Balancing Risk and Benefit: Is Physical Activity Protective or Harmful in Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders?
DOI:
https://doi.org/10.12775/QS.2026.65.74000Keywords
Ehlers-Danlos syndrome, hypermobility spectrum disorders, joint hypermobility, physical activity, exerciseAbstract
Background. Hypermobile Ehlers–Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are heritable connective tissue disorders characterized by generalized joint hypermobility, joint instability, chronic musculoskeletal pain, and variable systemic involvement. hEDS is the most common EDS subtype, while HSD includes individuals with symptomatic hypermobility who do not meet hEDS criteria. Both conditions share overlapping clinical features and are diagnosed clinically. Patients often experience pain, fatigue, functional limitations, autonomic symptoms, and substantial psychological burden.
Aim. This narrative review evaluates current evidence on physical activity in hEDS/HSD, focusing on the balance between potential benefits and risks.
Material and methods. A literature search was conducted in PubMed and Google Scholar using the keywords “Ehlers-Danlos syndrome” and “physical activity.” English-language studies published from 2015 onwards were included, with additional reference screening.
Results. Physical activity in hEDS/HSD is shaped by interacting physiological, psychological, and biomechanical factors. Chronic pain, fatigue, autonomic dysfunction, impaired proprioception, and reduced muscle strength limit exercise tolerance and promote inactivity. Psychological distress and fear of symptom exacerbation further reduce participation. However, tailored exercise and multidisciplinary rehabilitation are associated with improvements in pain, joint stability, physical function, and quality of life. Evidence regarding injury risk is inconsistent, suggesting outcomes depend on exercise type, intensity, and individual characteristics.
Conclusion. The impact of physical activity in hEDS/HSD is variable. Individualized, supervised, multidisciplinary rehabilitation may improve pain, stability, and quality of life despite underlying vulnerabilities. Current evidence remains limited and heterogeneous, highlighting the need for further high-quality research.
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Copyright (c) 2026 Zofia Golińska, Maciej Zając, Julia Rurkowska, Krzysztof Drelich, Jakub Polczyk, Filip Ogorzałek, Przemyslaw Rajzer, Wojciech Deptuch, Wiktor Szczuciński, Paweł Moćko
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