Exercise guide
Scleroderma, mainly systemic sclerosis (SSc), tightens the skin and can stiffen the hands, narrow the mouth opening and affect the lungs, heart, kidneys and gut. European guidelines say exercise should be considered as part of care: daily hand and mouth stretches to keep the movement you have, and aerobic and strength exercise for fitness, fatigue and mood. The gains in trials are real but modest, and in some trials they didn't last.
Because scleroderma can affect your heart and lungs without symptoms, check with your rheumatology team before you start, and keep up your yearly checks. This guide covers the stretches, with 3D demos and a daily routine, what the exercise trials found, Raynaud's and finger ulcers, breathing, fatigue, and the warning signs that need help.
European recommendations say physical exercise should be considered in systemic sclerosis, including mouth, hand, aerobic and strength exercise. The UK guideline recommends physiotherapy and occupational therapy, and the NHS says regular physiotherapy and stretching may help keep your muscles supple and loosen tight skin.
Scleroderma can affect your lungs, heart and kidneys, often without symptoms at first. Your heart and lungs should be checked before an exercise programme, and everyone with systemic sclerosis should have yearly heart and lung tests.
Warm your hands first, then stretch 2 to 3 times a day, 5 to 10 of each stretch held for 3 to 5 seconds, as the US National Scleroderma Foundation advises. In trials, hand exercise gave modest gains, and an online programme on its own made little difference.
Mouth stretches once or twice a day, for example when you brush your teeth, can help keep your mouth opening. In a small trial, a month of daily mouth exercises widened it by about 2 millimetres.
In a European trial of 170 people, mostly with the limited type and without finger ulcers, supervised arm-bike intervals and weights twice a week eased general pain, Raynaud's, tiredness and low mood, and improved fitness, though finger pain didn't improve and the fitness faded once the sessions stopped. Start with 5 to 10 minutes a day and build up towards 150 minutes a week.
Keep your hands and core warm, protect your fingertips and moisturise. Never pick at or squeeze an ulcer, see a doctor or specialist nurse promptly if one looks infected, and treat a finger turning black as an emergency.
Scleroderma is a group of autoimmune conditions in which the immune system makes the body produce too much collagen, causing hard, thickened skin and sometimes problems with muscles, bones, internal organs and blood vessels. Localised scleroderma (morphoea) mostly affects the skin, in patches or lines. Systemic sclerosis can affect the circulation and internal organs as well as the skin. There's no cure, but symptoms can usually be managed.
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Limited cutaneous systemic sclerosis usually affects the skin of the hands, lower arms, feet, lower legs and face, often starts with Raynaud's, and can later affect the lungs and gut. Diffuse systemic sclerosis can affect the skin all over the body and is more likely to affect internal organs.
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Systemic sclerosis is rare: about 19,400 people in the UK live with it, and about 1,000 to 1,200 are diagnosed each year. It's about 4 to 5 times more common in women. The NHS says it usually starts between 30 and 50, while a UK database study found it was most often diagnosed between 55 and 69.
The parts that matter most for exercise:
SRUK says over 75% of people with scleroderma have fatigue, and the UK guideline lists pain, stiff joints and muscle weakness among its everyday burdens. In a survey of 721 people with scleroderma, fatigue and Raynaud's were the barriers to exercise most often rated important, and adapting exercise, keeping warm and protecting the skin were what people said would help most.
European guidelines say your health, and your heart and lungs in particular, should be considered before you start an exercise programme, and that the programme should be tailored to you. Your rheumatology team knows which parts of your body scleroderma affects.
The UK guideline says everyone with systemic sclerosis should be checked every year for pulmonary hypertension, with breathing tests, a heart scan (echocardiogram) and blood tests, and for heart involvement. SRUK says yearly tests are something you're entitled to: ask if they're not being done.
The UK guideline recommends physiotherapy and occupational therapy for joint, tendon and muscle problems. An occupational therapist (OT) can assess your hands, make splints, offer warm wax treatments and suggest equipment and changes at home. If your lungs are affected, ask about pulmonary rehabilitation, a supervised exercise and education course.
The European recommendations from EULAR (the European Alliance of Associations for Rheumatology) say physical exercise should be considered in systemic sclerosis, including mouth, hand, aerobic and strength exercise, though they rest on weaker evidence: small trials and expert agreement. The UK guideline recommends physiotherapy and occupational therapy, and Dutch recommendations agreed by patients and professionals advise regular exercise.
