The relevance of applying exercise training principles when designing therapeutic interventions for patients with inflammatory myopathies: a systematic review


Physical exercise seems to be a safe and effective intervention in patients with inflammatory myopathy (IM). However, the optimal training intervention is not clear. To achieve an optimum training effect, physical exercise training principles must be considered and to replicate research findings, FITT components (frequency, intensity, time, and type) of exercise training should be reported. This review aims to evaluate exercise interventions in studies with IM patients in relation to (1) the application of principles of exercise training, (2) the reporting of FITT components, (3) the adherence of participants to the intervention, and (4) to assess the methodological quality of the included studies. The literature was searched for exercise studies in IM patients. Data were extracted to evaluate the application of the training principles, the reporting of and the adherence to the exercise prescription. The Downs and Black checklist was used to assess methodological quality of the included studies. From the 14 included studies, four focused on resistance, two on endurance, and eight on combined training. In terms of principles of exercise training, 93 % reported specificity, 50 % progression and overload, and 79 % initial values. Reversibility and diminishing returns were never reported. Six articles reported all FITT components in the prescription of the training though no study described adherence to all of these components. Incomplete application of the exercise training principles and insufficient reporting of the exercise intervention prescribed and completed hamper the reproducibility of the intervention and the ability to determine the optimal dose of exercise.

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Frequency, intensity, time, and type of exercise


Inclusion body myositis


Inflammatory myopathies


Physical exercise




Randomised controlled trail


Rating of perceived exertion and pain


  1. 1.

    Greenberg SA (2008) Inflammatory myopathies: evaluation and management. Semin Neurol 28(2):241–249. doi:10.1055/s-2008-1062267

    Article  PubMed  Google Scholar 

  2. 2.

    Vincze M, Danko K (2012) Idiopathic inflammatory myopathies. Best Pract Res Clin Rheumatol 26(1):25–45. doi:10.1016/j.berh.2012.1001.1013

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Mastaglia FL, Phillips BA (2002) Idiopathic inflammatory myopathies: epidemiology, classification, and diagnostic criteria. Rheum Dis Clin North Am 28(4):723–741

    Article  PubMed  Google Scholar 

  4. 4.

    Furst DE, Amato AA, Iorga SR, Gajria K, Fernandes AW (2012) Epidemiology of adult idiopathic inflammatory myopathies in a U.S. managed care plan. Muscle Nerve 45(5):676–683. doi:10.1002/mus.23302

    Article  PubMed  Google Scholar 

  5. 5.

    Smoyer-Tomic KE, Amato AA, Fernandes AW (2012) Incidence and prevalence of idiopathic inflammatory myopathies among commercially insured, Medicare supplemental insured, and Medicaid enrolled populations: an administrative claims analysis. BMC Musculoskel Disord 13:103. doi:10.1186/1471-2474-1113-1103

    Article  Google Scholar 

  6. 6.

    Bernatsky S, Panopalis P, Pineau CA, Hudson M, St Pierre Y, Clarke AE (2011) Healthcare costs of inflammatory myopathies. J Rheumatol 38(5):885–888. doi:10.3899/jrheum.101083 (Epub 102011 Mar 101081)

    Article  PubMed  Google Scholar 

  7. 7.

    Furst DE, Amato AA, Iorga SR, Bancroft T, Fernandes AW (2012) Medical costs and health-care resource use in patients with inflammatory myopathies in an insured population. Muscle Nerve 46(4):496–505. doi:10.1002/mus.23384

    Article  PubMed  Google Scholar 

  8. 8.

    Dalakas MC (1991) Polymyositis, dermatomyositis and inclusion-body myositis. N Engl J Med 325(21):1487–1498. doi:10.1056/nejm199111213252107

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (second of two parts). N Engl J Med 292(8):403–407. doi:10.1056/nejm197502202920807

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Horlings CG, van Engelen BG, Allum JH, Bloem BR (2008) A weak balance: the contribution of muscle weakness to postural instability and falls. Nat Clin Pract Neurol 4(9):504–515. doi:10.1038/ncpneuro0886

    Article  PubMed  Google Scholar 

  11. 11.

