Regular Exercise IS Anti-Inflammatory

Hello There Rheumatology Fans

The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review

Whoop-de-doo this article title has a lot for me to enjoy in it. I am going to get into as much detail as I can on this and what it means for our practice so strap in.

What To Expect In This Article

• Introduction (free)

• Exercise For Autoimmune Diseases - Particularly “Auto-inflammatory Arthritis”

• Variety Is The Spice Of Life

• Allow The Person To Take The Power Back

• Acute Affects

• Further Learning Resources

Introduction

Lets start with an overview of what they did for this article publication before we get into it because it is important we understand that to interpret all this appropriately.

The “20 year” part relates to the time duration they searched within, specifically January 1, 2003, and August 31, 2023. I already saw someone mistake this that they investigated exercises over a 20 year period. No. Its when the studies they looked at were published!

The authors search came up with a whopping 14565 articles which through a screening process (they read at least the title of every single one - wow) they got this down to 87 that they could include in a systematic review. The total number of patients included in all these studies combined was 2779 which is a good number.

I am no statistician but the systematic review process combines this data as best possible to increase the number of reference points for each outcome. In this case inflammation related biomarkers (CRP, interleukin-6, TNF-a).

SO WHAT

Ok, so the aim of this is to try and answer the question “Is exercise anti-inflammtory in autoimmune diseases”? This is important because most effective treatment in these conditions is pharmacological, everything else can help but is of modest effect and is kind of assumed to a degree because it is unethical to withhold the medicine from people. This means we need big numbers to see the small changes that might occur.

Exercise has always been promoted in these diseases and having more data to support it is great, this supports our decision making. It importantly needs to not be pro-inflammatory or we might be counter-acting the other treatments!

What Did They Find?

The headline finding is that exercise is anti-inflammatory in those with autoimmune disease which is great! This needs to be regularly engaged with and akin to a lifestyle change - more on that later.

Changes in biomarkers will be modest at best, so exercise is certainly no replacement for Pharmacological management but should be seen as an adjunct.

Of great interest to me was the finding regarding acute exercise interventions which showed no change or slight pro-inflammatory effects although these were transient.

What Remains Unclear?

There were not studies available for all autoimmune diseases so we do need to be cautious when extrapolating but I am fairly confident we can on a general level assume that these diseases will react roughly the same to exercise.

Moderate exercise programs seem to be the ones most commonly tested and so we are on steady ground here. We know less about high intensity exercise. Having said that there are studies in Rheumatoid Arthritis with a good safety profile with high intensity and again I am happy to extrapolate to other diseases. The main lack of clarity is around whether high intensity is MORE effective than moderate or low. My current best guess is that it wont be sufficiently bette rto recommend it OVER moderate or low intensity and the much more important factor is regularity.

CLINICAL IMPACT

I know why you are all here and it is not my very rudimentary understanding of statistics.

Exercise For Autoimmune Diseases - Particularly “Auto-inflammatory Arthritis”