P067 Motivators, facilitators and barriers for patients and healthcare professionals towards exercise programmes in inflammatory rheumatic diseases: a qualitative literature review
Authors: Amarnani Raj , Hadjidemetriou Magdalena , Ainsworth Kaley , Chiwah Farai , Katti Shailesh , Mundell Alexandra , Metsios George S , Lester Catherine 
Published: April 2023

Abstract

Background/Aims
Physical activity and exercise are often recommended to patients with inflammatory rheumatic diseases, based on the EULAR 2018 physical activity and 2021 self-management guidelines. However, multiple internal and external factors often play a role in facilitating the uptake of these interventions. The aim of this literature review is to critically appraise the motivators, facilitators and barriers to disease management, specifically exercise programmes, in patients with inflammatory rheumatic diseases and the healthcare professionals involved in their care. This is done with a view to help further guide our clinical practice and service development.

Methods
Pre-defined search terms were used to identify papers published in English, studying any form of physical activity/exercise interventions for inflammatory rheumatic diseases. This included seronegative spondyloarthritis (including axial/psoriatic/enteropathic/reactive arthritis), rheumatoid arthritis, and broadly grouped connective tissue diseases including systemic lupus erythematosus, systemic sclerosis and myositis. Databases included MEDLINE via PubMed, CINAHL, Embase and Cochrane Database of systematic reviews from January 2018 onwards. Qualitative data regarding any motivators, facilitators and barriers to exercise for patients and health care professions were extracted. 427 studies were identified and screened of which 12 were included in the final analysis.

Results
In seronegative spondyloarthritis, the main motivators for patients included a reduction in disease activity and disability. Facilitators included social support and support from health care professionals, including the wider multidisciplinary team. Major barriers included lack of time, fatigue, pain and economic concerns. Similarly, in rheumatoid arthritis, main motivators were improvement in pain, function and strength with facilitators being social and healthcare professional support. The major barrier seen across all studies was fatigue. For the broad connective tissue diseases, motivators included general improvement in symptoms and knowledge of the benefits of physical activity. Facilitators included social and healthcare professional support as well as access to suitable exercise facilities. Finally, barriers included lack of understanding of exercise interventions and disease burden. For healthcare professionals, similar findings were found in both seronegative spondyloarthritis and rheumatoid arthritis with major motivators being increased quality of care provision and improvements in disease activity. Facilitators included ability to access high quality educational materials, and barriers included limited experience of exercise prescribing and the challenges of telehealth. No studies were identified for the viewpoints of healthcare professionals in other connective tissue diseases.

Conclusion
Exercise programmes have an important role in the management of patients with inflammatory rheumatic diseases. By gaining a better understanding of the motivators, facilitators and barriers towards exercise in both patients and healthcare professionals, we can further develop interventions that address these domains and help better integrate physical activity into routine patient care. Particular importance should be placed on training healthcare professionals across the multidisciplinary team to facilitate the uptake of physical activity interventions.
Disclosure
R. Amarnani: None. M. Hadjidemetriou: None. K. Ainsworth: None. F. Chiwah: None. S. Katti: None. A. Mundell: None. G.S. Metsios: None. C. Lester: None.