Evidence Summary (Added 2022)
We identified 9 studies (1-9) that investigated improvements in muscle strength in the connective tissue disease population, involving mainly patients with idiopathic inflammatory myopathies but also a few studies looking at patients with scleroderma. Patients included had a mixture of stable and active disease and 5 of the studies involved adults only. Interventions involved a range of physical activities from aerobic exercise to specific tailored sets of resistance exercises for a single muscle group. 5 of the 9 studies were systematic reviews and they all reported a positive effect on muscle strength. The remaining 4 studies were RCTs with a range of 22 to 428 participants and half of these studies showed no significant improvement in muscle strength.
Quality of evidence:
Grade A – High Quality Evidence. Numerous randomised controlled trials and systematic reviews of high quality. Only minor concerns for studies were performance bias (since interventions could not be blinded) and some of the trials had a small sample size)
Strength of recommendation
Grade 1 (CTD) – Strong recommendation
Muscle strength is reduced in those with inflammatory rheumatic disease. There is a strong evidence base that physical activity and exercise interventions can help improve muscle strength. In particular, muscle strength is improved by physical activity in those with idiopathic inflammatory myopathies and the evidence base for a similar effect in those with scleroderma is growing.
- 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.
- 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.
- 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.
- 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.
- 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).
- 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).
- de Oliveira, D., Misse, R., Lima, F. and Shinjo, S., 2018. Physical exercise among patients with systemic autoimmune myopathies. Advances in Rheumatology, 58(1).
- Rausch Osthoff, A., Juhl, C., Knittle, K., Dagfinrud, H., Hurkmans, E., Braun, J., Schoones, J., Vliet Vlieland, T. and Niedermann, K., 2018. Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis. RMD Open, 4(2), p.e000713.
- 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.