The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review

Sophie I E Liem, Theodora P M Vliet Vlieland, Jan W Schoones, Jeska K de Vries-Bouwstra, Sophie I E Liem, Theodora P M Vliet Vlieland, Jan W Schoones, Jeska K de Vries-Bouwstra

Abstract

Given the shortcomings of previous literature reviews evaluating the effect and safety of exercise therapy in SSc, we aimed to carry out a systematic review of the literature specifically on this topic. A structured search strategy was performed in Medline (via PubMed) and other electronic databases from 1990 to 3 September 2019. Randomized controlled trials, observational designs, conference abstracts and trial registrations were included if they concerned SSc patients ≥18 years of age, exercise therapy and reported outcomes related to physical functioning. Nine articles were included. Four randomized controlled trials compared (a) hand exercises, (b) orofacial exercises, (c) aerobic exercises or (d) aerobic exercises plus resistance training with no exercise, demonstrating effects on hand function (a), maximum mouth opening (b), peak oxygen uptake (c + d) and quality of life. All five observational studies concerning hand, orofacial, aerobic and/or strengthening exercises reported improvements of hand function, mouth opening, aerobic capacity and/or muscle strength. In conclusion, the evidence on the effect and safety of exercise therapy in SSc is scanty.

Keywords: exercise; exercise therapy; review; scleroderma; systemic sclerosis.

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Figures

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Fig. 1
Flow diagram of selection process

