To introduce and justify the development of the WORLD Principle, a novel, patient-centered framework designed to formulate safe, effective, and personalized exercise prescriptions for patients with gout, thereby addressing the critical gap in structured non-pharmacological management guidance within current clinical practice.

This study systematically analyzed the pathophysiological mechanisms of gout, including hyperuricemia, monosodium urate crystal deposition, acute inflammatory flares, and chronic joint damage, alongside a comprehensive review of existing evidence on physical activity in gout management. The analysis encompassed epidemiological studies, Mendelian randomization trials, and clinical intervention studies examining the effects of various exercise modalities on serum urate levels, flare frequency, pain, inflammation, and quality of life. Based on this evidence synthesis, the WORLD Principle framework was constructed and deconstructed into five core components. The study further evaluated the framework's alignment with major international gout management guidelines, including those from the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR), and explored its practical integration into clinical practice through patient assessment, education, and digital health tools.

The WORLD Principle comprises five core components: Water/Weather, addressing hydration status and environmental conditions to support urate excretion and exercise safety; Oxygen, emphasizing moderate-intensity aerobic exercise to achieve anti-inflammatory effects and cardiorespiratory benefits; Regular, highlighting the necessity of consistency and long-term adherence for sustained therapeutic outcomes; Low-intensity, prioritizing joint protection through low-impact modalities to prevent exercise-induced flares; and Diseases, mandating comprehensive screening and management of common comorbidities such as obesity, cardiovascular disease, and type 2 diabetes. The framework aligns closely with the treat-to-target philosophy endorsed by international guidelines and provides an operational structure for implementing non-pharmacological recommendations that have previously lacked specificity. Integration strategies include structured patient assessment, targeted education to address knowledge gaps, and the use of digital tools such as mobile applications and wearable activity trackers to monitor adherence and support long-term engagement.

The WORLD Principle offers a systematic, evidence-based, and patient-centered structural framework for exercise prescription in patients with gout. By addressing the unique pathophysiological challenges, comorbidity profiles, and safety considerations of this population, it effectively guides clinicians in formulating safe and individualized exercise regimens. The framework aligns with international management guidelines, supports comprehensive patient care, and holds significant potential for improving long-term outcomes in gout management.