Exercise and
Scleroderma
Deb Kegelmeyer PT, DPT, MS, GCS
Associate Professor Health and Rehabilitation Sciences
Ohio State University
Exercise, Activity and
Scleroderma

Exercise is important for health and well being for
everyone

Individuals with health conditions such as scleroderma
can be at increased risk of health conditions such as
heart disease, obesity and diabetes if they do not
remain active.

Inactivity also leads to loss of function and loss of
independence

Exercise is safe for those with scleroderma if modified
based on your own individual strengths and weaknesses
Being active improves:

Range of motion of the joints

Ability to walk

Ability to get in and out of chairs, cars, bed and
bathtubs

Stiffness and decreases pain

Endurance

Sleep

Eating and bowel and bladder function

mood
What about pain and
stiffness?

Pain and stiffness can make exercise and daily activity
difficult

There are ways to decrease pain and stiffness before
and during exercise

Heat

Water

massage
Wax or Paraffin Baths

Application of wax to the hands and
feet has been found to be beneficial
by some patients.

Attention to the temperature of the
wax is vital.

The oils in the wax and the warmth
serve as a useful preparation for
exercise.

Wax can be applied daily and can be
used with care in the home.
The Effect of Paraffin and Exercise on Hand
Function in Persons with Scleroderma:A Series of
Single Case Studies. J HAND THER. 2009;22:71e78.
The use of heat can assist in
preparing muscles for exercise
and is a modality much favored
by patients with scleroderma.
Hot water bottles and
electrically heated pads are
useful.
However, a hot bath or
shower is also beneficial.
Hydrotherapy
(water therapy) is
recommended.

Some patients find the temperature of pool
water is cool and can lead to an attack of
Raynaud’s.

If a pool of suitable temperature is
available, swimming and exercise in water
may help to preserve range of motion, as
well as preventing decrease in lung volume.
Look for a pool that advertises water
therapy for arthritis.

You should watch for fatigue and all
activities must be tailored to your exercise
tolerance.
Massage

People find massage soothing and some therapists may
use aromatherapy oils to assist.

Massage of the skin will help to mobilize stiff tissue as
well as having a beneficial effect on the circulation and
nutrition of the skin.
Self Massage

Teaching patients to massage themselves helps to increase
independence and control.

Face and hand massage are good for decreasing pain and
improving tissue mobility

Alternatively a partner could assist.

Hand: https://www.youtube.com/watch?v=6wUWDlfSQN8

Face: https://www.youtube.com/watch?v=V4ANcs7oh9s
Exercises, stretches and massage
for hands, face and feet are
essential.

Several studies showed that a combination of exercise
and massage improved function in the

Face

Hands

Stretching was included as a part of all exercise
programs to maintain flexibility

For the face stretching and active exercise are the same
exercises

For hands stretching should be augmented by squeezing
putty or a ball to improve both mobility and strength.
All joints and
muscle groups
should be
incorporated.
https://ahc.aurorahealthcare.org/fywb/X18006.pdf
Exercise for the lungs and the respiratory
muscles should also be taught
concentrating on lung expansion.
Incentive Spirometer
Available at www.amazon.com
Breathing exercises

Use incentive inspirometer

10 deep breaths, slowly exhale

Practice blowing as though trying to blow out a lot of
birthday candles all at once. Can use a feather or piece
of paper to blow on, try to make it move. Or try to
make a light weight object move across a table by
blowing on it.
Stretches to maintain and
improve flexibility of the chest
are necessary for adequate
breathing
Aerobic activities to induce
deeper breathing could be
suggested, e.g. swimming and
walking.
Aerobics

Some individuals with Scleroderma also develop
pulmonary hypertension.

If you have difficulty exercising, get short of breath
easily or have had a change in your ability to exercise
you should see your physician before starting or
changing your exercise routine.

There are few studies but there is some indication that
individuals with pulmonary hypertension and
scleroderma can tolerate a program of exercise using a
stationary bike 45 minutes 3 times a week.
Good sample exercise
program

http://www.move.va.gov/docs/NewHandouts/PhysicalA
ctivity/P33_SampleFlexibilityProgramForBeginners.pdf
Referral to an occupational
therapist may be appropriate for
some patients.

Splinting to prevent deformity has never been
proven to be useful, but it may be helpful in
assisting activities. The occupational therapist can
also advise the patient about pacing of activities
to preserve energy and any adaptations and
gadgets to preserve independence.
Digisplint