Intensive aerobic and muscle endurance exercise in patients with systemic sclerosis: a pilot study

Abstract

BackgroundNo previous studies have examined the effect of intensive exercise in systemic sclerosis patients with pulmonary impairment. The objective of this study was to examine the effect of an eight-week intensive aerobic exercise and muscle endurance training program for patients with systemic sclerosis with 50–100% of forced vital capacity.MethodsA single-subject experimental design with repeated systematic measures during a six week A-phase (non-interventional baseline period) and an eight week B-phase (exercise intervention period) was used. Three women and one man with median age 66 years and median disease duration of 3.5 years completed aerobic exercise corresponding to 15 on the Borg RPE scale (strenuous) and muscular endurance training three times/week. Physical capacity (six-minute walk test), aerobic capacity (submaximal treadmill test) and muscle endurance in shoulder and hip flexion (Functional Index 2) were assessed every other week throughout the 14-week study. Activity limitation (Health Assessment Questionnaire), quality of life (Short Form 36), Raynaud, Fatigue and Global Health during the recent week (Visual Analogue Scales) were assessed at weeks 0, 6, 14.ResultsThree participants improved significantly in muscular endurance, and two participants improved significantly or clinically relevant in aerobic capacity. All other variables remained unchanged, except for a trend towards reduced fatigue.ConclusionsThis eight week exercise program was largely successful with positive effects on aerobic capacity and muscle endurance.Trial registrationClinicaltrials.gov Identifier: NCT01813578

Exercise as an anti-inflammatory therapy for rheumatic diseases—myokine regulation

“…Studies have shown that aerobic and resistance exer cise training programmes consistently improve the aerobic capacity, muscle strength and selfreported func tional ability of patients with RA, 72-77 adult SLE 78-81 and juvenileonset SLE, 82 ankylosing spondylitis, [83][84][85][86] systemic sclerosis, [87][88][89][90] and idiopathic inflammatory myo pathies, including polymyositis, dermatomyositis and body inclusion myositis. [91][92][93][94][95][96][97][98][99] Importantly, a number of studies have found an association of these effects with improve ments in selfreported fatigue and healthrelated quality of life.…”

“…121 The high degree of safety (that is, no evidence of disease flares or changes in ESR or CRP levels) of exercise training programmes, encompassing aerobic exercises with or without strength training, has also been shown in patients with SLE, 78-82 ankylosing spondylitis [83][84][85] and systemic sclerosis. [87][88][89][90] Moreover, studies have reported no increases in muscle inflammation or damage after resistance exercise training programmes by patients with idiopathic inflammatory myopathy. 93,94,98 Although preliminary, evidence exists that exercise does not exacerbate systemic inflammation, particu larly in patients with RA, SLE or idiopathic inflamma tory myopathy.…”

“…34,35,132 Both the upstream and downstream signalling pathways for IL6 differ mark edly between myocytes and macrophages ( Figure 3). 33 Unlike IL6 signalling in macrophages, which is depend ent upon activation of the nuclear factorκB (NFκB) Box 5 | Exercise is medicine-systemic sclerosis Improved physical capacity ■ Increased muscle strength, function and mobility in response to aerobic plus resistance exercise programmes 89,90 ■ Increased aerobic capacity in response to aerobic 87 and aerobic plus resistance exercise programmes 88 ■ Improved self-reported quality of life and fatigue in response to aerobic plus resistance exercise programmes 88,90 Unchanged level of inflammatory markers ■ Unchanged disease activity scores or markers of systemic inflammation and muscle damage (creatine kinase and aldolase) in response to aerobic 87 and aerobic plus resistance exercise programmes [88][89][90] signalling pathway, expression of intramuscular IL6 is regulated by a network of signalling cascades that prob ably involves crosstalk between the Ca 2+ -NFAT (nuclear factor of activated Tcells) and glycogen-p38 MAPK (mitogenactivated protein kinase) pathways. 34 Therefore, when IL6 activates monocytes or macrophages, it creates a proinflammatory response, whereas contraction induced activation of IL6 and its signalling in muscle cells is independent of a preceding TNF response or of NFκB activation.…”

Aerobic and resistance exercise in systemic sclerosis: State of the art

“…In a study of 53 patients with SSc (Schouffoer et al, ), one patient experienced progressively painful skin (although no thickening or inflammation of the skin was observed), and another patient presented with Achilles tendon rupture during circuit training. One patient with severe ILD in the study by Alexanderson, Bergegård, Björnådal, and Nordin () did not tolerate intensive aerobic exercise, and had dyspnoea and cough at attempts to increase exercise loads. In a recent study with a sample of 220 patients with SSc (Rannou et al, ), two patients reported fatigue, one patient reported hip pain after aerobic exercise and another patient reported calf pain.…”

Nonpharmacological Treatment in Systemic Sclerosis

“…The authors detected significantly improved muscular endurance in three participants and significantly or clinically significantly improved aerobic capacity in two participants [22].…”