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Disabil Rehabil. 2019 Feb;41(4):445-455. doi: 10.1080/09638288.2017.1398278. Epub 2017 Nov 10.

Exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type.

Author information

a Great Ormond Street Institute of Child Health , University College London , London , UK.
b Hospital of St. John and St Elizabeth , London , UK.
c School of Health and Social Work , University of Hertfordshire , Hatfield , UK.
d Imperial College Healthcare NHS Trust, Paediatrics , St. Mary's Hospital , London , UK.
e Department of Pathology , Cambridge University , Cambridge , UK.
f Neurogastroenterology , Queen Mary University of London , London , UK.
g Physiocare , Twyford , UK.



To explore exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type and to explore patient experiences of physiotherapy.


A cross sectional questionnaire survey design was used to collect quantitative and qualitative data from adult members of the Hypermobility Syndromes Association and Ehlers-Danlos Syndrome Support UK. Descriptive and inferential statistics were used to analyse the data. Qualitative data was analysed thematically.


946 questionnaires were returned and analysed. Participants who received exercise advice from a physiotherapist were 1.75 more likely to report high volumes of weekly exercise (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.30-2.36, p < 0.001) than those with no advice. Participants who believed that exercise is important for long-term management were 2.76 times more likely to report a high volume of weekly exercise compared to the participants who did not hold this belief (OR = 2.76, 95% CI = 1.38-5.50, p = 0.004). Three themes emerged regarding experience of physiotherapy; physiotherapist as a partner, communication - knowledge, experience and safety.


Pain, fatigue and fear are common barriers to exercise. Advice from a physiotherapist and beliefs about the benefits of exercise influenced the reported exercise behaviours of individuals with Ehlers-Danlos syndrome - hypermobility type in this survey. Implications for rehabilitation Exercise is a cornerstone of treatment for Ehlers-Danlos syndrome/Ehlers-Danlos syndrome - hypermobility type. Pain, fatigue and fear of injury are frequently reported barriers to exercise. Advice from physiotherapists may significantly influence exercise behaviour. Physiotherapists with condition specific knowledge and good verbal and non-verbal communication facilitate a positive therapeutic experience.


Ehlers–Danlos syndrome – hypermobility type; Joint Hypermobility syndrome; exercise behaviour; exercise beliefs; physiotherapy

[Indexed for MEDLINE]

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