300 Section - Safety and Impacts of Physical Activity for Individuals Living with Hypermobility Spectrum Disorders and Hypermobile Ehlers-Danlos Syndrome: A Scoping Review

Objectives : Many individuals with Hypermobility Spectrum Disorders (HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS) have difficulties participating in physical activity (PA) due to acute injury risk, fear of injury, chronic pain, and fatigue. Although there is reasonable evidence for therapeutic exercise in managing the symptoms of HSD/hEDS, the safety and magnitude of effect of structured (individual or group exercise or sports) and unstructured (play or household activities) PA in this population remains unclear. This scoping review aims to summarize existing evidence in these domains.

Design: MEDLINE, Embase, CINAHL, Scopus and SportDiscus were searched for primary journal articles. Studies specific to PA and individuals of any age with HSD/hEDS were included. Studies exploring PA in combination with other therapeutic modalities were excluded. Independent full-text screening and extraction were performed using Covidence. PA safety was defined as frequency and types of adverse events. The International Classification of Functioning, Disability and Health was utilized to summarize PA effects.

Results: Of 3,718 citations identified, 2,026 duplicates were removed, 1692 articles were screened, and 57 articles were included for data extraction. Structured PA included resistance exercises, dance, and cycling. Unstructured PA included time spent doing basic and instrumental activities of daily living. Three cross-sectional studies reported on PA safety. Two of 12 participants experienced dyspnea during cycling. Sixty-one of 85 participants experienced ≥1 musculoskeletal injury during dance. Resistance exercise generally improved joint pain (3 studies) and proprioception (4 studies) for adults with HSD/hEDS.

Conclusion: Although PA has been reported to result in some adverse events in people with HSD/hEDS, structured PA seems to have benefits for pain and proprioception. Future research should explore quality of evidence for different types of PA in HSD/hEDS, and whether people with HSD/hEDS have higher risk of adverse events with specific types of PA compared to the general population in a direct comparison study.