A qualitative study published in BMJ Open provides patient-centered insight into why supervised high-intensity interval training can motivate some patients with rheumatoid arthritis to sustain exercise long after a structured program ends—while also underscoring why others struggle to do so.
Although the findings are not practice-changing, they reinforce and humanize a challenge rheumatologists know well: exercise is essential in rheumatoid arthritis, yet difficult to implement consistently in real life.
The study explored experiences of supervised high-intensity interval training (HIIT) among patients with rheumatoid arthritis (RA) and examined how they maintained exercise independently following the intervention, wrote lead study author Gunilla Limbäck, PhD, of the University of Gothenburg in Sweden, and colleagues. Researchers conducted in-depth, semistructured interviews with 20 patients (16 women) who had completed at least half of a 12-week supervised HIIT and strength-training program delivered twice weekly in a hospital setting in Western Sweden. Interviews occurred 3 to 6 months following program completion and were analyzed using qualitative content analysis.
Participants generally described HIIT as demanding but manageable. Many entered the program uncertain whether high-intensity exercise was safe or feasible with RA, fearing increased pain or disease flares. Instead, most reported the opposite, including improved physical capacity, reduced joint symptoms, less fatigue, and enhanced mental well-being. According to the study, the short, alternating bursts of high and lower intensity were perceived as making strenuous exercise achievable, even for those with limited prior exercise experience.
Four key experiential categories emerged regarding supervised HIIT: it was challenging yet effective; group participation facilitated adherence; individualized guidance from a rheumatology-trained physiotherapist increased confidence; and perceiving tangible benefits in the body was highly motivating. Patients emphasized the importance of physiotherapists who understood RA-specific limitations and could tailor exercise intensity using heart rate monitoring and symptom-based adjustments.
The study highlighted the social and psychological dimensions of exercise. Training in a group of peers with RA fostered accountability, reduced isolation, and normalized physical limitations. Several participants noted that seeing others with similar or greater challenges succeed encouraged them to persist.
Following the supervised program, experiences diverged. Fifteen patients reported continuing to exercise, often integrating it into daily routines and viewing it as a core component of disease management. These patients described increased self-efficacy, goal setting, and reliance on the positive physical and mental effects of exercise as key drivers of maintenance.
However, five participants did not sustain exercise and expressed a sense of resignation. Barriers included lack of motivation, competing life demands, discomfort exercising alone or in gyms, and a perceived need for ongoing supervision. Some patients who adhered well during the supervised phase struggled once structured support was removed, according to the study, suggesting reliance on external motivation rather than internalized habits.
Across both groups, patients consistently called for follow-up visits with knowledgeable physiotherapists, framing exercise as a lifelong treatment requiring monitoring and adjustment—much like pharmacologic therapy. Those with little prior exercise experience or difficulty completing unsupervised sessions during the intervention appeared particularly vulnerable to dropout.
For clinicians, these findings reinforce existing beliefs that patients with well-controlled RA can safely tolerate high-intensity exercise, and professional guidance matters. The study humanizes why translating exercise recommendations into sustained behavior remains difficult. The researchers noted that while some patients readily adopted exercise as "medicine," others required prolonged professional support to maintain activity once supervision ended.
The study was limited by the inclusion of patients with low-to-moderate disease activity, which may limit generalizability to those with higher disease activity.
The authors declared having no competing interests.
Source: BMJ Journals
