Exploration of country-specific barriers and facilitators for the implementation of physical activity according to the EULAR physical activity recommendations for people with rheumatic musculoskeletal diseases in four different European countries: the COPA project

Abstract

Objectives Promotion of physical activity (PA) in individuals with rheumatic and musculoskeletal diseases (RMDs) is essential for disease management, yet evidence on social, environmental, and system-level determinants remains limited. This study aimed to quantify the prevalence of these determinants and compare them across four European nations. Method A cross-country survey was developed based on a scoping review and semi-structured stakeholder interviews. The survey comprised 27 items across social, environmental, and system domains. Participants rated each item as a facilitator, barrier, or neutral, using a scale from - 10 (barrier) to + 10 (facilitator). Responses were analyzed to assess cross-country differences in demographic characteristics, PA behavior, and determinant ratings. Results A total of 734 individuals with RMDs participated (41.1% RA, 40.7% axSpA, and 18.1% OA) from France (30.5%), Switzerland (34.4%), the Netherlands (17.3%), and Turkey (17.7%). Significant between-country differences were identified in PA behaviors and demographics (p < 0.05). Overall determinant scores did not differ significantly (p = 0.101). Key facilitators varied across countries: knowledge and fitness to perform exercises was prominent in Switzerland; scheduled exercises in the Netherlands and France; and health professionals in France and Turkey. Common barriers included weather conditions-particularly in Turkey and the Netherlands-costs of memberships or sport facilities, especially in France, and work-related duties in Turkey and the Netherlands. Conclusions Despite comparable overall scores, the relevance of social, environmental, and system-level determinants of PA varied across countries These findings highlight the importance of country-specific contextual factors for understanding PA participation and for designing tailored, effective PA promotion strategies in people with RMDs.