AB0532 The effectiveness of exercise therapy in patients with systemic sclerosis: a systematic review
Authors: S.I.E. Liem, T.P.M. Vliet-Vlieland, J.W. Schoones, J.K. de Vries-Bouwstra
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Exercise therapy is an important and relatively often used nonpharmacological intervention<sup>1</sup>, yet its effectiveness based on studies where exercise therapy is evaluated as single intervention (and not part of a comprehensive program<sup>2</sup>) has not been determined. <h3>Objectives</h3> To evaluate the effectiveness of exercise therapy in SSc patients by means of a systematic review of the literature. <h3>Methods</h3> A systematic literature search was performed in February 2017 in ten databases including Pubmed and Embase from 1990 to February 2017. We included clinical studies with an observational or experimental design as long as the study population concerned ≥3 SSc patients, the intervention consisted only of exercise therapy (categorised into hand exercises, mouth opening exercises, and aerobic exercises either or not combined with other exercises) and its clinical outcome according to at least one assessment of effectiveness done before and after the intervention was reported. Studies where exercise therapy was part of a multidisciplinary intervention were excluded. The selection of studies, data extraction and assessment of methodological quality was done by two of the researchers independently. <h3>Results</h3> The search strategy yielded 636 titles and abstracts, with eventually six studies being included (2 randomised controlled trials (RCTs), 3 observational designs (ODs) and 1 single subject experimental design (SSED)). The total number of patients included per study ranged from 4 to 48, patients' mean age from 44.0 to 66.5 years and mean disease duration from 3.5 to 12.6 years. One study concerned hand exercises (an RCT comparing strengthening and mobility exercises using a telemedicine intervention consisting of a portable device guiding patients during workout and sending data to health professionals to no-telemedicine), two studies on mouth stretching and oral-augmentation exercises (an OD and a RCT), and three studies on aerobic exercise (two ODs and one SSED; one program with only aerobic training and two programs combining aerobic and resistance training, lasting 30–60 min, 2–3 days/week for 8–12 weeks). The study on hand exercises reported a greater improvement of hand function using the telemedicine intervention. The RCT on mouth exercises showed a statistically significant effect on maximum mouth opening in the exercise group compared to no exercise at 3 months but not at 6 months follow-up, whereas the OD showed improvement of mouth opening directly after the mouth exercise program. The three studies on aerobic exercise indicate effectiveness and no dropouts were observed. The program of solely aerobic exercise on a treadmill improved patient's exercise tolerance and aerobic capacity. The two programs combining aerobic and resistance exercise showed improvements of strength and muscle function in the OD and improvements of muscular endurance and aerobic capacity in the SSED. <h3>Conclusions</h3> The literature on the effect of exercise therapy in SSc patients is scanty. Collaborative efforts to conduct methodologically sound intervention studies with adequate reporting is needed.<sup>3</sup> <h3>References</h3> [1] Meijs J, et al. Clin Rheumatol2013;33(6):825–832. [2] Willems L, et al. Arthritis Care &amp; Res. 2015;67(10):1426–1439. [3] Ravaud P, et al. Nat Clin Pract Rheumatol2006;2(6):313–319. <h3>Disclosure of Interest</h3> None declared