References

    1. Hinchcliff M, Varga J.. Systemic sclerosis/scleroderma: a treatable multisystem disease. Am Fam Physician 2008;78:961–8.
    1. Bassel M, Hudson M, Taillefer SS. et al. Frequency and impact of symptoms experienced by patients with systemic sclerosis: results from a Canadian National Survey. Rheumatology 2011;50:762–7.
    1. Cuomo G, Santoriello C, Polverino F. et al. Impaired exercise performance in systemic sclerosis and its clinical correlations. Scand J Rheumatol 2010;39:330–5.
    1. Pettersson H, Åkerström A, Nordin A. et al. Self-reported physical capacity and activity in patients with systemic sclerosis and matched controls. Scand J Rheumatol 2017;46:490–5.
    1. Liem SIE, Meessen J, Wolterbeek R. et al. Physical activity in patients with systemic sclerosis. Rheumatol Int 2018;38:443–53.
    1. Kowal-Bielecka O, Landewe R, Avouac J. et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR). Ann Rheum Dis 2009;68:620–8.
    1. Smidt N, de Vet HC, Bouter LM. et al. Effectiveness of exercise therapy: a best-evidence summary of systematic reviews. Aust J Physiother 2005;51:71–85.
    1. Meijs J, Zirkzee EJ, Schouffoer AA. et al. Health-care utilization in Dutch systemic sclerosis patients. Clin Rheumatol 2014;33:825–32.
    1. Willems LM, Kwakkenbos L, Bode C, van den Hoogen FH, van den Ende CH.. Health care use and patients' perceptions on quality of care in systemic sclerosis. Clin Exp Rheumatol 2013;31(2 Suppl 76):64–70.
    1. Willems LM, Vriezekolk JE, Schouffoer AA. et al. Effectiveness of nonpharmacologic interventions in systemic sclerosis: a systematic review. Arthritis Care Res 2015;67:1426–39.
    1. Pizzo G, Scardina GA, Messina P.. Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma. Clin Oral Investig 2003;7:175–8.
    1. Pinto AL, Oliveira NC, Gualano B. et al. Efficacy and safety of concurrent training in systemic sclerosis. J Strength Cond Res 2011;25:1423–8.
    1. Yuen HK, Marlow NM, Reed SG. et al. Effect of orofacial exercises on oral aperture in adults with systemic sclerosis. Disabil Rehabil 2012;34:84–9.
    1. Sandqvist G, Åkesson A, Eklund M.. Evaluation of paraffin bath treatment in patients with systemic sclerosis. Disabil Rehabil 2004;26:981–7.
    1. Antonioli CM, Bua G, Frigè A. et al. An individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility. Clin Rheumatol 2009;28:159–65.
    1. Maddali Bongi S, Del Rosso A, Galluccio F. et al. Efficacy of a tailored rehabilitation program for systemic sclerosis. Clin Exp Rheumatol 2009;27(3 Suppl 54):44–50.
    1. Bongi SM, Del Rosso A, Galluccio F. et al. Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis. Clin Rheumatol 2009;28:1167–73.
    1. Maddali-Bongi S, Landi G, Galluccio F. et al. The rehabilitation of facial involvement in systemic sclerosis: efficacy of the combination of connective tissue massage, Kabat's technique and kinesitherapy: a randomized controlled trial. Rheumatol Int 2011;31:895–901.
    1. Schouffoer AA, Ninaber MK, Beaart-van de Voorde LJ. et al. Randomized comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis. Arthritis Care Res 2011;63:909–17.
    1. Poole JL, Skipper B, Mendelson C.. Evaluation of a mail-delivered, print-format, self-management program for persons with systemic sclerosis. Clin Rheumatol 2013;32:1393–8.
    1. Poole JL, Mendelson C, Skipper B, Khanna D.. Taking charge of systemic sclerosis: a pilot study to assess the effectiveness of an internet self-management program. Arthritis Care Res 2014;66:778–82.
    1. de Oliveira NC, Portes LA, Pettersson H, Alexanderson H, Boström C.. Aerobic and resistance exercise in systemic sclerosis: state of the art. Musculoskeletal Care 2017;15:316–23.
    1. Oliveira NC, dos Santos Sabbag LM, de Sa Pinto AL, Borges CL, Lima FR.. Aerobic exercise is safe and effective in systemic sclerosis. Int J Sports Med 2009;30:728–32.
    1. Shoemaker MJ, Wilt JL, Dasgupta R, Oudiz RJ.. Exercise training in patients with pulmonary arterial hypertension: a case report. Cardiopulm Phys Ther J 2009;20:12–8.
    1. Chernev I, Gustafson K, Medina-Bravo A.. Functional outcome in a patient with an acute quadriparesis secondary to systemic sclerosis: a case report. Arch Phys Med Rehabil 2009;90:170–2.
    1. Mugii N, Someya F, Hasegawa M.. Reduced hypoxia risk in a systemic sclerosis patient with interstitial lung disease after long-term pulmonary rehabilitation. Clin Med Insights Case Rep 2011;4:53–6.
    1. Alexanderson H, Bergegård J, Björnådal L, Nordin A.. Intensive aerobic and muscle endurance exercise in patients with systemic sclerosis: a pilot study. BMC Res Notes 2014;7:86..
    1. Rannou F, Boutron I, Mouthon L. et al. Personalized physical therapy versus usual care for patients with systemic sclerosis: a randomized controlled trial. Arthritis Care Res 2017;69:1050–9.
    1. Mugii N, Hamaguchi Y, Maddali-Bongi S.. Clinical significance and usefulness of rehabilitation for systemic sclerosis. J Scleroderma Relat Disord 2018;3:71–80.
    1. Mugii N, Hasegawa M, Matsushita T. et al. The efficacy of self-administered stretching for finger joint motion in Japanese patients with systemic sclerosis. J Rheumatol 2006;33:1586–92.
    1. Bongi SM, Del Rosso A, Passalacqua M, Miccio S, Cerinic MM.. Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase. Arthritis Care Res 2011;63:1134–41.
    1. Someya F, Mugii N.. Pulmonary rehabilitation outcome of exercise-induced oxygen desaturation in systemic sclerosis with interstitial lung disease. J Health 2013; 05:1–5.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG.. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097..
    1. Shea BJ, Reeves BC, Wells G. et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017;358:j4008.
    1. Rausch Osthoff AK, Niedermann K, Braun J. et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018;77:1251–60.
    1. Furlan AD, Pennick V, Bombardier C, van Tulder M.. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 2009;34:1929–41.
    1. Downs SH, Black N.. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health 1998;52:377–84.
    1. Ghogomu EA, Maxwell LJ, Buchbinder R. et al. Updated method guidelines for Cochrane musculoskeletal group systematic reviews and metaanalyses. J Rheumatol 2014;41:194–205.
    1. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association diagnostic and therapeutic criteria committee. Arthritis Rheum 1980;23:581–90.
    1. van den Hoogen F, Khanna D, Fransen J. et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 2013;65:2737–47.
    1. Landim SF, Bertolo MB, Marcatto de Abreu MF. et al. The evaluation of a home-based program for hands in patients with systemic sclerosis. J Hand Ther 2019;32:313–21.
    1. Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M.. The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients. Arthritis Res Ther 2018;20:112..
    1. Mitropoulos A, Gumber A, Akil M, Klonizakis M.. Exploring the microcirculatory effects of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis. Microvascular Res 2019;125:103887.
    1. Piga M, Tradori I, Pani D. et al. Telemedicine applied to kinesiotherapy for hand dysfunction in patients with systemic sclerosis and rheumatoid arthritis: recovery of movement and telemonitoring technology. J Rheumatol 2014;41:1324–33.
    1. Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M.. Investigating the effectiveness and feasibility of exercise on microvascular reactivity and quality of life in systemic sclerosis patients: study protocol for a feasibility study. Trials 2018;19:647..
    1. Sydow E, Arat S, Nijs G. et al. An explorative study evaluating feasibility and effectiveness of two different exercise programs in systemic sclerosis associated microstomia. J Scleroderma Relat Disord 2018;3:199–209.
    1. Sydow E, Severi S, Van der Elst K. et al. A mixed method study to explore the feasibility and patient satisfaction of two different exercise programs in systemic sclerosisassociated microstomia. Ann Rheum Dis 2019;78:1060.
    1. Kwakkenbos L, Carrier ME, Boutron I. et al. Randomized feasibility trial of the scleroderma patient-centered intervention network hand exercise program (SPIN-HAND). J Scleroderma Relat Disord 2018;3:91–97.
    1. NCT03092024. Scleroderma Patient-Centered Intervention Network (SPIN) Hand Program Feasibility Study. (Last accessed November 27, 2019).
    1. NCT03419208. Scleroderma Patient-Centered Intervention Network (SPIN) Hand Program. (last accessed November 27, 2019).
    1. NCT03614208. Individualized Home-Based Exercise Program for Patient with Systemic Sclerosis. (Last accessed November 27, 2019).
    1. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P.. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med 2017;167:40–7.
    1. de Rooij M, van der Leeden M, Avezaat E. et al. Development of comorbidity-adapted exercise protocols for patients with knee osteoarthritis. Clin Interv Aging 2014;9:829–42.

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