Background Physical activity is of fundamental importance for people with rheumatic diseases (RD). The traditional approach of Physiotherapy (PT) has been placed side by side with other physical programs, such as Yoga (Y), aimed at reducing chronic pain and improving the quality of life.

Objectives To evaluate the effects of PT and Y on patients with inflammatory and non-inflammatory RD: Chronic Arthritis (CA) and Primary Fibromyalgia (FM).

Methods Patients were enrolled in a prospective study including 3 months of PT and 3 months of Y (with a specific focus on the control of breathing - Ai-jutsu). Each activity was performed bi-weekly in a dedicated facility. Patients were randomly allocated to either the group starting with PT or that starting with Y. After 3 months they switched to the other activity. At the beginning and at the end of each activity patients underwent a medical assessment of their physical status and were proposed questionnaires: 1) HAQ for disability in everyday life; 2) ZUNG self-rating depression scale; 3) Tampa scale for Kinesiophobia assessing the fear and avoidance of movement. Patients with FM compiled also the FIQ for the impact of FM in everyday life. All patients rated their physical pain by VAS (Visual Analogic Scale) from 0 to 10.

Results Thirteen patients with CA (77% female, median age 62 years, median disease duration 19 years) and 8 with FM (100% female, 56 years, 9 years) participated in the study. At baseline, there were no differences between CA and FM patients in terms of ZUNG, HAQ and Tampa scores. After 3 and 6 months of activity, all items had a tendency toward improvement, with a statistically significant reduction for VAS in both groups (nearly -30%). By intra-group comparison between the beginning and the end of each activity, we observed that patients with CA had a significant reduction of ZUNG and HAQ scores (50 vs 40.5 and 0.600 vs 0.475, respectively) during PT activity, while FM patients had a trend toward the increase of Tampa score (24.5 vs 34.5). During Y activity, significant reductions were observed in VAS score for CA patients (5 vs 2.5) and in Tampa score for FM patients (34.5 vs 23.5). Overall, all items had a tendency toward improvement for FM patients during Y activity.

Conclusions This pilot study involving both patients with inflammatory and non-inflammatory RD demonstrated benefit from an integrated program of sequential PT and Y and highlighted differences in patients' needs according to their disease type. Particularly, PT seemed to bring more benefit to CA patients, probably because of the individualized work on joint movement range and muscular strengthening, while FM patients may have had a negative impact by this approach, as seen by the increase in the fear of movement. Conversely, FM patients had a tendency toward improvement during Y activity.

Acknowledgements We thank the Patients Association (ABAR) for promoting and supporting the activities of this study and Essse Accademia for gently introducing our patients to the world of Yoga.

Disclosure of Interest C. Nalli: None declared, L. Andreoli: None declared, R. Avanzini: None declared, P. Tipa: None declared, M. Zanetti: None declared, C. Milini: None declared, S. Olivieri Employee of: Accademia Essse, E. Abrami: None declared, R. Furfari: None declared, R. Gorla: None declared, A. Tincani: None declared