Skip to content

IRD CTD – Manage Fatigue

Evidence Summary (Updated 2022)

Fatigue is a common symptom in patients with inflammatory rheumatic diseases. There is moderate quality evidence showing that physical exercise interventions can improve fatigue levels in those with SLE (1-3). There have been a number of more recent systematic reviews across CTDs that have continued to support these findings. (4-13)

Quality of evidence:

Grade B – Moderate quality evidence in CTDs

Strength of recommendation
Grade 2 – Moderate Recommendation for CTDs

Fatigue is a challenging symptom and there is evidence to suggest for those with CTDs, physical activity and exercise interventions can help with these symptoms.


  1. 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.
  2. Yuen HK, Cunningham MA. Optimal management of fatigue in patients with systemic lupus erythematosus: a systematic review. Ther Clin Risk Manag. 2014;10:775-786.
  3. Tench CM, McCarthy J, McCurdie I, White PD, D’cruz DP. Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise. Rheumatology. 2003 Sep 1;42(9):1050-4.
  4. Basta, F., Afeltra, A. and Margiotta, D., 2018. Fatigue in systemic sclerosis: a systematic review. Clinical and Experimental Rheumatology, 36(4), pp.150-160.
  5. Zhang H, Liu Y, Ma J, Li Z. Systematic review of physical exercise for patients with idiopathic inflammatory myopathies. Nurs Health Sci. 2021 Jun;23(2):312-324. doi: 10.1111/nhs.12817. Epub 2021 Feb 23. PMID: 33511721.
  6. Y. Khader, S. Ghazaleh, A. Beran, C. Burmeister, A. Acharya, M. Awad, and C. Nehme. The Effectiveness of Physical Exercise on Cardiopulmonary Fitness in Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis. TP102. TP102 BEYOND COPD: GROWING THE REACH OF PULMONARY REHABILITATION. May 1, 2021, A4139-A4139
  7. Misse RG, Borges IBP, Dos Santos AM, Gupta L, Shinjo SK. Effect of exercise training on fatigue and pain in patients with systemic autoimmune myopathies: A systematic review. Autoimmun Rev. 2021 Oct;20(10):102897. doi: 10.1016/j.autrev.2021.102897. Epub 2021 Jul 15. PMID: 34274546.
  8. 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.
  9. Miyamoto ST, Valim V, Carletti L, Ng WF, Perez AJ, Lendrem DW, Trennel M, Giovelli RA, Dias LH, Serrano ÉV, Subtil AM, Abreu VC, Natour J. Supervised walking improves cardiorespiratory fitness, exercise tolerance, and fatigue in women with primary Sjögren’s syndrome: a randomized-controlled trial. Rheumatol Int. 2019 Feb;39(2):227-238. doi: 10.1007/s00296-018-4213-z. Epub 2019 Jan 2. PMID: 30604204.
  10. Keramiotou K, Anagnostou C, Kataxaki E, Galanos A, Sfikakis PP, Tektonidou MG. The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial. RMD Open. 2020 Jan;6(1):e001141. doi: 10.1136/rmdopen-2019-001141. PMID: 31958285; PMCID: PMC6999688.
  11. Cetin SY, Calik BB, Ayan A. Investigation of the effectiveness of Tai Chi exercise program in patients with scleroderma: A randomized controlled study. Complement Ther Clin Pract. 2020 Aug;40:101181. doi: 10.1016/j.ctcp.2020.101181. Epub 2020 Apr 25. PMID: 32891271.
  12. Voet, N., van der Kooi, E., van Engelen, B. and Geurts, A., 2019. Strength training and aerobic exercise training for muscle disease. Cochrane Database of Systematic Reviews, 2019(12).
  13. Lopes-Souza, P., Dionello, C., Bernardes-Oliveira, C., Moreira-Marconi, E., Marchon, R., Teixeira-Silva, Y., Paineiras-Domingos, L., da Cunha Sá-Caputo, D., Xavier, V., Bergmann, A., Klumb, E. and Bernardo-Filho, M., 2021. Effects of 12-week whole-body vibration exercise on fatigue, functional ability and quality of life in women with systemic lupus erythematosus: A randomized controlled trial. Journal of Bodywork and Movement Therapies, 27, pp.191-199