. 2024 Jun 5;17:3563–3585. doi: 10.2147/JIR.S377102

Table 1.

Exercise Effects on Physiological, Physical and Psychological Health Outcomes in Adult Non-IBM IIM

Study/design	Diagnosis/ Patients, n/ Disease Activity/ HCs, n	Exercise Duration, Intensity, Frequency	Physiological (Disease activity, Inflammation,	Physical	Psychological
RESISTANCE TRAINING
Escalante et al 1993⁷⁰ Open study	PM, DM Active n = 5	Dynamic and ROM 8 weeks NR	CK: 0	Muscle strength: +	NA
Alexanderson et al 1999⁷¹ Open study	PM, DM Established n = 10	Dynamic, home- based 12 weeks NR 5 d/week	CK: 0 MRI: 0 Biopsy: 0	Muscle endurance: +	QoL, SF-36: PF: + RP: +
Dastmalchi et al 2007⁶⁶ Open study (same exercise protocol as Alexanderson⁷¹)	PM, DM n = 9 Established HC n = 11	Resistance, home exercise 12 weeks 5 d/week	Fibre type Pre-exercise: Pts fewer type 1 fibres vs HCs (P < 0.05) Post-exercise: Pts more type 1 fibres vs baseline (P < 0.05) CSA Pts–HC: 0 Post-exercise: Type 1 increased Type 2 increased (P < 0.05)	NA
Alexanderson et al 2000⁷² Open study	PM, DM Active n = 11	Dynamic, home based 12 weeks NR 5 d/week	CK: 0 MRI: 0 CD3+ T-cell: 0	Muscle endurance +	QoL: PF + BP + V +
Heikkilä et al 2001⁷³ Open study	PM, DM, IBM Established n = 22	Dynamic 3 weeks NR	CK: 0	Muscle endurance + Grip strength 0 Pain 0	ADL: 0
Varju et al 2003⁷⁴ Open study	PM, DM Established, active n = 19	Dynamic 3 weeks NR 5 d/week	CK: 0	Muscle strength: + FVC: + Fatigue: + Pain 0	NA
Alexanderson et al 2007⁷⁵ Open, repeated measures	PM, DM Established n = 8	Dynamic 7 weeks 10 VRM (70% of max) 3 d/week	6-item core set Resp: n = 2 MITAX: + CD3+ T-cell: 0	Muscle strength: +^a,b,c Muscle endurance: +^a,d	ADL: 0
Nader et al 2010¹⁷ Open study (same protocol as Alexanderson⁷⁶)	PM, DM Established n = 8	Same as () Dynamic 7 weeks 10 VRM (70% of max) 3 d/week	Biopsy, mRNA expression 34 pro-inflammatory genes downregulated (−1.5 to −3.5 fold) (p<0.04–0.003) Biopsy, mRNA expression 3 pro-oxidative metabolism genes upregulated (+1.6 to +1.8 fold) (p<0.04–0.005) 4 pro-lipid synthesis genes downregulated (−1.5 to −2.6 fold) (p<0.02–0.008) 22 pro-fibrotic genes downregulated (−1.5 to −3.7 fold) (p<0.4–0.004) 3 anti-fibrotic genes upregulated (+1.5 to +2.7 fold) (p<0.04–0.02)	NA
Chung et al 2007²⁸ RCT, double-blind	PM, DM Established n = 37 CrG n = 19 PlacG n = 18	Dynamic, home based 20 weeks NR 5 d/week	CK: 0% change in PCr/β-NTP ratio EG-CG: +	Physical capacity EG-CG + Muscle strength EG-CG + Muscle endurance EG-CG + Pain 0	QoL: Depression: 0
Mattar et al 2014⁷⁷ Open study	PM, DM Established n = 13	Dynamic, vascular occlusion 12 weeks 30% of max 2 d/week	Phys Global VAS: + Pat Global VAS: + CK, Ald: 0 CSA +4.5%	Muscle strength + Phys cap +	QoL: All SF-36 domains + (including MH) ADL: +
Regardt et al 2014⁷⁸ Open study	PM, DM Established n = 11	Dynamic, home-based hand exercise 12 weeks 3 d/week	CK: 0	Pinch grip strength: + Grip strength: 0	ADL: 0
Spiritovic M, et al 2021⁷⁹ RCT	PM, DM established disease n=53 EG n=30 CG n=23	EG: 24 weeks, supervised. Once a week: 40 min of daily activity training, Once a week, 30 min resistance and stability training CG: No intervention	EG: TNF+ Trend IL1β - Trend MCP-1 - CG: TNF+ IL1bβ: – EG and CG: CK, LD 0 EG: Local mRNA TNF+ IL1bβ, IL-6, IL-8, MCP-1: 0	Muscle strength and endurance EG-CG: + EG-CG: Force vector area + ECM/BCM +	Depression EG-CG+ EG and CG: QoL 0 EG and CG: Fatigue 0 ADL EG-CG+
Svec X et al 2022²⁵ (Same exercise protocol as Spriritovic⁷⁹)	PM, DM Established disease n=70 EG n=27 CG n=25 HC n=18	EG: 24 weeks, supervised. Once a week: 40 min of daily activity training, Once a week, 30 min resistance and stability training CG: No exercise HC-strenuous exercise	Plasma Hsp90 EG-CG: + EG: 0 (stabilizing) CG: 0	NA	NA
AEROBIC EXERCISE ALONE OR IN COMBINATION WITH RESISTANCE TRAINING
Wiesinger et al 1998⁸⁰ RCT	PM, DM Established n = 14 EG n = 7 CG n = 7	Aerobic, stationary cycling + step-up class 6 weeks 60% VO_2max 2–3 d/week	CK: 0	Aerobic capacity EG-CG: + Muscle strength EG-CG: +	ADL EG-CG: +
