Can exercise help me?

Alongside existing to fund ground-breaking research to understand the causes behind Raynaud's and scleroderma, and to raise awareness of these two conditions, SRUK also functions to empower members of our community. This is by ensuring that they are as well-informed as possible regarding their condition through the information we provide, and by encouraging individuals to try various self-management techniques that will help to maintain a good day-to-day quality of life.

An evident concern of the community revolves around the question of whether they will still be able to do their favourite hobbies and keep working, with an especially prominent worry being if they can remain active. Here at SRUK, we are strong advocates of people living with Raynaud's and scleroderma to continuing to do the things they enjoy; the benefits of exercise are countless for both physical health as well as mental health, however it is essential for anyone with Raynaud's or scleroderma to acknowledge their body's limits, which are often propagated by either condition.

There is an increasing level of research being conducted to examine the effects of exercise in people living with scleroderma. This topic is an area of interest as over 95% of scleroderma cases are associated with microvasculature (large network of arterioles (smallest arteries), capillaries, and venules (smallest veins) in the body) dysfunction, especially in the fingers and toes. The debilitating nature of this symptom can have drastically damaging effects on a person's quality of life, and also tends to result in a higher number of hospital admissions. This can soon spiral into a vicious cycle, as regular hospital visits can be a psychologically stressful experience. Physical activity, in particular aerobic exercise and resistance training, has been demonstrated to improve microvasculature function, and also releases endorphins (hormone produced in the body) which trigger a feeling of positivity that can aid mental health.

One review paper, entitled 'Aerobic and resistance exercise in systemic sclerosis: State of the art', compiled previous studies to exhibit the positive impact exercise can have on people with scleroderma, including increased aerobic capacity, hand mobility, functional ability in daily activities, and an improved health-related quality of life. The effects of high intensity interval training (HIIT) and resistance training (combined exercise) on the microvasculature and blood circulation is yet to be investigated, and reports of the intensity of the exercise programme are yet to be revealed.

Building upon the strong evidence that HIIT and resistance training can improve vasculature function in a wide range of clinical conditions, a team from the Rheumatology Department at Sheffield Hallam University are commencing a study with the purpose of assessing the effects of specifically HIIT and resistance training on microvasculature function in 30 individuals with scleroderma who are receiving treatment. The data from this investigation will be used to explore feasibility of a combined programme and to inform a potential multicentre clinical trial in the future for further observation. To be of most benefit to the community, it is necessary for the feasibility to be understood of an exercise programme that would firstly improve vascular function and potentially reduce the frequency and severity of Raynaud's attacks and ulcers, and secondly to potentially decrease the reliance on pharmacological agents.

The study will focus specifically on the effects of HIIT and resistance training on individuals with scleroderma. There are several definitions to these programmes but according to Nuffield Health, HIIT involves active periods ranging from 30 seconds to 3 minutes working at between 80-100% of your maximum heart rate with recovery periods generally being the same length of time as the active period. Whilst several of the benefits have been exaggerated by the media, one advantage is greater excess post-exercise oxygen consumption, when compared to continuous exercise. This increases metabolism, which means that the body's average temperature is higher.

A typical HIIT session lasts around 20 minutes – here is a typical example:

• Warm up: two minutes at a steady cycle low resistance
• Cycle very hard at 90% effort level for 60 seconds on a high resistance
• Recover for 90 seconds on a low speed and resistance
• Repeat this interval five times in total
• Cool down: two minutes at low resistance
• Repeat three times per week with at least one day recovery in between.

Resistance training focusses more on lifting and pulling against resistance and is more commonly referred to as weight-training. This can involve the use of dumbbells, bodyweight, machines, kettlebells, powerbands or other sources of external resistance. Nuffield Health states that regular resistance training can: decrease the risk of heart disease by lowering blood pressure and body fat and improving cholesterol; improve strength and make everyday tasks easier; and build muscles.

A machine-based training example that may be appropriate for beginners is:

• Perform one set of 15 repetitions on each machine with 45 seconds rest between each exercise.
  • Leg press
  • Seated row
  • Leg extensions
  • Leg curls
  • Lat pulldown
  • Shoulder press
  • Ab crunch
  • Back extension
  • Chest press.

The suggested exercises may not be appropriate for everyone and we recommend that before starting any new exercise regime, you consult with your GP or physiotherapist. We also advise that you talk to a personal trainer at your gym to develop a training regime that is tailored around you, takes into account your scleroderma and/or Raynaud's, and ensures that you are exercising at a level that is most suitable for your body's abilities.

There are a range of measures that an individual with Raynaud's or scleroderma may need to take to ensure that they are not over-exerting themselves and are protecting themselves from Raynaud's attacks – we have further information here.

It is often necessary to try out different approaches, but it is essential to remember that the two conditions can present itself very differently from one person to the next, and so just because something works for someone else does not mean it has to work for you.

Raynaud's and scleroderma should by no means force you to stop doing the things you love, but it is necessary to act within your body's limits and to recognise that you may not be able to be as active as you once were.

We understand that this can be incredibly challenging to acknowledge, but SRUK are here to help you every step of the way.

If you have any questions or are looking for advice, you can contact our helpline volunteers on 08003112756 or email info@sruk.co.uk.

If you are interested in helping SRUK to fund work like this, then please visit our donations page here: https://www.sruk.co.uk/donate/. We rely on the generosity of our community to continue to support groundbreaking research in both scleroderma and Raynaud's.

If you would like information on other treatments for Raynaud's and scleroderma, please visit: https://www.sruk.co.uk/raynauds/managing-raynauds/ and https://www.sruk.co.uk/scleroderma/managing-scleroderma/

An inspiring story of how Sylvia, a member of SRUK's community, managed to keep running after her diagnosis : https://www.sruk.co.uk/about-us/news/sylvias-story-using-diet-and-exercise-thrive-scler/