The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review

Abstract

Background: The anti-inflammatory effect of exercise may be an underlying factor in improving several autoimmune diseases. The aim of this systematic review was to examine the evidence on the role of exercise training in mitigating inflammation in adolescents and adults with autoimmune disease.

Methods: PubMed, Web of Science, and Embase databases were systematically reviewed for related studies published between January 1, 2003, and August 31, 2023. All randomized and non-randomized controlled trials of exercise interventions with autoimmune disease study participants that evaluated inflammation-related biomarkers were included. The quality of evidence was assessed using the Tool for the assEssment of Study qualiTy and reporting in EXercise scale and Cochrane bias risk tool.

Results: A total of 14,565 records were identified. After screening the titles, abstracts, and full texts, 87 were eligible for the systematic review. These studies were conducted in 25 different countries and included a total of 2779 participants (patients with autoimmune disease, in exercise or control groups). Overall, the evidence suggests that inflammation-related markers such as C-reactive protein, interleukin 6, and tumor necrosis factor α were reduced by regular exercise interventions. Regular exercise interventions combined with multiple exercise modes were associated with greater benefits.

Conclusion: Regular exercise training by patients with autoimmune disease exerts an anti-inflammatory influence. This systematic review provides support for the promotion and development of clinical exercise intervention programs for patients with autoimmune disease. Most patients with autoimmune disease can safely adopt moderate exercise training protocols, but changes in inflammation biomarkers will be modest at best. Acute exercise interventions are ineffective or even modestly but transiently pro-inflammatory.

Keywords: Autoimmune diseases; Cytokines; Inflammation; Physical activity; Training.

Graphical abstract

Fig. 1

Flowchart of the search and selection of studies. AS = ankylosing spondylitis; IBD = inflammatory bowel disease; IIMs = idiopathic inflammatory myopathies; JIA = juvenile idiopathic arthritis; MS = multiple sclerosis; PF = pemphigus foliaceus; RA = rheumatoid arthritis; SLE = systemic lupus erythematosus; SSc = systemic sclerosis; T1D = type 1 diabetes; TA = Takayasu arteritis.

Fig. 2

Anti-inflammatory effects of regular exercise on autoimmune diseases. ↑ = increase; ↓ = decrease; CCL = chemokine ligand; CRP = C-reactive protein; IFN-γ = interferon-γ; IL = interleukin; MIP = macrophage inflammatory protein; sICAM = soluble intercellular adhesion molecule; TNF-α = tumor necrosis factor α.