Rheumatology International (2018) 38:443–453
PHYSICAL MEDICINE AND REHABILITATION
Physical activity in patients with systemic sclerosis
S. I. E. Liem
· J. M. T. A. Meessen
· R. Wolterbeek
· N. Ajmone Marsan
· M. K. Ninaber
· T. P. M. Vliet Vlieland
J. K. de Vries‑Bouwstra
Received: 6 October 2017 / Accepted: 7 November 2017 / Published online: 18 November 2017
© The Author(s) 2017. This article is an open access publication
Objectives To compare self-reported levels of physical activity (PA) of systemic sclerosis (SSc) patients with the general
population. To evaluate in SSc patients factors associated with PA levels and needs and preferences regarding PA.
Methods Fifty nine SSc patients completed the Short QUestionnaire to ASsess Health-Enhancing PA. The proportion of
patients meeting the Dutch Recommendation for PA (= moderate PA for 30 min on ≥ 5 days/week) and total minutes of
PA per week were calculated and compared with similar data from the Dutch population. Characteristics were univariately
and multivariately compared between patients with low and high PA levels (either ≤ or > mean minutes/week of the Dutch
population). Needs and preferences regarding PA promotion and guidance related to exercise were assessed by questionnaires.
Results Stratiﬁed for age (< 55 or ≥ 55 years) and gender, the proportion SSc patients meeting the Dutch recommenda-
tion for PA was not signiﬁcantly diﬀerent from the Dutch population. The total minutes of PA per week was signiﬁcantly
lower among SSc patients (1704 vs. 2614, P < 0.001). Multivariable analyses showed that in SSc patients the male gender,
scleroderma health assessment questionnaire (SHAQ) and lack of energy were signiﬁcantly associated with lower PA levels
(P = 0.007; P = 0.042; P = 0.025). Two-third of patients required more information about PA.
Conclusion In SSc patients, the total minutes of PA per week are signiﬁcantly lower compared to the general population.
The male gender, functional ability as reﬂected by SHAQ and lack of energy seem to interfere with PA. These results might
guide health professionals in providing their patients with appropriate information on PA.
Keywords Systemic sclerosis · Scleroderma · Physical activity · Activities of daily living · Exercise
Systemic sclerosis (SSc) is a rare autoimmune disease that is
characterised by ﬁbrosis and vasculopathy and clinically by
Raynauds phenomenon and involvement of multiple organ
systems, such as the gastrointestinal tract, kidneys, heart,
lungs and musculoskeletal system. Based on the extent and
localisation of skin involvement SSc, is subdivided into dif-
fuse cutaneous SSc and limited SSc .
As a result of the impact of SSc on patients’ overall health
status, the exercise capacity of SSc patients was found to
be limited as well . Studies on exercise capacity in SSc
patients have so far mainly focused on aerobic capacity,
and included maximal and submaximal endurance tests [5,
6]. However, from the patient’s perspective physical activ-
ity (PA) incorporated in a person’s daily life may be even
more relevant. PA should be distinguished from exercise
although the terms are often used interchangeably. PA
includes exercise as well as other activities which involve
bodily movement and are done as part of playing, working,
active transportation, house chores and recreational activi-
ties. Exercise is a subcategory of physical activity that is
planned, structured, repetitive, and purposeful in the sense
that the improvement or maintenance of one or more com-
ponents of physical ﬁtness is the objective .
This study has been previously published during the congress
of the European League Against Rheumatism in London in
June 2016 as well as the congress of the American College of
Rheumatology in Washington DC in November 2016, both as a
poster presentation [1, 2].
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s00296-017-3879-y) contains
supplementary material, which is available to authorized users.
* J. K. de Vries-Bouwstra
Extended author information available on the last page of the article