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

Abstract 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 Godin Leisure-Time Exercise Questionnaire (GLTEQ) and daily steps recorded by smartphone. Influencing factors were evaluated using Inflammatory arthritis FAcilitators and Barriers (IFAB) questionnaire. Spearman's correlation analysis was used to explore relationships between variables. Results Among 151 r-axSpA patients, 93% were aware of health benefits of PA, and 97.4% reported that physicians had recommended PA to them. However, a few 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 13.3% were classified as active. Individual exercise (62.3%) was the main form. The sedentary group (GLTEQ score < 14) demonstrated significantly poorer awareness of recommendations and higher disease activity compared with 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 sedentary and moderately active/active group. Conclusion Despite recognizing health benefits of PA, patients had limited awareness of PA recommendations and under-engage in PA. This insufficient awareness correlated with lower activity and worse disease status. Healthcare professionals should enhance PA education and encourage regular PA.