Patients With Scleroderma Report Health-Related Barriers to Physical Activity

man exercising on elliptical in gym
man exercising on elliptical in gym
Researchers identified physical activity barriers and facilitators among patients with scleroderma.

Patients with scleroderma report facing many health and medical-related barriers to physical activity; however, they report facilitators to staying physically active despite these barriers, according to study results published in Disability and Rehabilitation.

According to the researchers, patients with scleroderma often have difficulties in remaining physically active because of the manifestations of the disease, including the skin, musculoskeletal system, and internal organs.

The study included 41 patients with scleroderma (median age, 60 years; 34 women) enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort. Researchers elicited responses from groups of patients with scleroderma and created a list of barriers to physical activity, as well as general and barrier-specific facilitators. Patients then rated the importance of barriers and their experience or likelihood of using the facilitators on a scale from 0 (no importance/ no experience/ no likelihood) to 10 (extremely important barrier or facilitator for exercise).

A total of 9 nominal group sessions resulted in an initial list of 181 physical activity barriers, 457 barrier-specific facilitators, and 20 examples of general facilitators experienced by patients. Based on a qualitative content analysis, the researchers grouped the barriers into 4 categories: health and medical; social and personal; time, work, and lifestyle; and environmental. Of the 20 barriers included in the final list of items, 14 (70%) were health and medical barriers, which addressed symptoms like fatigue, as well as medical conditions, for eg, Raynaud’s phenomenon, and activity restrictions.

Among the 61 health and medical barrier-specific facilitators, most facilitators involved strategies to beginning and selecting physical activities, adapting the conduct of activities, adjusting the intensity and duration of activities using adapted equipment or other materials to reduce discomfort, and health behaviors to reduce the effect of the barriers. Of the total barriers, 20% involved social or personal factors, including fear of injury, feeling embarrassed or discouraged due to physical ability, appearance, or judgment from others. Of the 23 social and personal barrier-specific facilitators, most facilitators included methods to feel comfortable with physical activity. There was 1 time, work, and lifestyle-related barrier regarding finding time to exercise, and 3 related facilitators, including exercising at home or work to reduce travel time. Researchers also observed 1 environmental barrier associated with access to physical activity opportunities, with 4 facilitators.

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Overall, 15 barriers, 69 barrier-specific facilitators, and 9 general facilitators received at least one-third of ratings ≥8 for importance or likelihood of using facilitators; 1 barrier, 60 barrier-specific facilitators, and 9 general facilitators received at least 50% of ratings ≥8.

Study limitations included the fact that this was a small qualitative study, which enrolled participants from scleroderma patient conferences and may not be representative of all patients with scleroderma. In addition, in contrast to the larger SPIN cohort from which patients were enrolled, a larger proportion of this study’s participants had the diffuse scleroderma subtype.

“Previous studies have not elicited facilitators to address scleroderma-specific problems; therefore barrier-specific facilitators identified in the present study will be useful for patients and rehabilitation therapists who are searching for effective strategies to address these barriers,” the researchers concluded.


Harb S, Cumin J, Rice DB, et al. Identifying barriers and facilitators to physical activity for people with scleroderma: A nominal group technique study [published March 19, 2020]. Disability Rehab. doi:10.1080/09638288.2020.1742391