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IRD CTD – Improve your ability to carry out daily activities

Evidence summary (updated 2022)

Exercise based interventions improves fatigue and physical fitness in SLE [1-2,4] and there are improvements seen in disease activity scores in Polymyositis and Dermatomyositis patients [3,5]. Exercise programmes were safe and do not adversely affect disease activity in those with SLE [6]. Motivating patients to keep physically active can help maintain independence and allow them to continue with employment and perform key activities.
On updated review, 14 studies (7-20) investigated the effect of physical activity in patients with CTD on their ability to carry out daily activities. Patients had a spectrum of CTDs including scleroderma, SLE and idiopathic inflammatory myopathies but and most studies (9 out of 13) did not restrict participants to adults. Reflecting the epidemiology, most patients were female. Interventions were varied from aerobic training to specific resistance exercises with two studies including new technologies such as a wearable tracker or health app. 9 studies were systematic reviews and only one did not demonstrate a positive effect. The 5 remaining studies (9,12,18,19,20) were RCTs with 4 out of 5 of these showing a positive result , however one study using a novel intervention of blood flow resistance training did not demonstrate any differences (18).

Quality of evidence:
Grade A – High quality evidence. There was a potential reporting bias since outcomes were often self-reported with interventions not blinded. One study showed unexplained significant loss to follow up, but this was not seen repeatedly overall the data is robust.

Strength of recommendation
Grade 1 – Strong recommendation due to consistency seen across multiple studies and reviews.

Conclusion:
There is significant evidence that physical activity can help improve ability to carry out activities of daily living for patients with a range of CTDs.

References:
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. 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.
4. Department of Health. Start Active, Stay Active. In: Strategy; 2011.
5. 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.
6. Wiesinger GF, Quittan M, Graninger M, Seeber A, Ebenbichler G, Sturm B, Kerschan K, Smolen J, Graninger W. Benefit of 6 months long-term physical training in polymyositis/dermatomyositis patients. British journal of rheumatology. 1998 Dec 1;37(12):1338-42.

  1. 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.
  2. Van Thillo A, Vulsteke JB, Van Assche D, Verschueren P, De Langhe E. Physical therapy in adult inflammatory myopathy patients: a systematic review. Clin Rheumatol. 2019 Aug;38(8):2039-2051. doi: 10.1007/s10067-019-04571-9. Epub 2019 May 21. PMID: 31115788.
  3. 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.
  4. Björk M, Dragioti E, Alexandersson H, Esbensen BA, Boström C, Friden C, Hjalmarsson S, Hörnberg K, Kjeken I, Regardt M, Sundelin G, Sverker A, Welin E, Brodin N. Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-reported Function: A Systematic Review and Meta-analysis – The ENHANCE Study. Arthritis Care Res (Hoboken). 2021 Oct 11. doi: 10.1002/acr.24805. Epub ahead of print. PMID: 34632707.
  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.
  6. Nilssen IR, Koksvik HS, Grønning K, Steinsbekk A. Rehabilitation in warm climate for young adults with inflammatory arthritis: A 12-month randomized controlled trial. J Rehabil Med. 2020 Apr 14;52(4):jrm00040. doi: 10.2340/16501977-2666. PMID: 32179929.
  7. Liem, S., Vliet Vlieland, T., Schoones, J. and de Vries-Bouwstra, J., 2019. The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review. Rheumatology Advances in Practice, 3(2).
  8. de Oliveira, D., Misse, R., Lima, F. and Shinjo, S., 2018. Physical exercise among patients with systemic autoimmune myopathies. Advances in Rheumatology, 58(1).
  9. Davergne, T., Pallot, A., Dechartres, A., Fautrel, B. and Gossec, L., 2019. Use of Wearable Activity Trackers to Improve Physical Activity Behavior in Patients With Rheumatic and Musculoskeletal Diseases: A Systematic Review and Meta‐Analysis. Arthritis Care & Research, 71(6), pp.758-767.
  10. Najm, A., Gossec, L., Weill, C., Benoist, D., Berenbaum, F. and Nikiphorou, E., 2019. Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review. JMIR mHealth and uHealth, 7(11), p.e14730.
  11. Byrnes, K., Wu, P. and Whillier, S., 2018. Is Pilates an effective rehabilitation tool? A systematic review. Journal of Bodywork and Movement Therapies, 22(1), pp.
  12. Jørgensen, A., Aagaard, P., Frandsen, U., Boyle, E. and Diederichsen, L., 2018. Blood-flow restricted resistance training in patients with sporadic inclusion body myositis: a randomized controlled trial. Scandinavian Journal of Rheumatology, 47(5), pp.400-409.
  13. Gilbert, A., Lee, J., Ehrlich-Jones, L., Semanik, P., Song, J., Pellegrini, C., Pinto PT, D., Dunlop, D. and Chang, R., 2018. A randomized trial of a motivational interviewing intervention to increase lifestyle physical activity and improve self-reported function in adults with arthritis. Seminars in Arthritis and Rheumatism, 47(5), pp.732-740.
  14. 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.