Mediterr J Rheumatol 2021;32(4):378-85
Position Statement on Exercise Dosage in Rheumatic and Musculoskeletal Diseases: The Role of the IMPACT-RMD Toolkit
Authors Information

1. School of Physical Education, Sport Science and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, Greece
2. Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, United Kingdom
3. Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom
4. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
5. Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
6. Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
7. Centre for Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
8. Department of Physical Education and Sport Science, University of Thessaly, Karies, Trikala, Greece
9. ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences. Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
10. School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
11. National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
12. Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
13. School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
14. Rheumatology Department, King’s College Hospital, London, United Kingdom
15. Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
16. School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland

GS Metsios, TPM Vliet Vlieland, CHM Van den Ende, A Stavropoulos-Kalinoglou, I Fatouros, M van der Esch, SAM Fenton, RH Moe, JJCS Veldhuijzen van Zanten, Y Koutedakis, AS Veskoukis, C Boström, N Kennedy, GE Fragoulis, GD Kitas


There is convincing evidence to suggest that exercise interventions can significantly improve disease-related outcomes as well as comorbidities in rheumatic and musculoskeletal diseases (RMDs). All exercise interventions should be appropriately defined by their dose, which comprises of two components: a) the FITT (frequency, intensity, time and type) and b) the training (ie, specificity, overload, progression, initial values, reversibility, and diminishing returns) principles. In the published RMD literature, exercise dosage is often misreported, which in “pharmaceutical treatment terms”, this would be the equivalent of receiving the wrong medication dosage. Lack of appropriately reporting exercise dosage in RMDs, therefore, results in limited clarity on the effects of exercise interventions on different outcomes while it also hinders reproducibility, generalisability and accuracy of research findings. Based on the collective but limited current knowledge, the main purpose of the present Position Statement is to provide specific guidance for RMD researchers to help improve the reporting of exercise dosage and help advance research into this important field of investigation. We also propose the use of the IMPACT-RMD toolkit, a tool that can be used in the design and reporting phase of every trial.


Article Submitted: 30 Jun 2021; Article Accepted: 25 Jul 2021; Available Online: 27 Dec 2021


This work is licensed under a Creative Commons Attribution 4.0 International License (CC-BY). 

©Metsios GS, Brodin N, Vliet Vlieland TPM, et al.