Lifestyle interventions in the management of systemic sclerosis: a systematic review of the literature

• Published in: Rheumatology advances in practice 2024, Vol.8 (2), p.rkae037-rkae037
• Main Authors: Parodis, Ioannis, Tsoi, Alexander, Gomez, Alvaro, Chow, Jun Weng, Girard-Guyonvarc’h, Charlotte, Stamm, Tanja, Boström, Carina
• Format: Article
• Language: English
• Subjects: Analysis; Exercise therapy; Lifestyle intervention; Medical research; Medicin och hälsovetenskap; Medicine, Experimental; Mental health; Patient education; physical activity; physical exercise; Scleroderma (Disease); self-management; Sleep; Smoking; Systematic Review and/or Meta-Analysis; Systemic scleroderma; systemic sclerosis
• ISSN: 2514-1775; 2514-1775
• DOI: 10.1093/rap/rkae037

Abstract Objectives We aimed to investigate the efficacy of lifestyle interventions for the management of SSc. Methods We searched the MEDLINE, Embase, Web of Science and CINAHL databases in June 2021. We included studies conducted on five or more patients with SSc published between 1 January 2000 and the search date evaluating lifestyle interventions, excluding systematic reviews without meta-analyses. Critical appraisal was conducted using critical appraisal tools from the Joanna Briggs Institute. Thirty-six studies were included for full-text evaluation. Results A total of 17 studies evaluated the effect of physical exercise alone, whereas 14 studies evaluated educational interventions for mental health management, often with physical exercise as a central component. At an aggregated level, these studies support patient education and physical exercise for the improvement of physical function, in particular hand and mouth function. Studies on diet and nutrition were few (n = 5) and pertained to gastrointestinal as well as anthropometric outcomes; these studies were insufficient to support any conclusions. Conclusion Physical exercise and patient education should be considered for improving physical function in patients with SSc. These interventions can be provided alongside pharmacotherapy, but there is no evidence supporting that they can be a substitute. Further research should aim at assessing the effects of reductions of harmful exposures, including tobacco smoking and alcohol, improving sleep and enhancing social relations, three hitherto underexplored facets of lifestyle in the context of SSc. Lay Summary What does this mean for patients? For individuals living with systemic sclerosis, a rare autoimmune disease affecting the skin and internal organs, managing symptoms and maintaining quality of life can be challenging. The present systematic review delves into lifestyle interventions, including exercise and dietary changes, aiming to improve patient outcomes. While exercise interventions showed promise in enhancing mobility and overall well-being, evidence regarding dietary modifications was limited. However, combining interventions targeting physical function with various aspects of self-management could further amplify their impact on quality of life. For patients, this research underscores the potential benefits of incorporating tailored lifestyle changes alongside drug treatments. It suggests that regular exercise could alleviate symptoms such