Wiesinger et al 1998⁸¹ CT	PM, DM Established n = 13 EG n = 7 CG n = 6	Aerobic, stationary cycling + step-up class 24 weeks 60% of VO_2max 1–2 d/week	CK: 0	Aerobic capacity EG + / CG 0 Muscle strength EG + / CG 0	ADL EG: + CG: 0
Alemo Munters et al 2013⁴² RCT, 1-year open extension	PM, DM Established n = 23 EG n = 12 CG n = 11 HCs n = 12	EG: Aerobic, stationary cycling + resistance, dynamic (home based and hospital) 12 weeks 70% of VO_2max, 30–40 VRM 3 d/week CG: non exercising	6-item core set EG: Resp. n = 7 CG: Resp. n = 0 CD3+T cell: 0	Aerobic cap: EG-CG: + Muscle strength: EG-CG: +	Patient preference EG: + ADL EG-CG: + QoL EG-CG: +
Alemo Munters et al 2013⁶⁷ RCT	PM, DM Established n = 21 EG n = 11 CG n = 10 HCs n = 12	(Same exercise protocol as Alemo Munters⁵³)	6-item core set EG: Resp. n = 6 CG: Resp. n = 0 Lactate levels EG-CG: +	Biking endurance: EG-CG: +	NA
Munters LA et al 2016,¹⁶ RCT (same exercise protocol as Alemo Munters⁴²)	PM, DM Established n = 15 EG n = 7 CG n = 8	NA	Gene expression EG: 5 genes (ER-stress) down-reg: + (- 1.3 to −2.6 fold) 12 genes (remodeling/hypertrophy) up-reg: + (1.1 to 4.3 fold) 11 genes (mitochondrial biogenesis/protein synthesis) Up-reg: + (1.1 to 1.2 fold) CG: 4 genes (apoptosis) up-reg: - (1.1 to 1.6 fold) 6 genes (protein synthesis/immune remodeling) down-reg: - (−1.1 to −1.6 fold)	NA	NA
Alexanderson et al 2014⁷⁶ RCT, 2-year open extension	PM, DM Active n = 19 EG n=10 CG n=9	Resistance, home-based + aerobic, outdoor walking 12 weeks, NR, 50–70% of predicted max HR, 5 d/week	CPK Pre-exercise: 0 24 w: 0 52 w: EG-CG + 104 w: 0 CD-3+ T-cell EG: 0 CG: 0	Muscle endurance: EG: +, CG: + Aerobic cap: EG: +, CG: +	NHP EG-CG: 0 EG: + Energy CG: + Sleep
Boehler J et al 2017⁶⁸ Subset from a RCT (Same exercise protocol as Alemo Munters⁴²)	PM, DM Established n=6 EG n=3 Performed intensive aerobic and andurance-based resistance training, 3d/week, see ref 22 above. CG n=3 Non-exercising	EG: Aerobic, stationary cycling + resistance, dynamic (home based and hospital) 12 weeks 70% of VO_2max, 30–40 VRM 3 d/week CG: non exercising	Transcriptional regulation + ↓PEDF signaling, ↓protein kinase signaling ↓glucocorticoid receptor signaling Protein level + ↓oxidative stress, ↑ mitochondrial biogenesis ↑muscle remodeling These together indicate: ↓immune response, ↑aerobic metabolism ↓muscle atrophy	NA	NA
Boehler J et al 2019⁶⁹ Subset from a RCT (same exercise protocol as Alemo Munters⁴²)	PM, DM Established n=3 (All from EG in ref 22)	Aerobic, stationary cycling + resistance, dynamic (home based and hospital) 12 weeks 70% of VO_2max, 30–40 VRM 3 d/w	Downregulation of mitochondrial damage protein Harakiri + and TLR7 +	NA	NA
de Souza JM et al 2019⁸² Open study	IMNM Established n=8	Resistance training (supervised) 12 weeks 8–12 RM in 3 sets Aerobic exercise, moderate-intensity treadmill walking/running. 30–50 minutes	6-item core set: 0 (PGA, patient VAS, MMT, HAQ, MYOACT, CPK)	Muscle strength: + Aerobic capacity: 0 (VO_2max) (time to anaerobic threashold, time to exhaustion and time to respiratory compensation point +)	NA
de Oliveria et al 2019³¹ Open study	PM, DM, ASS Established n=9	Resistance training (supervised) 12 weeks 8–12 RM, Aerobic exercise, moderate-intensity treadmill walking/running. 30–50 minutes	6-item core set: 0 (PGA, patient VAS, MMT, HAQ, MYOACT, CPK) ↓ Muscle fat mass + ↓ Body fat mass + Blood lipids 0 Glucose, mg/dL 0 ↓ Insulin, Ul/mL + ↓ C-peptide mg/dL +	Muscle strength + Aerobic capacity VO₂_max (+) Time to exhaustion + Time to RCP +
Tiffreau V et al 2017⁸³ RCT	PM Established n=21 EG n=10 CG n=11	EG: 4-week in-hospital rehab: Resistance training (60% / 1RM) daily in 2 sets. Aerobic exercise, (60% of est. VO_2max) 3 d/week. Inspiratory/expiratory breathing exercise, 30-min walking, ROM exercise Home exercise with parts of above rehab program daily. CG: prescription of 30 min physical therapy 3 d/week.	Muscle strength 12 mo MMT 0–5 Right side 0 Left side + Isokinetic torque 0 Pain 12 mo +	CPK 0 CRP 0	HAQ-DI ADL 12 mo EG-CG + QoL SF-36 at 12 mo EG-CG RP + GH + At 1 mo EG-CG V + RE + PF 0 BP 0 SF 0 MH 0

