Sedentary behaviour in rheumatoid arthritis–barriers and facilitators, a qualitative analysis

Objectives Sedentary behaviour (SB) is a modifiable risk factor in the management of rheumatoid arthritis (RA). SB interventions may be more acceptable where pain, fatigue and fluctuating disease activity limit physical activity (PA). To inform the development of effective/scalable interventions, this study aimed to; (1) determine how people with RA conceptualise SB and (2) explore lived experiences of SB to identify barriers and facilitators. Methods Semi-structured interviews were conducted with adults with RA, recruited in the UK using opportunistic and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results Participants (n = 14) used SB, activity, movement and PA/exercise interchangeably. Three themes were generated. Motivation explained engagement or breaks in SB; SB was reduced when movement was meaningful, enjoyable, or linked to valued roles. Anticipated effort and fear of pain reinforced SB. Resilience and adaptive strategies reduced SB, while competing demands reinforced SB. Movement, captured negotiation between activity and rest, shaped by physical symptoms, contextual factors, and sociocultural influences. The same factors (e.g., family) operated as a facilitator and barrier. Participants recognised that rest prevented exacerbations, however, prolonged sedentariness worsened stiffness and function. Identity in Flux, reflected changes in perceived capability, stigma and loss of identity reinforcing SB for some, while others reconstructed identity to maintain valued roles and social participation. Conclusion SB is shaped by psychological, social and contextual determinants, not symptoms alone. Interventions should adopt identity-sensitive, flexible approaches that enhance meaningful motivations and address pain-related fears, rather than relying on prescriptive targets.