Oefeningen bij sclerodermie — warme extremiteiten, PAH-screening EERST, dagelijkse handmobiliteit

ACR/EULAR 2013 classification + 2024 EULAR systemic sclerosis management framework. Scleroderma (systemic sclerosis) is an autoimmune fibrosis affecting skin (limited vs diffuse subsets) + microvasculature (Raynaud's phenomenon is universal — among the earliest features) + organs (pulmonary arterial hypertension, interstitial lung disease, scleroderma renal crisis, ubiquitous GI dysmotility). Treatment is organ-specific (CCBs for Raynaud's, ERAs/PDE5i for PAH, nintedanib for ILD, ACEi for SRC). Exercise priorities differ from most autoimmunes: warm extremities mandatory (no cold-air exposure during exercise), PAH screening (6MWD + echo + RHC if indicated) is CRITICAL before any aerobic prescription, and daily hand-mobility ROM is non-negotiable to prevent the contractures that disable scleroderma patients faster than any other feature. Mitropoulos 2018 + Lima 2015 RCTs established that graded aerobic + hand-mobility exercise reduces disability and maintains range without triggering vasospastic events. AVOID exhaustive exertion if PAH or ILD limit cardiopulmonary reserve.

Volya's catalogue carries the foundation moves: wall-push-up for scaled upper-body strength + hand-loading (combats finger contractures), scapular-retraction for posture, supported-glute-bridge for posterior chain, cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic + ILD-aware breath control, pursed-lip-breathing for PAH/ILD dyspnea management, standing-march for managed cardio (after PAH screen), ankle-pump for circulation + DVT prevention. The AI coach also knows the nutrition side — GI dysmotility (90%+) drives small frequent meals + sit upright 30+ min post-meal + last meal 3+ h before bed, GERD-protective AVOID late-night meals/alcohol/caffeine/tomato/citrus/spicy/fatty/carbonated + elevate bed head 6 inches, esophageal dysmotility soft + moist textures + SLP eval if worsens, SIBO low-FODMAP trial per GI, weight loss common from GI/malabsorption → high-protein 1.4-1.6 g/kg/day, iron + B12 + folate + fat-soluble vitamins labs annually, Raynaud's adequate calories during cold + omega-3 1-3 g/day for microvascular function, PAH modifier low-sodium <2 g/day + cardiology team. CRITICAL: Scleroderma Foundation + EUSTAR (European Scleroderma Trials and Research) + ACR + rheumatology + pulmonology if PAH/ILD + cardiology + nephrology + GI + dietitian familiar with scleroderma. This is NEVER a replacement for rheumatology + multispecialty care.