Exercise in lupus: safe, useful, but uncommon

3 minute read

Replacing 10 minutes of sitting with physical activity improves CV risk, but pain and fatigue hold patients back.

A French research team has conducted a literature review of benefits and risks of physical activity in lupus patients.

Published in Seminars in Arthritis and Rheumatism, key outcomes reported include significant benefits in fatigue, depression and health-related quality of life resulting from aerobic and strength training programs.

“This systematic review including 40 articles shows that physical activity has numerous significant benefits in SLE and may improve various aspects of the disease such as cardiovascular risk, aerobic capacity, muscle strength, limb function, HR-QoL, fatigue and depression,” they wrote.

“Moreover, [physical activity] appeared generally safe in SLE patients with inactive disease, stable treatment and without significant coronaropathy.”

These observations occur in the context of a patient population with low rates of physical activity participation relative to the general population.

Physical activity measured using accelerometers found that one-third to a half of patients didn’t do any moderate-to-vigorous activity. And only 28-40% of patients met WHO recommendations of 150 minutes of moderate or 75 minutes of vigorous activity weekly, according to self-reported measures.

Poor fitness, pain and fatigue were the main reasons given for not doing physical activity.

The main benefits arising from activity programs were increases in aerobic capacity, with improvements in upper body symptoms and function resulting from resistance training. Several – though not all – studies found that fatigue was inversely correlated with time spent in moderate-to-vigorous physical activity, and also with aerobic capacity. Combining aerobic and strength training was likely the most useful approach in lupus patients.

Meanwhile, converting sedentary or low activity time to moderate or vigorous activity improved insulin sensitivity and arterial pressure, and one study reported a 20% decrease in 10-year cardiovascular risk when patients reallocated 10 minutes of sedentary behaviour per day to moderate or vigorous physical activity.

Adherence to training programs was moderate, with around half to two-thirds of patients complying, and one study found that only 20% continued to exercise a year after the training program had ended.

“Some physicians have tried to introduce a fun part using Wii Fit system with better compliance rates. This highlights the importance of trying to make PA programs as personalised and as attractive as possible, rather than looking like a constraint,” noted the authors.

No serious adverse events were reported, though patients were screened prior to taking part in the studies.

The review authors called for recommendations to promote physical activity and its benefits in SLE patients and referred in social media to an upcoming taskforce on the topic.

Meanwhile they’ve created a summary of considerations.

Semin Arthritis Rheum 2022, online 19 November

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