Effect of a tailored home-based exercise program in patients with systemic sclerosis: A randomized controlled trial

Mirko Filippetti, Lucia Cazzoletti, Francesco Zamboni, Pietro Ferrari, Cristian Caimmi, Nicola Smania, Stefano Tardivo, Marcello Ferrari, Mirko Filippetti, Lucia Cazzoletti, Francesco Zamboni, Pietro Ferrari, Cristian Caimmi, Nicola Smania, Stefano Tardivo, Marcello Ferrari

Abstract

Objective: The aim was to evaluate the effect of a home-based exercise program on functional capacity, health-related quality of life (HRQoL), and disability, in patients with systemic sclerosis (SSc).

Methods: A 6-month randomized controlled trial was conducted on SSc patients by comparing a home-based minimally supervised exercise program (exercise on a stationary cycle and strengthening of upper limbs; stretching of the hands) with usual care. At baseline and after 3 and 6 months, the patients underwent: 6 minutes walking test; hand mobility in scleroderma test; maximal exercise test on an ergocycle; strength measures (handgrip, quadriceps, and biceps). HRQoL (short-form 36 [SF-36]) and disability (health assessment questionnaire disability index [HAQ-DI]) were measured at the same time.

Results: Forty-four patients participated in the study. Twenty-two were randomly assigned to the intervention group (IG, mean age 63.60 ± 10.40 years) and 22 to the control group (CG, 61.80 ± 14.40 years). At 6 months, the distance walked in 6 minutes increased by 46 m (baseline 486, 95% CI 458-513 m; 6 months 532, 95% CI 504-561 m) in IG, whereas it decreased by 5 m (baseline 464, 95% CI 431-497 m; 6 months 459, 95% CI 427-490 m) in CG with a significantly different temporal trend at the between-groups comparison (P < .001). An improvement was also observed for strength measures (handgrip, P = .003; quadriceps, P < .001; biceps, P < .001), for the SF-36 physical component score (P < .001) and for the HAQ-DI (P = .011).

Conclusions: This study indicates that in SSc patients, a minimally supervised home-based exercise program improves physical performance, quality of life, and disability in comparison with usual care.

Keywords: disability; exercise therapy; muscles; quality of life; resistance training; scleroderma.

Conflict of interest statement

All the authors declare that they have no conflict of interest derived from the outcomes of this study.

© 2020 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Flow diagram
Figure 2
Figure 2
Temporal trend of performance outcome measures of patients in IG and CG. Legend: The error bars represent the 95% confidence interval of the outcome estimates. *P ≤ .05 of time per group interaction. ● Intervention group (IG); ○ control group (CG)
Figure 3
Figure 3
Temporal trend in quality of life and disability outcome measures of patients in the IG and CG. Legend: SF‐36: short‐form 36; PCS: physical component score; MCS: mental component score; HAQ‐DI: health assessment questionnaire disability index. The error bars represent the 95% confidence interval of the outcome estimates. *P ≤ .05 of time per group interaction. ● Intervention group (IG); ○ control group (CG)

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