Sjögren's Syndrome

Dry eyes and dry mouth are the defining features, but the symptoms that most affect daily life are usually joint pain and fatigue. Around a third of patients also describe widespread pain that overlaps with fibromyalgia 2.

A minority develop involvement beyond the glands — lung, kidney or nerve. That group is managed by rheumatology first, and rehabilitation is planned around what the organ involvement allows.

Fatigue in Sjögren's is not proportional to inflammation and does not respond reliably to immunosuppression. Exercise is one of the few interventions tested against it, but trial results on fatigue itself are inconsistent 345.

The programme starts below what the patient thinks they can manage and increases in small steps. Starting at a level that provokes a two-day crash is the most common reason patients abandon exercise and conclude it does not work for them.

Dry mouth affects swallowing and speech, so sessions include frequent breaks for fluids. Dry eyes make some visual-feedback training uncomfortable and the exposure time is shortened. Dental problems are common because saliva protects teeth, and we ask about dental care rather than treating it as unrelated.

No physiotherapy modality restores gland function. Claims that laser, magnetic field or ozone treatment improve dryness are not supported by evidence we would rely on, and we do not offer them for that purpose.

Dry eyes make prolonged screen-based exercise uncomfortable, dry mouth makes sustained talking difficult during sessions, and both worsen in air-conditioned gyms and heated pools.

These sound minor and they determine whether someone completes a programme. Session timing, frequent breaks and having drops and water available are planned rather than improvised.

Fitness is the most reliable gain. In a 2026 pooled analysis of six randomised trials with 277 participants, exercise improved cardiopulmonary fitness, functional capacity, vitality and mental health, but not fatigue, pain or disease activity 4. An earlier pooled analysis of five trials did find less pain and fatigue, particularly with resistance training 5. The review behind the European fatigue recommendations, however, found no statistically significant effect on fatigue 3. In short, the evidence on fatigue is inconsistent.

European recommendations still advise tailored physical activity and/or psychological approaches for fatigue in inflammatory rheumatic diseases, chosen with the patient and adjusted to disease activity and other conditions 6. Resistance training gave the clearest benefit in the earlier analysis 5. It can sit alongside walking, cycling or pool work, adapted to dry eyes and mouth. Exercise is worth doing for fitness and function, with realistic expectations about fatigue.