Systematic review of physical exercise for patients with idiopathic inflammatory myopathies

Abstract

Idiopathic inflammatory myopathies (IIM) are systemic autoimmune connective tissue diseases. The safety and effectiveness of exercise for patients with idiopathic inflammatory myopathies remains unclear. This study aimed to systematically review the evidence for physical exercise among patients with idiopathic inflammatory myopathies. Relevant experimental studies were identified through searching the PubMed, Cochrane, Embase, Scopus, and CINAHL databases, and studies involving any type of physical exercise for ≥1 month were considered. The primary outcome was muscle strength, and the secondary outcomes included aerobic fitness, functional performance, health status, quality of life, activities of daily living, pain, and fatigue. Eight randomized controlled trials and thirteen nonrandomized uncontrolled trials were reviewed. Physical exercise appeared safe, with several positive effects. However, selection or allocation biases and small sample sizes affected the certainty of the evidence. While physical exercise appeared safe for patients with idiopathic inflammatory myopathies with several positive effects, studies of a higher methodological quality and involving patients with active disease are needed. Furthermore, to design optimal exercise programs, consistent and sensitive outcome measures are needed to facilitate comparisons of results from different studies.

The effect of a 24-week training focused on activities of daily living, muscle strengthening, and stability in idiopathic inflammatory myopathies: a monocentric controlled study with follow-up

“…Data in A and C are presented as the mean ± standard error of the mean (whiskers). Data in the tree diagrams (B and D) present the percentage distribution of patients by outcome, which is stratified into five levels of improvement/deterioration over weeks 0-24. w, week; p*, unadjusted inter-group comparison by two-way ANOVA; p, unadjusted intra-group comparison by one-way ANOVA in black (IG) and gray (CG); p †, difference in the overall distribution in five levels of the patient outcome by chi-square test; p ‡, difference in the category of clinically meaningful improvement by chi-square test To date, studies on non-pharmacological interventions in IIM have provided evidence of efficacy for various interventions and employed a broad spectrum of outcome measures [9][10][11][12][13][14][15]. For indirect comparison, we focus on the top 12 published studies ranked by quality in the recent systematic review by Van Thillo et al [13], which comprised five randomized controlled trials (RCTs) [37][38][39][40][41] and seven non-randomized non-controlled trials (nRnCTs) [42][43][44][45][46][47][48].…”

“…For indirect comparison, we focus on the top 12 published studies ranked by quality in the recent systematic review by Van Thillo et al [13], which comprised five randomized controlled trials (RCTs) [37][38][39][40][41] and seven non-randomized non-controlled trials (nRnCTs) [42][43][44][45][46][47][48]. Additionally, we chose two RCTs [49,50] and one nRnCT [51] from the more recent systematic reviews [14,15]. These 15 studies [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] recruited mostly PM/DM patients (except for two studies with IBM patients), 3-23 patients each, and used various inclusion criteria.…”

“…These studies assess the effect of a broad range of treatment modalities and their combinations with various outcomes and are often limited by a small number of patients, short period of intervention, and lack of a control group, follow-up, or a blinded assessor [9,10]. To our knowledge, five systematic reviews provide a comprehensive overview of the already existing evidence on the effect and safety of non-pharmacological interventions in IIM and analyze the quality and limitations of the published studies [11][12][13][14][15]. However, the optimal training intervention for IIM patients has yet to be established.…”