BACKGROUND: Physical activity and targeted exercise have scientifically proven health benefits and are increasingly being used in the treatment of inflammatory rheumatic diseases. Studies and guidelines show that exercise is safe and effective, improves subjective well-being and positively influences objective clinical parameters. METHODOLOGY: The current literature was systematically reviewed to evaluate the evidence for the use of sport and exercise therapy in rheumatic diseases. Recommendations from international professional societies and recent studies were considered. RESULTS: Exercise therapy plays a central role in the prevention and treatment of various chronic diseases, including inflammatory rheumatic conditions, such as rheumatoid arthritis, spondylarthritis, psoriatic arthritis and collagenosis. For some diseases, such as vasculitides, specific recommendations are still lacking. Different types of training (endurance, strength, flexibility, coordination) can be combined according to individual needs and capabilities. The design of the training type, intensity, frequency and duration must be individually adapted to the disease profile, comorbidities, medication and fitness level. DISCUSSION: Sport and exercise therapy is not a one-size-fits-all approach but a personalized, evidence-based treatment concept. The therapy must consider the specific disease, its severity, comorbidities and the general health status of the patient. Overall, physical activity and exercise act as a safe broad spectrum medication that improves function, quality of life and comorbidities without increasing disease activity or causing flares.