Effectiveness and safety of high-intensity exercise in rheumatic diseases-friend or foe? A systematic review.

Abstract

Despite growing evidence supporting the benefits of physical activity in patients with rheumatic and musculoskeletal diseases (RMDs), both clinicians and patients often remain cautious-particularly regarding higher intensities. Although exercise is universally recommended in international guidelines for these populations, it is frequently accompanied by warnings to engage only in moderate-intensity training. The primary objective of this systematic review was to examine the effectiveness and safety of high-intensity, land-based exercise in patients with inflammatory rheumatic conditions, compared with usual care, no intervention, or low-intensity exercise. We aimed to determine whether high-intensity exercise leads to an increase in disease activity, pain intensity, or impairment of function. We conducted a systematic review through a systematic literature search in the electronic databases MEDLINE (via PubMed), the Cochrane Library, PEDro, and ClinicalTrials.gov. We identified relevant 29 studies (15 original randomized controlled trials and 14 secondary analyses or follow-up studies). The study quality as assessed using the Joanna Briggs Institute (JBI) checklist was generally adequate, with the main limitations being in patient and clinician blinding. The findings indicated that high-intensity exercise-whether aerobic, resistance-based, or in the form of high-intensity interval training (HIIT)-is safe for patients with inflammatory rheumatic diseases. We found moderate certainty evidence that high-intensity exercise does not increase disease activity, and may reduce pain and may improve function when compared with control interventions. While patients can certainly benefit from low- to moderate-intensity exercise, the current evidence does not suggest harm from high-intensity exercise. Exercise selection should follow an individualized, person-centred approach.