EULAR Urges Doctors to Prescribe Exercise

Why Are Rheumatologists Being Told to Push Exercise Harder?

The updated EULAR recommendations reflect a growing recognition that pharmacotherapy alone does not address the full burden of rheumatic and musculoskeletal diseases. Patients with conditions such as rheumatoid arthritis, axial spondyloarthritis, osteoarthritis, and systemic lupus erythematosus face elevated risks of cardiovascular disease, deconditioning, fatigue, and reduced quality of life — outcomes that respond to regular movement in ways drugs cannot fully replicate.

EULAR's task force emphasized that brief, fear-driven advice such as "avoid strain" is outdated. Instead, clinicians are encouraged to discuss physical activity at every relevant visit, tailor recommendations to disease activity, and refer patients to physiotherapists or supervised programs when needed. The guidance aligns with World Health Organization recommendations of at least 150 minutes of moderate aerobic activity per week, supplemented by strength training.

What Does the Evidence Show About Exercise and Arthritis Outcomes?

Multiple Cochrane reviews have concluded that aerobic and resistance training improve physical function and reduce pain in people with rheumatoid arthritis and osteoarthritis, with no evidence that appropriately dosed exercise accelerates joint damage. For inflammatory arthritis specifically, exercise has been associated with improvements in cardiorespiratory fitness — important given that cardiovascular disease is a leading cause of premature mortality in this population.

EULAR's update also highlights behavior-change techniques: goal setting, self-monitoring, and motivational interviewing improve long-term adherence more than generic advice. The recommendations call for health systems to make supervised exercise programs available, recognizing that patients often need support to start safely and sustain activity through disease flares.

How Should Patients With Arthritis Start Exercising Safely?

For most patients, walking, cycling, swimming, and water-based exercise are well tolerated entry points. Strength training using bodyweight, resistance bands, or light weights helps protect joints by reinforcing supporting musculature. EULAR encourages a gradual build-up rather than abrupt increases in volume or intensity, especially for those who have been inactive.

During disease flares, the guidance does not require stopping activity entirely. Instead, patients are encouraged to reduce intensity, switch to gentler modalities, and resume their usual program as symptoms settle. Persistent or severe joint swelling warrants clinical reassessment before continuing.