thoracic extension exercises may offer preventive support to those at risk of restrictive lung disease through the effects of IIM, and patients with inclusion body myositis may also be able to prevent contracture and extend functional daily activities through stretching and range of motion exercises. Monitoring It is important to recognize that all described exercise programs were conducted by physicians or physiotherapists during the stable phase of the disease (except Painelli). Patients were monitored closely for indicators of deleterious effects, such as increases in serum creatine kinase, inflammation or weakness. Monitoring of this kind can only be done in conjunction with a medical team who is aware of the risks posed by increased inflammatory response in patients with IIM. Future research The pathophysiology of IIMs is not well understood. Muscle weakness can be caused by a single or combined effect on muscle tissue by inflammation, inflammatory infiltrates, muscle atrophy, metabolic abnormalities that indicate disordered energy metabolism, and possibly neuropathy, among others. Therefore, physical exercise has the potential to cause harm. However, the results of these exercise studies, at minimum, show that exercise can attenuate muscle damage due to disease, inactivity and steroid use. They reflect the benefit of exercise through the strengthening of complement (non-diseased) muscles, and should encourage further studies to confirm whether diseased muscle may experience regeneration. The definition of improvement must be established, and reproducible longitudinal studies must be conducted to determine the efficacy of exercise as therapy for IIM. References Muscular disorders Physical therapy Physical exercise