From awareness to action: poor knowledge of physical activity correlates with lower activity and worse disease in axial spondyloarthritis

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OBJECTIVE: To investigate the awareness, implementation and factors influencing physical activity (PA) engagement among Chinese patients with radiographic axial spondyloarthritis (r-axSpA), and their relationships with disease status. METHODS: This cross-sectional study enrolled 151 r-axSpA patients and evaluated their awareness of PA while collecting sociodemographic and disease-related parameters. PA levels were assessed with the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and daily steps recorded by smartphones. Influencing factors were evaluated using the Inflammatory arthritis FAcilitators and Barriers (IFAB) questionnaire. Spearman's correlation analysis was used to explore relationships between variables. RESULTS: Among 151 r-axSpA patients, 98.0% were aware of health benefits of PA, and 97.4% reported that physicians had recommended PA to them. However, fewer patients knew the World Health Organization recommendations on aerobic PA (33.8%) and muscle-strengthening activities (33.1%), as well as the European League Against Rheumatism (EULAR) recommendations for PA (55.6%). According to daily steps, only 13.2% were classified as active. Individual exercise (62.3%) was the main form. A sedentary group (GLTEQ score < 14) demonstrated significantly poorer awareness of recommendations and higher disease activity compared with a moderately active/active group (GLTEQ score ≥ 14). Awareness of EULAR recommendations was positively correlated with GLTEQ score (P = 0.003). IFAB6 (lack of motivation, P = 0.015) and IFAB8 (knowledge of benefits of PA, P = 0.045) showed significant differences between the sedentary and the moderately active/active group. CONCLUSION: Despite recognizing health benefits of PA, patients had limited awareness of PA recommendations and under-engaged in PA. This insufficient awareness correlated with lower activity and worse disease status. Healthcare professionals should enhance PA education and encourage regular PA.

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