Notes: +, statistically significant within-group improvement; 0, no statistically significant change/no statistically significant difference between groups; -, statistically significant within-group worsening, (+ %); change in percentage without statistical analysis. ^aNo significant changes between −4 weeks and baseline in any of the measures; ^bsignificant improvement in deltoids, quadriceps, gastrocnemius, abdominal muscle groups, but not in biceps/latissimus dorsii; ^call eight participants improved >20% (defined as clinically relevant change); ^dimproved significantly in shoulder flexion task, but not in other muscle groups.

Abbreviations: ADL, Activities of daily living; AFPS, aggregate functional performance score; CK, creatine phosphokinase; CSA, cross-sectional area; CT, controlled trial; d/week; days/week; DM, dermatomyositis; ECM/BCM, extracellular mass to body cell mass ratio; EG-CG +, statistically significant improvement in EG vs CG; FVC, forced vital capacity; HAQ, Health Assessment Questionnaire; HC, healthy control; HR, heart rate; IBM, inclusion body myositis; IL1β, interleukin 1-beta; LD, lactodehydrogenase; MCP-1, Monocyte chemoattractant protein 1; MITAX, Myositis Intention to treat activity index; MMT-8, MMT 8 muscle groups; mRNA, messenger RNA; NA, not assessed; NHP, Nottingham Health Profile; NR, not reported; PM, polymyositis; Phsp90, plasma heat shock protein 90; Pts, patients; RCP, respiratory compensation point; RCT, randomized controlled trial; max, maximum; Resp., responder; RM, repetition maximum; ROM, range of motion; SF-36, Short Form 36; SF-36 PF, Physical Function; GH, General Health; V, Vitality; MH, Mental Health; PSC, SF-36 Physical composite score; MSC, SF-36 Mental composite score; TNF, Tumor Necrosis Factor; VAS, visual analogue scale; VO_2max, maximal oxygen uptake; VO_2peak, peak oxygen uptake; VRM, voluntary repetition maximum.