Question
What are the key principles for safely progressing exercise in patients with Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD)?
Answer
Safe exercise progression for patients with EDS and HSD requires a careful, stepwise approach that accounts for joint instability, pain sensitization, and systemic comorbidities. The guiding principle is "start low, go slow," meaning exercises should begin at a low intensity and progress gradually. Initial focus should be on joint alignment, proprioception, and activation of stabilizing muscles, often in non-weight-bearing or horizontal positions. Only after achieving good control and alignment should patients advance to more challenging positions, such as upright or functional activities.
Progression should be based on one variable at a time—such as range of motion, speed, resistance, or duration—to minimize the risk of flares or injury. Rate of perceived exertion (RPE) is a valuable tool for adjusting exercise intensity, especially since heart rate may not always correlate with exertion in this population. Therapists should also be vigilant for signs of overexertion, improper form, or joint subluxation, and modify exercises accordingly. Incorporating rest periods, using external supports, and providing written or app-based instructions can further enhance safety and adherence. Ultimately, the goal is to build resilience and function while minimizing setbacks.
This Ask the Expert is an edited excerpt from the course, 'Effectively Treating Ehlers-Danlos Syndrome and Related Comorbidities', presented by Heather Purdin, PT, CMPT.
Continued and its subsidiaries provide professional education authored by qualified Subject Matter Experts for continuing education purposes. These materials are intended for educational purposes and do not constitute medical advice or a substitute for individual clinical judgment. Continued is not a clinical healthcare provider; the licensed professional is solely responsible for ensuring that the application of any techniques or information presented is within their legal scope of practice and jurisdictional requirements.