In a European trial of 170 people, mostly with limited systemic sclerosis, 12 weeks of supervised arm-bike intervals (30 seconds hard, 30 seconds rest, for 30 minutes) and upper-body weights twice a week eased general pain, Raynaud's symptoms, tiredness and low mood, and improved fitness and strength, with no exercise-related side effects. Its main outcome, finger pain, didn't improve. The fitness gains had faded by 24 weeks, once the sessions stopped, and people with active finger ulcers, severe heart disease or severe pulmonary hypertension weren't included.
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In an earlier trial of 34 people with limited systemic sclerosis, 12 weeks of interval training on an arm bike or an exercise bike improved fitness, and arm cranking also improved how the small blood vessels in the fingers work. Both groups had less discomfort from Raynaud's.
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Two reviews, each of 8 randomised trials (487 and 729 people), found that hand exercise and rehabilitation improved hand function and movement a little. One also found a small improvement in daily activities; the other found no change in an overall disability score. Most of the trials had some risk of bias, and the later review found none of high quality.
In a trial of 466 people offered a self-guided online hand programme, hand function was no better than with usual care at 3 or 6 months, though fewer than half used it more than twice. In a French trial of 220 people, a month of supervised physiotherapy helped at 1 month but not at 12.
In a Turkish trial of 56 people, a month of daily mouth exercises widened the opening by about 2 millimetres. In a US trial, the extra gain at 3 months was gone by 6 months, and people did only about half the planned exercises. Supervised physiotherapy kept the mouth opening better at 12 months in the French trial, and an Italian trial found home face and jaw exercises helped, more so with weekly physiotherapy.
The UK guideline includes pulmonary rehabilitation in care for scleroderma lung disease, and supervised exercise training for pulmonary arterial hypertension. In lung scarring from any cause, rehabilitation added about 40 metres to the distance people could walk in 6 minutes (13 trials, 585 people, moderate certainty), and in pulmonary hypertension about 49 metres (11 trials, 418 people, low certainty), with no rise in serious harms.
A review of 9 exercise studies in systemic sclerosis found that 7 reported no adverse events. The larger trials checked people's heart and lungs first and supervised the harder sessions.
In 2024 the UK guideline said evidence for exercise specific to scleroderma fatigue wasn't available, though it's generally encouraged. The 2025 trial then found a modest improvement on one fatigue scale but not on a shorter one. Dutch recommendations advise exercise for fatigue, based on research in other conditions.
A Dutch expert panel didn't agree to recommend yoga or tai chi for fatigue, or connective tissue massage or manual lymph drainage for the hands. EULAR says manual lymph drainage, a gentle massage that moves fluid, could be considered for puffy hands, based on one small trial.
Medicines to calm the immune system, to treat the lungs, circulation and blood pressure, and regular checks of the organs are the core of care, and they're your team's decisions. Exercise works alongside them for your hands, mouth, fitness, tiredness and mood, never instead of them.
Warm your hands first: warm water, a warm shower or a warm, moist pack for 15 to 20 minutes, never hot. Then stretch about 2 to 3 times a day: go past the first tightness until you feel the stretch, hold for 3 to 5 seconds, and do 5 to 10 of each, as the National Scleroderma Foundation's handout by an occupational therapist advises. Your fingers may go pale during a stretch; let the colour come back before you stretch that finger again. Moisturise afterwards.
Make a fist, then stretch your fingers out like a star; touch each fingertip with your thumb tip, then slide your thumb down each finger; and with your hands face down on a table, lift each finger in turn. A physiotherapist or occupational therapist can add exercises that bend one finger joint at a time.
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Our 3D figure doesn't show this one. It stretches the middle finger joints, which scleroderma tends to bend and stiffen, and the skin over them. The nearest moves with a 3D demo are the wrist flexor stretch (palm flat on a wall) and the straight-hand position of the tendon glides. The steps are from the National Scleroderma Foundation's handout:
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EULAR says manual lymph drainage could be considered for puffy hands, though a Dutch panel didn't agree to recommend it. Ask your team or hand therapist.
After warming your hands: 5 to 10 of each stretch, held 3 to 5 seconds, 2 to 3 times a day (National Scleroderma Foundation). The band and ball moves add strength: our editorial starting point is 1 set of 10, and only without fingertip ulcers.
