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

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.
I.P. has received grants from the Swedish RheumatismAssociation (R-969696), King Gustaf V’s 80-yearFoundation (FAI-2020–0741), Swedish Society of Medicine(SLS-974449), Nyckelfonden (OLL-974804), ProfessorNanna Svartz Foundation (2021-00436), Ulla and RolandGustafsson Foundation (2021-26), Region Stockholm (FoUI-955483) and Karolinska Institutet. C.B. has received grantsfrom the Swedish Rheumatism Association and Norrbacka-Eugeniastiftelsen.