    Szulc P, Beck TJ, Marchand F, Delmas PD (2005) Low skeletal muscle mass is associated with poor structural parameters of bone and impaired balance in elderly men—the MINOS study. J Bone Miner Res 20(5):721–729 (Epub 2004 Dec 2020)

    Article  PubMed  Google Scholar 

  12. 12.

    Alexanderson H, Lundberg IE (2012) Exercise as a therapeutic modality in patients with idiopathic inflammatory myopathies. Curr Opin Rheumatol 24(2):201–207. doi:10.1097/BOR.0b013e32834f19f5

    Article  PubMed  Google Scholar 

  13. 13.

    Lundberg IE, Vencovsky J, Alexanderson H (2014) Therapy of myositis: biological and physical. Curr Opin Rheumatol 26(6):704–711

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Woods JA, Vieira VJ, Keylock KT (2006) Exercise, inflammation, and innate immunity. Neurol Clin 24(3):585–599. doi:10.1016/j.ncl.2006.03.008

    Article  PubMed  Google Scholar 

  15. 15.

    Gielen S, Adams V, Mobius-Winkler S, Linke A, Erbs S, Yu J, Kempf W, Schubert A, Schuler G, Hambrecht R (2003) Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure. J Am Coll Cardiol 42(5):861–868

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Boström C, Dupré B, Tengvar P, Jansson E, Opava CH, Lundberg IE (2008) Aerobic capacity correlates to self-assessed physical function but not to overall disease activity or organ damage in women with systemic lupus erythematosus with low-to-moderate disease activity and organ damage. Lupus 17(2):100–104. doi:10.1177/0961203307085670

    Article  PubMed  Google Scholar 

  17. 17.

    Mathur N, Pedersen BK (2008) Exercise as a mean to control low-grade systemic inflammation. Mediat Inflamm 2008:109502. doi:10.1155/2008/109502

    Article  Google Scholar 

  18. 18.

    Nader GA, Lundberg IE (2009) Exercise as an anti-inflammatory intervention to combat inflammatory diseases of muscle. Curr Opin Rheumatol 21(6):599–603. doi:10.1097/BOR.0b013e3283319d53

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Perandini LA, de Sa-Pinto AL, Roschel H, Benatti FB, Lima FR, Bonfa E, Gualano B (2012) Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases. Autoimmun Rev 12(2):218–224. doi:10.1016/j.autrev.2012.06.007

    Article  PubMed  Google Scholar 

  20. 20.

    Winters-Stone KM, Neil SE, Campbell KL (2013) Attention to principles of exercise training: a review of exercise studies for survivors of cancers other than breast. Br J Sports Med. doi:10.1136/bjsports-2012-091732

    PubMed  Google Scholar 

  21. 21.

    Campbell KL, Neil SE, Winters-Stone KM (2012) Review of exercise studies in breast cancer survivors: attention to principles of exercise training. Br J Sports Med 46(13):909–916. doi:10.1136/bjsports-2010-082719

    Article  PubMed  Google Scholar 

  22. 22.

    Ammann BC, Knols RH, Baschung P, de Bie RA, de Bruin ED (2014) Application of principles of exercise training in sub-acute and chronic stroke survivors: a systematic review. BMC Neurol 14(1):167. doi:10.1186/s12883-014-0167-2

    PubMed Central  Article  PubMed  Google Scholar 

  23. 23.

    Habers GE, Takken T (2011) Safety and efficacy of exercise training in patients with an idiopathic inflammatory myopathy: a systematic review (provisional abstract). Rheumatology 50(11):2113–2124

    Article  PubMed  Google Scholar 

  24. 24.

    Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D et al (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348:g1687

    Article  PubMed  Google Scholar 

  25. 25.

    Hoffmann J (2002) Physiological aspects of sport training and performance. Human Kinetics, Champaign

    Google Scholar 

  26. 26.

    Reimer DJ (1998) Physical fitness training. In: Field manual no 21-20: 241. US-Army, Washington, DC

    Google Scholar 

  27. 27.

    Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 63(8):834–840

    Article  PubMed  Google Scholar 

  28. 28.

    Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, Petticrew M, Altman DG (2003) Evaluating non-randomised intervention studies. Health Technol Assess 7(27):iii–x, 1–173

  29. 29.

    Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  30. 30.

    Schoene D, Valenzuela T, Lord SR, de Bruin ED (2014) The effect of interactive cognitive-motor training in reducing fall risk in older people: a systematic review. BMC Geriatr 14:107. doi:10.1186/1471-2318-14-107

    PubMed Central  Article  PubMed  Google Scholar 

  31. 31.

    Hegenscheidt S, Harth A, Scherfer E (2010) PEDro-Skala. Accessed 7 Aug 2015

  32. 32.

    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. doi:10.1371/journal.pmed.1000100

    PubMed Central  Article  PubMed  Google Scholar 

  34. 34.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012. doi:10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  35. 35.

    Alemo Munters L, Dastmalchi M, Andgren V, Emilson C, Bergegård J, Regardt M, Johansson A, Orefelt Tholander I, Hanna B, Lidén M, Esbjörnsson M, Alexanderson H (2013) Improvement in health and possible reduction in disease activity using endurance exercise in patients with established polymyositis and dermatomyositis: a multicenter randomized controlled trial with a 1-year open extension followup. Arthritis Care Res 65(12):1959–1968. doi:10.1002/acr.22068

    Article  Google Scholar 

  36. 36.

    Alemo Munters L, Dastmalchi M, Katz A, Esbjörnsson M, Loell I, Hanna B, Lidén M, Westerblad H, Lundberg IE, Alexanderson H (2013) Improved exercise performance and increased aerobic capacity after endurance training of patients with stable polymyositis and dermatomyositis. Arthritis Res Ther 15(4):R83

    PubMed Central  Article  PubMed  Google Scholar 

  37. 37.

    Alexanderson H, Alemo Munters L, Dastmalchi M, Loell I, Heimburger M, Opava CH, Lundberg IE (2014) Resistive home exercise in patients with recent-onset polymyositis and dermatomyositis—a randomized controlled single-blinded study with a 2-year followup. J Rheumatol. doi:10.3899/jrheum.131145

    Google Scholar 

  38. 38.

    Alexanderson H, Dastmalchi M, Esbjornsson-Liljedahl M, Opava CH, Lundberg IE (2007) Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis. Arthritis Rheum 57(5):768–777. doi:10.1002/art.22780

    Article  PubMed  Google Scholar 

  39. 39.

    Alexanderson H, Stenstrom CH, Jenner G, Lundberg I (2000) The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis. Scand J Rheumatol 29(5):295–301

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Alexanderson H, Stenstrom CH, Lundberg I (1999) Safety of a home exercise programme in patients with polymyositis and dermatomyositis: a pilot study. Rheumatology (Oxford) 38(7):608–611

    CAS  Article  Google Scholar 

  41. 41.

    Arnardottir S, Alexanderson H, Lundberg IE, Borg K (2003) Sporadic inclusion body myositis: pilot study on the effects of a home exercise program on muscle function, histopathology and inflammatory reaction. J Rehabil Med 35(1):31–35

    Article  PubMed  Google Scholar 

  42. 42.

    Chung YL, Alexanderson H, Pipitone N, Morrison C, Dastmalchi M, Stahl-Hallengren C, Richards S, Thomas EL, Hamilton G, Bell JD, Lundberg IE, Scott DL (2007) Creatine supplements in patients with idiopathic inflammatory myopathies who are clinically weak after conventional pharmacologic treatment: six-month, double-blind, randomized, placebo-controlled trial. Arthritis Rheum 57(4):694–702. doi:10.1002/art.22687

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Dastmalchi M, Alexanderson H, Loell I, Stahlberg M, Borg K, Lundberg IE, Esbjornsson M (2007) Effect of physical training on the proportion of slow-twitch type I muscle fibers, a novel nonimmune-mediated mechanism for muscle impairment in polymyositis or dermatomyositis. Arthritis Rheum 57(7):1303–1310. doi:10.1002/art.22996

    Article  PubMed  Google Scholar 

  44. 44.

    Heikkilä S, Viitanen JV, Kautiainen H, Rajamäki T, Mäntyvuo P, Harju T (2001) Rehabilitation in myositis: preliminary study. Physiotherapy 87(6):301–309

    Article  Google Scholar 

  45. 45.

