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IRD CTD – Improves Disease activity

Evidence summary (Updated 2022)

Whilst there is limited data in relation to physical activity and connective tissues disease, there were improvements seen in disease activity score in patients with Polymyositis and Dermatomyositis with physical activity interventions (1). Meta-analyses suggest that exercise does not adversely affect disease activity in those with SLE (2).
Three newer studies investigated the impact of physical activity on disease activity in those with CTDs. One RCT (3) looked at 51 patients with Sjogrens syndrome, of which half underwent supervised resistance training. It showed no change in disease activity. A small systematic review (4) on 100 patients with Idiopathic Inflammatory Myopathies who underwent various forms of physical activity also showed “limited evidence” for improvements in disease activity. Another larger systematic review (5) which contains one study involving patients with systemic sclerosis showed an improvement in disease activity but the quality of evidence was shown to be “high risk of bias” in 66.7% of studies.

Quality of evidence:

Grade C – Small number of trials with small sample sizes and high risk of bias in CTDs

Strength of recommendation
Grade 2 – Weak Recommendation in CTDs

More recent low-quality evidence suggests that physical activity may improve disease activity in CTDs, however this is a weak recommendation due to small numbers of trials with small sample sizes and high risks of bias.


  1. Alemo Munters L, Dastmalchi M, Andgren V, et al. Improvement in health and possible reduction in disease activity using endurance exercise in patients with established polymyositis and dermatomyositis: a multicenter randomized controlled trial with a 1-year open extension followup. Arthritis Care Res (Hoboken). 2013;65(12):1959-1968.
  2. O’Dwyer T, Durcan L, Wilson F. Exercise and physical activity in systemic lupus erythematosus: A systematic review with meta-analyses. Semin Arthritis Rheum. 2017;47(2):204-215.
  3. Minali, P., Pimentel, C., de Mello, M., Lima, G., Dardin, L., Garcia, A., Goñi, T. and Trevisani, V., 2019. Effectiveness of resistance exercise in functional fitness in women with primary Sjögren’s syndrome: randomized clinical trial. Scandinavian Journal of Rheumatology, 49(1), pp.47-56.
  4. Alexanderson H, Boström C. Exercise therapy in patients with idiopathic inflammatory myopathies and systemic lupus erythematosus – A systematic literature review. Best Pract Res Clin Rheumatol. 2020 Apr;34(2):101547. doi: 10.1016/j.berh.2020.101547. Epub 2020 Aug 17. PMID: 32819833.
  5. Sieczkowska SM, Smaira FI, Mazzolani BC, Gualano B, Roschel H, Peçanha T. Efficacy of home-based physical activity interventions in patients with autoimmune rheumatic diseases: A systematic review and meta-analysis. Semin Arthritis Rheum. 2021 Jun;51(3):576-587. doi: 10.1016/j.semarthrit.2021.04.004. Epub 2021 Apr 16. PMID: 33945907.