Rheumatologists acknowledge running may offer physical and mental health benefits among patients with rheumatoid arthritis (RA), including improved cardiovascular fitness, reduced pain medication use, and better disease control, but cite lack of RA-specific guidelines and patient fears about joint damage as major barriers to recommending it, according to a qualitative study published in BMJ Open.

The study identified disease stability, gradual progression, and symptom-guided pacing as critical factors for safe running in patients with RA. All 13 participating rheumatologists emphasized good disease control as essential before recommending running, with concerns focused on running during active inflammation and rapid training load increases.

Researchers conducted semistructured interviews with practicing Australian rheumatologists between March and May 2024, identifying five key themes through thematic analysis: perceived benefits of running, risks and clinical cautions, criteria for discussing running, barriers to running, and facilitators to running.

Key Benefits Observed

One rheumatologist described comprehensive improvements in patients who run: "They're leaner, their mental health is better, their muscle bulk is better. Their requirement for analgesia is less and their rheumatoid is generally better. So their overall health is better physically, but also mentally. And you know, they get addicted to it. So it's a really nice thing to see that they're empowered to do that."

Some participants suggested running may protect joint health, emphasizing this view is extrapolated from osteoarthritis research rather than RA-specific trials. "I can't speak for my colleagues, but we have some pretty good data that we can borrow from the osteoarthritis literature that suggests that running protects the joints long term," one participant noted.

Evidence Gaps Limit Recommendations

Participants expressed frustration with the lack of RA-specific evidence and guidelines, making it challenging to confidently recommend running. Patient misconceptions about joint harm emerged as a persistent obstacle.

One participant expressed frustration with colleagues' approaches: "Very few of my colleagues have an understanding on how you should look after a recreational or semi-elite or elite athlete who has inflammatory arthritis … many of my colleagues are quite content [if patients] can go to the shops and … see [their] grandkids … They don't have any concept of how to coach to the next level, let alone nail the disease to another level … that's the bit that really disappoints me in my colleagues as they actively discourage people from doing it, and that's a reflection of the fact they don't know what to do with them."

Another participant noted: "I've met some patients recently who had been advised previously by other doctors to not run, and I asked them how do you feel and actually they said they don't feel better and they miss running and they didn't feel better for not doing it."

One participant highlighted socioeconomic factors: "Overall I think it's a fantastic form of exercise and I think is underutilised, particularly in certain populations. The population that I serve in a public hospital setting, in a relatively socioeconomically deprived area, includes very few people who either run or are open to the concept of running, despite the fact that it's a low-cost, easily accessible form of exercise."

Disease Control and Cautions

"If they've got very active disease, they've got like active inflammation, very high inflammatory markers and they're having pain doing just normal daily activities. Then I'd suggest that running at that time might not be a good idea because it's likely to be very painful for them at that time," explained one rheumatologist.

Clinicians also called out foot and forefoot vulnerability — especially the metatarsophalangeal (MTP) joints — and advised extra caution when RA coexists with weight-bearing osteoarthritis. Several noted that systemic corticosteroids (e.g., prednisone) can boost energy but impair collagen and soft-tissue integrity, potentially increasing injury risk if training ramps up too fast.

Practical Recommendations

Participants recommended symptom-guided pacing: "Listen to your body. Run and it'll hurt you a little bit likely. But if the pain settles within an hour or two of stopping, then you keep doing it. But if you have a bad night the night after, or if you're really sore the next day, then you need to back off."

Rheumatologists frequently recommended referral to physiotherapy and exercise physiology, structured programs like "Couch-to-5km," well-fitted footwear, and community initiatives such as Parkrun. "I think the thing for Parkrun… you could walk it if you want to start, and it's not competitive in the sense of, you know, it's not lot like an Athletic Club. So you can do everything from running to running hard to walking slow. So there's a place for everyone there," one rheumatologist explained. Gradual load progression and maintaining resistance training during higher disease activity were also emphasized.

One participant emphasized that vigorous exercise is more powerful than supplements like curcumin, fish oil or glucosamine.

Participants only discussed running when it aligned with patient goals. "I'm very encouraging towards exercise, but I usually try and tailor it towards what are their goals and what are what are they actually going to do. So running is just one of many things, but unless they specifically mention the word running, I'm not going to mention it to them specifically," one rheumatologist stated.

Physician Experience Matters

Rheumatologists' personal running experience influenced their clinical discussions. "…because I run myself we can go pretty deep into a kind of anecdotal account of running, but I don't have any hard and fast rules that - I'm not prescriptive about it," one participant noted. Conversely, those without running experience reported limited confidence: "Not being an athlete myself, I don't have a lot of experience with people who run those distances, like running marathons, doing marathon training, running mountain roads."

The researchers acknowledged snowball sampling may have favored rheumatologists with more positive views of running.

The study included 13 rheumatologists (76% male) with mean clinical experience of 27 years (range 10 to 54 years) from 5 Australian states, according to lead study author Samantha Shearman of Australian Catholic University, and colleagues. Six participants (46%) identified as current runners. Interviews averaged 20 minutes and were conducted remotely.

The authors declared having no competing interests.

Source: BMJ Open