Physical activity of older patients with rheumatoid arthritis

Rheumatoid arthritis (RA) in older adults presents a complex clinical challenge, exacerbated by age-related comorbidities, musculoskeletal degeneration, and psychosocial factors, all contributing to significant mobility limitations and reduced quality of life. This narrative review synthesizes current evidence on rehabilitation interventions to enhance physical function in RA patients, focusing on walking, aquatic therapy, sauna and massage therapies, and yoga. A comprehensive search of Medline/PubMed, Scopus, Web of Science, and DOAJ (up to May 2025) identified studies highlighting the efficacy of structured physical activity (PA) in reducing disease activity, fatigue, and pain, while improving functional capacity and mental health. Walking interventions, including high-intensity interval protocols, demonstrate immunomodulatory and cardiometabolic benefits, with significant reductions in Disease Activity Score (DAS28) and inflammatory markers. Aquatic therapy, leveraging water's buoyancy, improves functional outcomes and reduces depressive symptoms, while sauna and massage therapies offer pain relief and enhanced flexibility. Yoga, as a mind-body practice, significantly lowers disease activity and enhances physical function and psychological well-being. Wearable technologies, such as actigraphy and pedometry, support personalized exercise regimens by providing real-time data for dynamic goal-setting. The European Alliance of Associations for Rheumatology (EULAR) and American College of Rheumatology (ACR) guidelines advocate for tailored exercise integration into RA management. Despite these benefits, adherence remains challenging due to pain, fatigue, and psychological barriers, necessitating individualized, biopsychosocial approaches. This review provides practical recommendations for rheumatology specialists to implement evidence-based rehabilitation strategies, emphasizing multidisciplinary care to optimize mobility and quality of life in older adults with RA.