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment
3D demoWrist flexor stretchBeginner · A wall
Thumb lifts and O-sign (thumb base exercises)Beginner · No equipmentFinger walking (SARAH hand stretch)Beginner · No equipment
3D demoWrist & forearm flowBeginner · No equipment
3D demoWrist circlesBeginner · No equipment
3D demoBand finger extensionBeginner · A band
3D demoBall squeezeBeginner · Other / check instructionsDo mouth stretches once or twice a day, perhaps when you brush your teeth. Warm your face first by massaging around your mouth with your fingertips, or holding a warm flannel over it for 30 seconds, and use a mirror. Open wide, stretch your lips sideways with your thumbs, puff your cheeks, pucker, smile and slide your chin from side to side, holding each stretch. Start with 5 of each held for 3 to 5 seconds (National Scleroderma Foundation), building to 10 seconds, twice a day: the programme in the Turkish trial.
SRUK says your mouth may ache for a few days after you start, but the stretches shouldn't be painful. Don't do them if you have ulcers or sore areas at the corners of your mouth until you've had medical advice. Keep your face warm in cold weather, see a dentist every 6 to 12 months, and see a dentist or doctor about any change in your mouth that lasts more than 2 weeks.
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Estimates vary a lot. Older studies, quoted in the Turkish trial, put it at 43% to 80% of people with systemic sclerosis, while a Dutch study of 382 people found 7%, with the opening staying steady in most of them over about 2 years.
Once or twice a day. Mouth stretches: 5 of each, held 3 to 5 seconds, building to 10 seconds. Side neck stretch: hold 5 to 10 seconds, 2 to 4 times each side, the move page's dose; neck exercises were part of the Italian trial's home programme. The chin tuck is our addition: 5 to 10 slow tucks (editorial).
These are starting points to discuss with your rheumatology team or physiotherapist.
Start with what you can manage: SRUK suggests 5 to 10 minutes a day, building up gradually. Walking, cycling and swimming suit many people. Over time, build towards the NHS guideline of 150 minutes a week of moderate activity, the kind where you can talk but not sing.
The trials used an arm bike (arm crank) for intervals of 30 seconds hard and 30 seconds rest, for 30 minutes, twice a week for 12 weeks, supervised after an exercise test. The trial authors suggest at least 12 weeks of twice-weekly aerobic and strength training. On your own, start with steady arm or leg cycling at an easy pace, and do hard intervals only in a supervised programme or once your team has checked your heart and lungs (our suggestion).
The NHS advises strength exercise on at least 2 days a week, and EULAR includes resistance exercise for fitness in systemic sclerosis. Our editorial starting point is 2 sets of 8 to 12 of each move. Protect your fingertips: pad or wrap handles, and choose moves that don't press on a sore finger.
In the trial, the fitness gains had faded within 12 weeks of stopping. Building exercise into your week is what keeps the benefit.
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Our editorial starting point: 2 sets of 8 to 12, with your palms flat and never pressing on a fingertip ulcer.
At a pace where you can talk but not sing. Arm bike: the move page's editorial start of 10 to 20 minutes, twice a week, in 3-minute bouts. Recumbent bike: 10 to 20 minutes, building to 30, the move page's dose. Walking: start with 5 to 10 minutes a day (SRUK).
To keep tight skin and joints moving. Elbow bends, 10 slow repetitions; table slides, 10 slow slides, 1 to 3 times a day; thoracic rotation, 6 each side; and ankle circles, 10 each way, are the move pages' doses. Doorway and calf stretches: hold 20 to 30 seconds, 2 to 3 times (editorial).
3D demoElbow bend and straighten (elbow range of motion)Beginner · No equipment
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoDoorway chest openerBeginner · A wall
3D demoThoracic rotationBeginner · No equipment
3D demoAnkle circlesBeginner · No equipment
3D demoWall calf stretch (gastrocnemius)Beginner · A wallKeep your hands and your core warm, wear gloves outdoors, dry your skin thoroughly and avoid touching cold surfaces. Moisturise after washing, protect your fingertips during tasks you can't avoid, and stop smoking. Gloves reduce Raynaud's, and in a trial silver-fibre gloves did no better than ordinary ones.
