Effects of interventions with resistance exercises on muscle strength, physical disability, and quality of life in systemic sclerosis patients: a systematic review with meta-analysis.

Abstract

Introduction: Systemic sclerosis (SSc) often leads to decreased muscle strength and mass, impairing physical performance and causing disability. Interventions with resistance exercise (RE) is an effective non-pharmacological approach to mitigate these issues. This systematic review aims to evaluate the effects of interventions with RE on muscle strength, muscle mass, physical performance, physical disability, and quality of life (QOL) in SSc patients, as well as to assess its adherence and safety.

Methods: A systematic review and meta-analysis were conducted based on a PICOS framework: Patient = Systemic Sclerosis; Intervention = Resistance exercise; Study design = Randomized clinical trials. Searches were performed across MEDLINE (PubMed), PMC, Web of Science, Cochrane Library, LILACS, and EMBASE up to January 2025.

Results: Ten randomized clinical trials, including 422 participants (~85% female), were eligible for analysis. Participants' ages ranged from 42 to 64 years, with body mass indices between 22.5 and 28.0 kg/m². The intervention period was standardized to 12 weeks. Interventions with RE significantly improved muscle strength (SMD = 2.76 kg; 95% CI, 1.32 to 4.20; p = 0.0002) and functional disability (SMD = -0.47; 95% CI, -0.93 to -0.00; p = 0.05) compared to controls. Interventions with RE also showed superiority in the physical component of QOL (SMD = 0.42; 95% CI, 0.04 to 0.81; p = 0.03). Although enhanced physical performance was observed, statistical pooling was not possible due to limited data. Interventions with RE had a low incidence of adverse events, but data on disease progression and adherence were insufficient.

Conclusion: Interventions with RE benefits muscle strength, physical function, and QOL in SSc patients, though optimal protocols and adherence strategies need further investigation. More robust studies are required to refine training methods and enhance clinical trial designs.