E018 Moving together: evaluating exercise prescription behaviours in rheumatology

Abstract Background/Aims Physical activity is a key component of managing rheumatological conditions, improving pain, fatigue, function, and long-term health outcomes. Despite this, exercise is inconsistently discussed and prescribed in rheumatology clinics. Evidence suggests patients are more likely to engage in physical activity when discussions are initiated and endorsed by a rheumatologist. This project evaluated current practice, clinician confidence, and strategies to improve education and communication around physical activity within a large NHS rheumatology service providing outpatient care across several hospital sites. Methods An audit of outpatient consultations between 2/12/2024 and 2/6/2025 was performed using inbuilt software from the electronic notes record. Encounters were filtered by diagnosis, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, fibromyalgia, and osteoarthritis. Free-text searches identified documentation of general exercise advice (e.g. “exercise plan,” “stay active,” “pacing”) and activity-specific advice (e.g. “walking,” “swimming,” “resistance training”). Data were summarised by condition. A baseline staff questionnaire assessed clinicians’ personal activity levels, confidence in delivering disease-specific exercise advice, and responses to clinical scenarios. Respondents included six doctors, six nurses, and two pharmacists. Results Across the six-month audit, 4,685 rheumatology encounters were reviewed. Documentation of exercise advice varied by diagnosis, recorded in 15.4% of consultations for rheumatoid arthritis, 17.0% for psoriatic arthritis, 21.6% for fibromyalgia, and 47.2% for ankylosing spondylitis. Lower documentation rates were observed for lupus (15.5%) and systemic sclerosis (8.6%). General advice was more frequently recorded than activity-specific recommendations. 50% of the staff surveyed met UK physical activity targets. Confidence in providing exercise advice varied across roles and conditions, with doctors generally reporting higher confidence than nurses or pharmacists. The highest confidence was recorded for advising a rheumatoid arthritis patient starting a walking programme (mean 3.5 for doctors, 3.3 for nurses, and 3.5 for pharmacists), while the lowest was for lupus with renal disease (3.2, 1.8, and 2.0 respectively). Moderate confidence was seen for fibromyalgia (3.0, 2.5, 2.5) and chronic low back pain (3.0, 2.7, 2.0), with lower scores for polymyalgia, greater trochanteric pain syndrome, and ankylosing spondylitis (1.5-2.7 across groups). Findings were shared at a departmental meeting to encourage reflection and engagement. Initiatives included promoting “exercise snacks” and walking meetings to enhance staff wellbeing and introducing templates with the electronic record to standardise exercise discussion frameworks. These incorporated pacing, gradual progression, and disease-specific guidance, with prompts to support follow-up and continuity of care. Conclusion This project identified variable clinician activity levels, confidence, and documentation of exercise advice across rheumatology conditions. Implementing structured templates and promoting physical activity among both staff and patients can enhance the consistency and quality of exercise counselling. A re-audit is planned to evaluate the impact of these interventions on clinician behaviour and patient outcomes. Disclosure W. van Klaveren: None. R. Porter: None. P. McCabe: None.