Welcome Back Rheumatology Fans,

I had the ABSOLUTE pleasure to talk to Jean-Pascal Grenier who published this great review on high-intensity exercise and Rheumatic Diseases.

You can find Jean-Pascal on LinkedIn or Research Gate or Instagram

Full Article Link: https://pubmed.ncbi.nlm.nih.gov/41566885/

Clinical Takeaways From The Podcast

• High-intensity exercise is not harmful for people with rheumatic disease according to current evidence.

• Outcomes such as pain, disability, and function are at least as good with high-intensity exercise as with lower-intensity approaches.

• Some functional outcomes (e.g., activities of daily living tests) may actually improve more with higher-intensity interventions.

• Persistent clinical caution around intensity may reflect historical beliefs rather than current evidence.

• Exercise prescription should still be individualised, considering disease activity, patient confidence, and training tolerance rather than relying on blanket intensity restrictions.

Podcast Summary

In this episode of The Rheumatology Physio Podcast, Jack is joined by researcher Jean-Pascal Grenier (JP) to explore a long-standing clinical question: Is high-intensity exercise harmful for people with rheumatic disease? The short answer, according to JP’s recent review, is no.

The conversation unpacks evidence examining high-intensity exercise interventions across conditions such as rheumatoid arthritis and other rheumatic diseases. High intensity was broadly defined in the literature as exercise performed at ≥70% of maximum heart rate, including aerobic training, resistance training, and interval-based protocols.

Across the studies reviewed, high-intensity exercise was found to be at least as effective as low- or moderate-intensity approaches for key outcomes such as pain, function, and disability. In several secondary outcomes—including activities of daily living and functional capacity tests—high-intensity exercise even showed superior improvements in some patient groups.

JP explains that the motivation for the review came from a persistent culture of caution around exercise for inflammatory disease. Patients are often advised to “take it easy” or avoid heavy exertion due to concerns about joint damage or disease flares. However, the evidence does not support the idea that higher exercise intensities are harmful.

Instead, the discussion highlights a mismatch between clinical messaging and available evidence. While exercise is widely recommended in rheumatology guidelines, caveats around intensity often remain despite limited supporting data.

Ultimately, the episode reframes the conversation around exercise prescription in rheumatology. Rather than defaulting to conservative, low-intensity programmes, clinicians may be able to confidently consider higher-intensity training when appropriate, recognising that patient preference, tolerance, and individual context still matter.

If you subscribe to Physio Matters Advanced Practice you immediately gain full access to my Online Course, paid posts on substack and 2 EBooks!

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit rheumatologyphysio.substack.com/subscribe