The Effect of Cognitive Exercise Therapy Approach in Individuals With Systemic Sclerosis
Condition: Systemic Sclerosis
MeSH terms: Scleroderma, Systemic; Scleroderma, Diffuse; Sclerosis
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effects of Cognitive Exercise Therapy Approach
      (BETY) on vascularization, muscle strength, functionality, anti-inflammatory and
      biopsychosocial status in individuals with systemic sclerosis and to present a named exercise
      model for this disease group with objective results.
    

Detailed description: 
      Systemic sclerosis is an inflammatory and chronic autoimmune disease. Systemic sclerosis,
      which was first defined by Hippocrates as thickened skin, can also progress with skin
      involvement and fibrosis of internal organs. Although the exact pathogenesis of the disease
      is not understood, it is thought to occur as a result of interactions between factors
      affecting collagen synthesis, fibrosis, capillary (vasculopathy) changes and immunological
      mechanisms. The role of inflammation has an important place in the pathogenesis of the
      disease. One of the most important factors governing the inflammatory process is cytokines.
      Changes in the response of the cytokines mentioned in systemic sclerosis, respiratory system
      involvement and related decrease in walking capacity, loss of muscle strength, weakening of
      hand functions, as well as weakening the psychological and social aspects of a person who is
      a biopsychosocial being. In addition to local physiotherapy applications such as paraffin
      applications, exercises for the face and hands, active stretching, exercise approaches such
      as exercises for aerobic endurance are also beneficial. However, there is no mention of a
      standardized exercise model, the quality of life of individuals with systemic sclerosis,
      which is a rare disease, activities of daily living, studies in which the social and
      psychological aspects of the individual are included in the treatment, and named and defined
      exercise methods are lacking in the literature. It is seen that studies are generally carried
      out with scales and functional tests.

      Cognitive Exercise Therapy Approach, presents an example of an innovative biopsychosocial
      model with its own biopsychosocial scale, the basic exercise model of which is core
      stabilization exercises, including pain management, mood management and sexual information
      management. For individuals with systemic sclerosis, which is in the group of rare diseases,
      it is necessary to present the results of the intervention with objective evaluation methods
      to the literature. In this study, it is aimed to present an exercise model named for this
      disease group with objective results by examining the effects of Cognitive Exercise Therapy
      Approach (BETY) on vascularization, muscle strength, functionality, anti-inflammatory and
      biopsychosocial status in individuals with systemic sclerosis.
    

Intervention name(s): Cognitive Exercise Therapy Approach (BETY)
Intervention type(s): Other
Intervention description(s): BETY, based on function-oriented core stabilization exercises, will be applied in patients with systemic sclerosis. This exercise model includes pain management strategies, dance therapy-authentic movement. Function-oriented core stabilization exercises have the feature of being made difficult against gravity according to the person's ability to do. Initial exercises start from the stage where the distal segment of the extremity is on the ground, called closed-kinetic. This level, which is quite easy, becomes more difficult following the success of the individual. It can be started from the mat level and progressed by modifying it with theraband and exercise ball. It is used at the beginning and end of dance therapy and authentic movement sessions. In the session, cognitive restructuring technique is used to break the vicious cycle of pain-emotional-spasm during exercise. This exercise model is the main rehabilitation approach of the Rheumatological Rehabilitation Unit.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Evaluation parameters will be applied to the participants twice with an interval of 12 weeks. The first evaluation will be made if the individuals who come to the routine doctor's examination agree to participate in the study. According to being included in one of the two groups as those who decided to attend the BETY sessions that have been going on for 18 years and those who did not agree to attend the sessions; The individuals included in the BETY group (Group 1) will be evaluated on the day of the last exercise session after their participation in the 12-week exercise group, the individuals who do not agree to participate in the BETY sessions but agree to participate in the evaluations at 12-week intervals (Group 2) will be evaluated when they come 12 weeks apart for their routine controls. For patients with systemic sclerosis, the recommendations given routinely in our unit will be made.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Systemic Sclerosis; Biopsychosocial model; BETY; Muscle strength; Functionality; Vascularization; Anti-inflammatory responses