The National Scleroderma Foundation says stretching helps even with finger ulcers, because it keeps the joints moving while the ulcer heals, though you may manage fewer repetitions. Our advice: don't press, grip or stretch over the ulcer itself, and ask your team which exercises to keep doing. The exercise trials didn't include people with active ulcers. Never squeeze or pick at an ulcer, and see a doctor or specialist nurse early if it's red or has pus.
Dutch recommendations suggest arm-bike exercise, guided by a physiotherapist, for people whose daily life is limited by Raynaud's or ulcers, and arm cranking eased Raynaud's discomfort in a small trial. Our Raynaud's guide covers keeping warm when you exercise.
SRUK says up to half of people with systemic sclerosis have some lung involvement, often with no symptoms at first, and in around 1 in 5 of them it gets worse over time. Tell your team about breathlessness that's worse on stairs or hills, a cough that won't go away or a tight chest, so they can check your lungs and heart.
Pulmonary rehabilitation is a course of exercise and education, usually twice a week for up to 8 weeks, run by trained professionals. It helps people walk further and manage everyday tasks. Ask your doctor for a referral.
SRUK says regular exercise within your comfort zone won't make your condition worse, and even a very short walk can make a real difference, but don't overdo it. The Pulmonary Hypertension Association UK says exercise done in moderation can help you cope with breathlessness, and the UK guideline recommends supervised exercise training.
In 24 people with lung scarring from systemic sclerosis, 5 weeks of training the breathing-in muscles with a device improved their walking test, but the study was small and not randomised: use a trainer only with your team's advice. For breathing control and positions that ease breathlessness, see our COPD (chronic obstructive pulmonary disease) guide.
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Slow breathing for calm, at least 5 minutes, the move page's dose; breath reach, 5 breaths, the move page's dose. Stress can also trigger Raynaud's.
Take regular breaks, switch between light and heavier tasks, and look for easier ways to do things, such as sitting rather than standing, or pushing rather than lifting. On a good day, stick to your plan rather than waiting until you're tired to stop. An activity chart can help you plan your week.
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SRUK says exercise can help with fatigue, starting with 5 to 10 minutes a day and building up, with advice from your occupational therapist or physiotherapist. In the 2025 trial, tiredness improved a little on one fatigue scale.
SRUK's kidney page says about 5% to 10% of people with systemic sclerosis develop a scleroderma renal crisis, a sudden, severe rise in blood pressure, mostly people whose skin is getting worse quickly. It says people at risk should learn to check their blood pressure at home, at least every other day: your team will advise whether this applies to you. A severe headache, blurred vision or a seizure needs urgent help. When you exercise hard or in hot weather, drink more to replace the fluid you sweat.
Reflux is common in systemic sclerosis. The NHS says it's often worse after eating, lying down and bending over. If reflux bothers you, leave a gap after meals before floor exercises, bending or hard exercise (our suggestion; in the 2025 trial, people didn't eat for 2 to 3 hours before sessions). Tell your GP (general practitioner) urgently about difficulty swallowing.
Steroid tablets are kept low in systemic sclerosis, because higher doses raise the risk of a renal crisis. If you do take them long term, our osteoporosis guide covers bone protection and exercise.
The daily hand and mouth routine is the core. The arthritis hand routine adds strengthening; skip its squeezes and pinches over fingertip ulcers. The starter, easy cardio and seated workouts add fitness: build up slowly.
Daily stretches for tight skin and stiff joints in the hands, wrists and face, from scleroderma charity handouts and trials, done after warming your hands.
12 minBeginner8 movesA wallThe daily stretches and strengthening moves from the SARAH hand trial and NHS hand therapy leaflets: finger bends, finger walking, wrist circles, squeezes and pinches.
15 minBeginner7 movesA dumbbell, A bench or boxWrist mobility and forearm strength for desk work, climbing, push-ups and handstands.
10 minBeginner7 movesA wall, A dumbbellA 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA 25-minute workout done sitting, in a chair or wheelchair: seated cardio intervals, light strength work, posture and stretches, with pacing and cooling built in.
25 minBeginner14 movesA bench or box, A dumbbellThis is general information, not a diagnosis: your rheumatology team knows your situation, so use the contact numbers they gave you. A&E means accident and emergency. In the US, call 911 where this page says 999.