    Johnson LG, Collier KE, Edwards DJ, Philippe DL, Eastwood PR, Walters SE, Thickbroom GW, Mastaglia FL (2009) Improvement in aerobic capacity after an exercise program in sporadic inclusion body myositis. J Clin Neuromuscul Dis 10(4):178–184. doi:10.1097/CND.0b013e3181a23c86

    Article  PubMed  Google Scholar 

  46. 46.

    Johnson LG, Edwards DJ, Walters S, Thickbroom GW, Mastaglia FL (2007) The effectiveness of an individualized, home-based functional exercise program for patients with sporadic inclusion body myositis. J Clin Neuromuscul Dis 8(4):187–194

    Article  Google Scholar 

  47. 47.

    Spector SA, Lemmer JT, Koffman BM, Fleisher TA, Feuerstein IM, Hurley BF, Dalakas MC (1997) Safety and efficacy of strength training in patients with sporadic inclusion body myositis. Muscle Nerve 20(10):1242–1248

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Varju C, Petho E, Kutas R, Czirjak L (2003) The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis. Clin Rehabil 17(1):83–87

    Article  PubMed  Google Scholar 

  49. 49.

    Wiesinger GF, Quittan M, Aringer M, Seeber A, Volc-Platzer B, Smolen J, Graninger W (1998) Improvement of physical fitness and muscle strength in polymyositis/dermatomyositis patients by a training programme. Br J Rheumatol 37(2):196–200

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Wiesinger GF, Quittan M, Graninger M, Seeber A, Ebenbichler G, Sturm B, Kerschan K, Smolen J, Graninger W (1998) Benefit of 6 months long-term physical training in polymyositis/dermatomyositis patients. Br J Rheumatol 37(12):1338–1342

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    Alexanderson H, Bergegård J, Björnådal L, Nordin A (2014) Intensive aerobic and muscle endurance exercise in patients with systemic sclerosis: a pilot study. BMC Res Notes 7(1):86

    PubMed Central  Article  PubMed  Google Scholar 

  52. 52.

    Borg G (1998) Borg’s rating of perceived exertion and pain scales. Human Kinetics, Champaign

    Google Scholar 

  53. 53.

    Scherr J, Wolfarth B, Christle JW, Pressler A, Wagenpfeil S, Halle M (2013) Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity, pp 1439–6327 (electronic)

  54. 54.

    Allender S, Cowburn G, Foster C (2006) Understanding participation in sport and physical activity among children and adults: a review of qualitative studies, pp 0268–1153 (print)

  55. 55.

    van de Mortel TF (2008) Faking It: social desirability response bias in self-report research. Aust J Adv Nurs 25(4):40–48

    Google Scholar 

  56. 56.

    Russell TG (2007) Physical rehabilitation using telemedicine. J Telemed Telecare 13(5):217–220. doi:10.1258/135763307781458886

    Article  PubMed  Google Scholar 

  57. 57.

    Silveira P, van de Langenberg R, van Het Reve E, Daniel F, Casati F, de Bruin ED (2013) Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: a phase II preclinical exploratory trial. J Med Internet Res 15(8):e159. doi:10.2196/jmir.2579

    PubMed Central  Article  PubMed  Google Scholar 

  58. 58.

    Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. Accessed 10 Jan 2014

  59. 59.

    Hulley SB, Cummings S, Browner WS, Grady DG, Newman TB (2007) Designing clinical research. Lippincott Williams and Wlkins, Philadelphia

    Google Scholar 

  60. 60.

    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    PubMed Central  Article  PubMed  Google Scholar 

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The authors thank Martina Gosteli for performing the search strategy. Further thanks goes to Dr. Martin Watson for proof reading the manuscript on English and structure.

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Correspondence to Pierrette Baschung Pfister.

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Baschung Pfister, P., de Bruin, E.D., Tobler-Ammann, B.C. et al. The relevance of applying exercise training principles when designing therapeutic interventions for patients with inflammatory myopathies: a systematic review. Rheumatol Int 35, 1641–1654 (2015).

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  • Myositis
  • Inflammatory myopathy
  • Aerobic exercise
  • Resistance training
  • Training principles
  • Training components