P068 The effects of exercise and physical activity in inflammatory rheumatic diseases: a scoping literature review
Authors: Amarnani Raj , Hadjidemetriou Magdalena , Mundell Alexandra , Katti Shailesh , Chiwah Farai , Ainsworth Kaley , Metsios George S , Lester Catherine 
Published: April 2023

Abstract

Background/Aims
Physical activity and exercise for the management of inflammatory rheumatic diseases is well described in the literature and is recommended in the EULAR 2018 physical activity and 2021 self-management guidelines. However, the extent to which physical activity and exercise is beneficial or detrimental in these patients is unclear. The aim of this review is to critically appraise the effects of physical activity and exercise interventions on patient-centred outcomes in a range of inflammatory rheumatic diseases in order to help guide clinical practice.

Methods
Pre-defined search terms were used to identify randomised controlled trials or systematic reviews published in English, studying any form of physical activity/exercise interventions for inflammatory rheumatic diseases. This included seronegative spondyloarthritis (including axial/psoriatic/enteropathic/reactive arthritis), rheumatoid arthritis, and broadly grouped connective tissue diseases including systemic lupus erythematosus, systemic sclerosis and myositis. Databases included MEDLINE via PubMed, CINAHL, Embase and Cochrane Database of systematic reviews from January 2018 onwards. Quantitative data regarding types of physical activity, any primary or secondary outcome measures and the quality of the evidence was compiled independently by two authors. 427 studies were identified and screened of which 160 were included in the final analysis.

Results
Numerous benefits of various quality in a range of physical activities across the diseases were identified. Interventions included swimming, aquatic exercises, global posture retraining and land based aerobic exercises (including walking, Nordic walking, Pilates, Tai Chi and High Intensity Interval Training). In terms of high-quality evidence, for seronegative spondyloarthritis, benefits were found for functional outcome scores, fatigue levels and disease activity scores. In rheumatoid arthritis, benefits were seen in fitness, disease activity scores, quality of life, muscle strength and pain reduction. Across the studied connective tissue diseases, benefits were seen in fitness, ability to carry out activities of daily living, muscle strength and fatigue. Low to moderate quality evidence for improvement was seen across all diseases in areas such as mood, sleep quality and flexibility/stiffness. However, there was significant heterogeneity amongst the dose and type of exercise interventions used between identified studies. This therefore precluded a meta-analysis which meant that this review was unable to recommend one specific exercise over another. Importantly, no adverse outcomes to physical activity were found in any of the identified studies.

Conclusion
It is evident that a range of exercise and physical activity interventions can have an important role in the management of inflammatory rheumatic diseases. Moreover, the wider well-established benefits of physical activity seen in the general population, including those of mental wellbeing and in cardiovascular disease, may be pertinent to the comorbidities associated with inflammatory rheumatic diseases. Future research would benefit from comparing doses and types of exercise interventions against each other in order to help further guide clinical practice.
Disclosure
R. Amarnani: None. M. Hadjidemetriou: None. A. Mundell: None. S. Katti: None. F. Chiwah: None. K. Ainsworth: None. G.S. Metsios: None. C. Lester: None.