Call 999 or go to A&E, and don't drive yourself, for:
If you can't reach them, call NHS 111 (our suggestion):
Ask for an urgent GP appointment or get help from NHS 111 if:
Stop if you get chest pain, feel faint or dizzy, become much more breathless than usual, or have palpitations, and get help if it doesn't settle quickly (our suggestion, in line with our heart and lung guides). If your fingers go white and numb, stop, get somewhere warm and warm them up slowly.
Scleroderma can affect your mood, and anxiety and low mood are common, so tell your team. For urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any time. If you feel you can't keep yourself safe, call 999 or go to A&E. In the US, call or text 988.
SRUK's free helpline, answered by trained volunteers affected by scleroderma or Raynaud's, is on 0800 311 2756, 9am to 7pm every day.
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Guidelines recommend exercise, and in trials it has been safe: 7 of 9 studies reported no adverse events, and the 170-person trial had no exercise-related side effects. Your team should check your heart and lungs first.
The gains are small: about 2 millimetres of mouth opening in a month, and modest improvements in hand movement, which didn't always last. The aim is to keep the movement you have and slow its loss.
The National Scleroderma Foundation says stretching helps even with ulcers, with fewer repetitions. Our advice is not to press or stretch over the ulcer itself, and to get it checked.
Pulmonary rehabilitation improves walking distance and breathlessness in lung scarring, and it's part of scleroderma care. But new or worse breathlessness needs your team's checks first.
Supervised arm-bike intervals were safe and helpful in two trials, in people who were checked first. People with severe heart or lung disease or active ulcers weren't included, so this is for after your team's checks.
Yes. European guidelines say exercise should be considered in systemic sclerosis, including hand, mouth, aerobic and strength exercise, and UK guidance recommends physiotherapy and occupational therapy. Check with your team first, because your heart and lungs should be assessed before an exercise programme.
A mix: daily hand and mouth stretches, aerobic exercise such as walking, cycling or an arm bike, and some strength work. In a trial of 170 people, supervised arm-bike intervals and weights twice a week for 12 weeks eased general pain, tiredness and low mood and improved fitness, though finger pain didn't improve.
They help a little: trials show modest gains in hand movement and function, while an online programme on its own made no clear difference. Warm your hands first and stretch 2 to 3 times a day, holding each stretch for 3 to 5 seconds. A hand therapist or occupational therapist can tailor them.
A little: in a small trial, a month of daily mouth exercises widened the opening by about 2 millimetres. Do them once or twice a day, perhaps when you brush your teeth, after warming your face. In another trial the extra gain had gone by 6 months, so keep them up.
The National Scleroderma Foundation says stretching still helps, with fewer repetitions. Our advice is to keep moving the joints you can but not to press, grip or stretch over the ulcer, and to ask your team which exercises to keep doing. See a doctor or specialist nurse promptly if an ulcer looks infected, and urgently if a finger turns black.
Tell your team first about any new or worse breathlessness, cough or chest tightness, so they can check your lungs and heart. Pulmonary rehabilitation is part of care for scleroderma lung disease and helps people walk further. With pulmonary hypertension, SRUK says exercise within your comfort zone won't make it worse, but don't overdo it.
Plan, prioritise and pace: take regular breaks, switch between light and heavier tasks, and stick to your plan on good days. Exercise can help: start with 5 to 10 minutes a day and build up. In a 2025 trial, tiredness improved a little with exercise.
Swimming suits many people with scleroderma. Check the pool temperature suits your Raynaud's, dry your skin and hair well, and moisturise afterwards. Ask your team first if you have open ulcers.
Yes, built up gradually: European guidelines say resistance exercise should be considered, and the 2025 trial included supervised weights. Protect your fingertips, use padded handles or gloves if gripping hurts, and avoid loading an ulcer.
There are no trials of yoga in scleroderma, and a Dutch expert panel didn't agree to recommend yoga or tai chi for fatigue. Gentle yoga can still help you relax, which may help with Raynaud's. Keep warm, and skip poses that put weight on painful hands.
Yes. Reflux is often worse after eating, lying down or bending, so leave a gap after meals before floor exercises or bending. Tell your GP urgently about difficulty swallowing or coughing when you eat.
Morphoea mostly affects the skin, though some types affect the muscle and bone beneath. There's little research on exercise for it; keeping joints moving matters most where a patch crosses a joint, so ask your dermatology or rheumatology team.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
