THE ROLE OF PHYSICAL EXERCISE IN REDUCING INFLAMMATION IN PATIENTS WITH SYSTEMIC SCLEROSIS
Abstract
Introduction and Aim: Systemic sclerosis (SSc) is a chronic, progressive disease that leads to multi-organ failure. In its pathogenesis, inflammation plays a significant role, particularly due to the reduced frequency of regulatory T cells that modulate this process. The aim of this paper was to analyze the available scientific evidence to determine how physical activity influences the reduction of inflammation and its relevance in the therapy of systemic sclerosis.
Results: Systemic sclerosis is associated with a chronic inflammatory state, as indicated by elevated inflammatory markers such as C-reactive protein and ferritin, which correlate with disease severity and symptom progression. Physical activity demonstrates potential in modulating inflammation by lowering inflammatory markers and improving overall bodily function. Regular, supervised exercise in patients with SSc yields measurable benefits, enhancing exercise capacity, muscle strength, quality of life and respiratory function.
Materials and Methods: During the writing of this paper, data analysis was conducted based on a review of available articles published in the PubMed database. The following combination of keywords was used: „sport in systemic sclerosis", „physical exercise in systemic sclerosis", "sport in systemic sclerosis”, „inflammation in systemic sclerosis” „inflammation and exercise”. The following filters were applied: Free full text, Clinical Trial, Randomized Clinical Trial and within the last 10 years.
Conclusion: Chronic inflammation in systemic sclerosis accelerates the development of complications, while regular, moderate physical activity under supervision can improve physical capacity, microcirculation, and reduce inflammatory symptoms. However, further research is necessary to confirm the beneficial effects of exercise as a therapeutic intervention in systemic sclerosis.
References
Barde, F., Lorenzon, R., Vicaut, E., Rivière, S., Cacoub, P., Cacciatore, C., Rosenzwajg, M., Daguenel-Nguyen, A., Fain, O., Klatzmann, D., & Mekinian, A. (2024). Induction of regulatory T cells and efficacy of low-dose interleukin-2 in systemic sclerosis: interventional open-label phase 1-phase 2a study. RMD open, 10(2), e003500. https://doi.org/10.1136/rmdopen-2023-003500
Maehara, T., Kaneko, N., Perugino, C. A., Mattoo, H., Kers, J., Allard-Chamard, H., Mahajan, V. S., Liu, H., Murphy, S. J., Ghebremichael, M., Fox, D., Payne, A. S., Lafyatis, R., Stone, J. H., Khanna, D., & Pillai, S. (2020). Cytotoxic CD4+ T lymphocytes may induce endothelial cell apoptosis in systemic sclerosis. The Journal of clinical investigation, 130(5), 2451–2464. https://doi.org/10.1172/JCI131700
Twardzina układowa – rekomendacje diagnostyczno-terapeutyczne Polskiego Towarzystwa Dermatologicznego. Część 1: diagnostyka i monitorowanie Dorota Krasowska, Lidia Rudnicka, Aleksandra Dańczak-Pazdrowska, Grażyna Chodorowska, Anna Woźniacka, Anna Lis-Święty, Joanna Czuwara, Joanna Maj, Sławomir Majewski, Anna Sysa-Jędrzejowska, Anna Wojas-Pelc https://www.termedia.pl/Twardzina-ukladowa-rekomendacje-diagnostyczno-terapeutyczne-Polskiego-Towarzystwa-Dermatologicznego-Czesc-1-diagnostyka-i-monitorowanie,56,30931,1,0.html
Twardzina układowa - Otylia Kowal-Bielecka, Marek Bielecki https://podyplomie.pl/wiedza/wielka-interna/1377,twardzina-ukladowa
Wasfy, M. M., & Baggish, A. L. (2016). Exercise Dose in Clinical Practice. Circulation, 133(23), 2297–2313. https://doi.org/10.1161/CIRCULATIONAHA.116.018093
Adamu, B., Sani, M. U., & Abdu, A. (2006). Physical exercise and health: a review. Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, 15(3), 190–196. https://doi.org/10.4314/njm.v15i3.37214
Allanore, Y., Wung, P., Soubrane, C., Esperet, C., Marrache, F., Bejuit, R., Lahmar, A., Khanna, D., Denton, C. P., & Investigators (2020). A randomised, double-blind, placebo-controlled, 24-week, phase II, proof-of-concept study of romilkimab (SAR156597) in early diffuse cutaneous systemic sclerosis. Annals of the rheumatic diseases, 79(12), 1600–1607. https://doi.org/10.1136/annrheumdis-2020-218447
Feldmann, D., Jandova, I., Heilmeier, U., Kollert, F., Voll, R. E., & Finzel, S. (2023). Inflammatory arthritis in systemic sclerosis is associated with elevated C-reactive protein and requires musculoskeletal ultrasound for reliable detection. Frontiers in medicine, 9, 933809. https://doi.org/10.3389/fmed.2022.933809
Stock, C. J. W., Bray, W. G., Kouranos, V., Jacob, J., Kokosi, M., George, P. M., Chua, F., Wells, A. U., Sestini, P., & Renzoni, E. A. (2024). Serum C-reactive protein is associated with earlier mortality across different interstitial lung diseases. Respirology (Carlton, Vic.), 29(3), 228–234. https://doi.org/10.1111/resp.14609
