay Duruoz9,
  8. Bente Appel Esbensen10,11,
  9. Klaus-Peter Günther12,
  10. Emailie Hurkmans13,
  11. Carsten Bogh Juhl14,15,
  12. Norelee Kennedy16,
  13. Uta Kiltz3,4,
  14. Keegan Knittle17,
  15. Michael Nurmohamed18,
  16. Sandra Pais19,
  17. Guy Severijns20,
  18. Thijs Willem Swinnen21,22,
  19. Irene A Pitsillidou23,
  20. Louise Warburton24,
  21. Zhivko Yankov25,
  22. Theodora P M Vliet Vlieland2
  1. 1 School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
  2. 2 Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
  3. 3 Rheumazentrum Ruhrgebiet, Herne, Germany
  4. 4 Ruhr University, Bochum, Germany
  5. 5 Faculty of Health Sciences and Arthritis Research UK Centre of Excellence for Sport, Exercise and Osteoarthritis, University of Southampton, Southampton, UK
  6. 6 Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden
  7. 7 Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
  8. 8 National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  9. 9 PMR Department, Rheumatology Division, Marmara University, School of Medicine, Istanbul, Turkey
  10. 10 Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet., Glostrup, Denmark
  11. 11 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  12. 12 University Center of Orthopaedics and Traumatology, University Medicine at Technische Universität Dresden, Dresden, Germany
  13. 13 Department Social Affaire and Health, ECORYS Nederland BV, Rotterdam, Netherlands
  14. 14 Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  15. 15 Departmentof Occupational and Physical Therapy, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark
  16. 16 School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
  17. 17 Department of Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
  18. 18 Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, The Netherlands
  19. 19 Centre for Biomedical Research, University of Algarve, Faro, Portugal
  20. 20 EULAR PARE Patient Research Partner, ReumaNet, Leuven, Belgium
  21. 21 Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
  22. 22 Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
  23. 23 EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
  24. 24 Primary Health Care Sciences, Keele University, Keele, UK
  25. 25 PRP (Patient Research Partner EULAR), Bulgarian Ankylosing Spondylitis Patient Society, Sofia, Bulgaria and ASIF (Ankylosing Spondylitis International Federation), London, UK
  1. Correspondence to Professor Karin Niedermann, School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland; karin.niedermann{at}


Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

  • rehabilitation
  • rheumatoid arthritis
  • spondyloarthritis
  • Hip osteoarthritis
  • knee osteoarthritis
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  • A-KRO and KN contributed equally.

  • Handling editor Josef S Smolen

  • Contributors AR and KN contributed equally. AR was the research fellow for the project, undertaking the SLR. The fellow was supervised by the steering group consisting of KN (convenor), TPMVV (methodologist), JB (expert). KN and TPMVV supervised the process of the SLR. KN organised and chaired the TF meetings. AR and KN drafted the manuscript with advice from TPMVV and JB. All authors have contributed to the recommendations by participating in the TF meetings; during discussion and agreement on the recommendations; revising and approving the manuscript for publication.

  • Funding The TF would like to thank EULAR for financial support of this work.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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