Extrapersonal barriers and facilitators to physical activity in rheumatic and musculoskeletal diseases: a scoping review

This study aims to map patient-perceived extrapersonal determinants influencing physical activity (PA) behaviour among individuals with rheumatic and musculoskeletal diseases (RMDs).

We conducted a scoping review in accordance with PRISMA-ScR guidelines, registered in PROSPERO. PubMed, the Cochrane Library, and CINHAL were searched from inception to July 2025. Eligible studies included adults with inflammatory arthritis or osteoarthritis reporting extrapersonal barriers or facilitators of PA from the patient perspective. Determinants were coded using the Theoretical Domains Framework and synthesised inductively into higher-order domains.

Forty-two studies (29 qualitative studies and 13 surveys), including 3084 participants from 17 countries, were included. We identified 233 determinants, grouped into 25 themes across 3 domains: social, environmental, and system-level factors. Frequently reported determinants-acting as either barriers or facilitators depending on context-included social support, financial cost, weather conditions, access to adapted PA programmes, and work or family commitments. Several determinants received limited attention in prior reviews, such as habitual family activities, the role of children or grandchildren, pet ownership, proximity to natural environments, patient associations, and active transport.

PA behaviour among people with RMDs is influenced by a wide range of contextual determinants that extend beyond individual motivation or disease-related factors. Implementation strategies should therefore address social, environmental, and system-level conditions to improve long-term adherence. Future research should assess the prevalence, perceived impact, and cross-country variability of these determinants.