Mor, A., Friedman, S., Hashmueli, S., Peled, A., Pinzani, M., Frankel, M., & Safadi, R. (2024). Targeting CCL24 in Inflammatory and Fibrotic Diseases: Rationale and Results from Three CM-101 Phase 1 Studies. Drug safety, 47(9), 869–881. https://doi.org/10.1007/s40264-024-01436-2
Kuley, R., Stultz, R. D., Duvvuri, B., Wang, T., Fritzler, M. J., Hesselstrand, R., Nelson, J. L., & Lood, C. (2022). N-Formyl Methionine Peptide-Mediated Neutrophil Activation in Systemic Sclerosis. Frontiers in immunology, 12, 785275. https://doi.org/10.3389/fimmu.2021.785275
Jiang, Y., Li, X., Zhou, W., Jin, M., Li, S., Lao, Y., Zhu, H., & Wang, J. (2022). Clinical significance of serum ferritin in patients with systemic sclerosis. Journal of clinical laboratory analysis, 36(8), e24597. https://doi.org/10.1002/jcla.24597
Zheng, G., Qiu, P., Xia, R., Lin, H., Ye, B., Tao, J., & Chen, L. (2019). Effect of Aerobic Exercise on Inflammatory Markers in Healthy Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in aging neuroscience, 11, 98. https://doi.org/10.3389/fnagi.2019.00098
Uzeloto, J. S., de Toledo-Arruda, A. C., Silva, B. S. A., Braz, A. M. M., de Lima, F. F., Grigoletto, I., Ramos, D., Golim, M. A., & Ramos, E. M. C. (2022). Effect of physical training on cytokine expression in CD4+ T lymphocytes in subjects with stable COPD. Therapeutic advances in respiratory disease, 16, 17534666221091179. https://doi.org/10.1177/17534666221091179
Sandsdal, R. M., Juhl, C. R., Jensen, S. B. K., Lundgren, J. R., Janus, C., Blond, M. B., Rosenkilde, M., Bogh, A. F., Gliemann, L., Jensen, J. B., Antoniades, C., Stallknecht, B. M., Holst, J. J., Madsbad, S., & Torekov, S. S. (2023). Combination of exercise and GLP-1 receptor agonist treatment reduces severity of metabolic syndrome, abdominal obesity, and inflammation: a randomized controlled trial. Cardiovascular diabetology, 22(1), 41. https://doi.org/10.1186/s12933-023-01765-z
Tadayon Zadeh, F., Amini, H., Habibi, S., Shahedi, V., Isanejad, A., & Akbarpour, M. (2020). The Effects of 8-Week Combined Exercise Training on Inflammatory Markers in Women with Multiple Sclerosis. Neuro-degenerative diseases, 20(5-6), 212–216. https://doi.org/10.1159/000518580
Hiensch, A. E., Mijwel, S., Bargiela, D., Wengström, Y., May, A. M., & Rundqvist, H. (2021). Inflammation Mediates Exercise Effects on Fatigue in Patients with Breast Cancer. Medicine and science in sports and exercise, 53(3), 496–504. https://doi.org/10.1249/MSS.0000000000002490
Yakut, H., Özalevli, S., Aktan, R., Özgen Alpaydın, A., Merih Birlik, A., & Can, G. (2021). Effects of supervised exercise program and home exercise program in patients with systemic sclerosis: A randomized controlled trial. International journal of rheumatic diseases, 24(9), 1200–1212. https://doi.org/10.1111/1756-185X.14177
Waszczykowski, M., Dziankowska-Bartkowiak, B., Podgórski, M., Fabiś, J., & Waszczykowska, A. (2021). Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients-one-year follow-up study. Scientific reports, 11(1), 15174. https://doi.org/10.1038/s41598-021-94549-y
Mitropoulos, A., Gumber, A., Crank, H., Akil, M., & Klonizakis, M. (2018). The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients. Arthritis research & therapy, 20(1), 112. https://doi.org/10.1186/s13075-018-1605-0
Mitropoulos, A., Gumber, A., Akil, M., & Klonizakis, M. (2019). Exploring the microcirculatory effects of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis. Microvascular research, 125, 103887. https://doi.org/10.1016/j.mvr.2019.103887
Mitropoulos, A., Gumber, A., Crank, H., Akil, M., & Klonizakis, M. (2020). Exploring the feasibility of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis. Clinical rheumatology, 39(6), 1889–1898. https://doi.org/10.1007/s10067-019-04921-7
Filippetti, M., Cazzoletti, L., Zamboni, F., Ferrari, P., Caimmi, C., Smania, N., Tardivo, S., & Ferrari, M. (2020). Effect of a tailored home-based exercise program in patients with systemic sclerosis: A randomized controlled trial. Scandinavian journal of medicine & science in sports, 30(9), 1675–1684. https://doi.org/10.1111/sms.13702
Cetin, S. Y., Calik, B. B., & Ayan, A. (2020). Investigation of the effectiveness of Tai Chi exercise program in patients with scleroderma: A randomized controlled study. Complementary therapies in clinical practice, 40, 101181. https://doi.org/10.1016/j.ctcp.2020.101181.
Views:
18
Downloads:
11
Copyright (c) 2025 Aleksandra Gradek, Marcin Sawczuk, Dominika Nowak, Adam Zarzycki, Julia Tarnowska, Filip Szydzik, Bartosz Żegleń, Katarzyna Kozon, Monika Grudzień, Anna Leśniewska

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.