Can exercise help my lupus?

Studies investigating the correlation between exercise and disease activity in lupus have found that there is no significant impact of exercise on disease activity. However, literature examining the effect of exercise on disease-related patient reported outcomes (PROs) has found a positive correlation between exercise and symptom management in lupus, including a significant improvement in pain, function, and quality of life.^1,2,3,4

There are several studies that have investigated the effect of exercise on physical fitness and function in patients with lupus. A prospective cohort study of 38 lupus patients found that lupus patients in the exercise group had improved endothelial function assessed by brachial artery (flow-mediated dilation) (6.3 [6.7]% vs 14.1 [9.1]%, P = 0.006).⁵ A non-randomized control trial showed that progressive treadmill aerobic exercise can significantly increase the cardiorespiratory fitness of patients with lupus without worsening arterial stiffness, inflammation, or oxidative stress in these patients (95% confidence interval [CI] 0.98 to 3.55; p=0.001).⁶

A meta-analysis of aerobic capacity data from five studies found a mean increase in aerobic capacity of 1.85 ml/kg/min (95% CI: 1.12 to 2.58) in post-exercise scores.³ Another randomized controlled study examined the effects of a one-year physical activity program on aerobic capacity and physical activity among 35 women with lupus.⁷ Aerobic capacity, as measured by the volume of oxygen consumed per minute liters/minute) at maximal exercise, increased by 21% from baseline to the end of the study period (p<0.0001) in the exercise group versus 16% in the control group (p<0.0001). However, the difference between the exercise and control groups was not statistically significant and the improvements were sustained at one-year follow-up for both groups. In a randomized controlled trial examining aerobic capacity in patients with lupus assigned to 12-week cardiovascular training (CT) and resistance training (RT) programs, researchers found that both exercise groups had significantly increased aerobic capacity compared to the control group as measured by a 12-minute walk test, with a mean difference of 205.7 meters (95% CI: 94.7 to 316.8).⁸ Additionally, the Health-Related Quality of Life (HRQoL) outcomes, as measured by the Study 36-Item Short Form Health Survey (SF-36) were significantly improved post-intervention in the CT group as compared to the control group. For instance, after 12 weeks of intervention, the CT group had a significant improvement in physical role functioning score from 33.3 to 49.8 (p ≤ 0.05), as compared to that in the control group, which only improved from 24.9 to 29.7. However, of note, the lupus Disease Activity Inventory (SLEDAI) did not improve significantly for either group post-intervention.

With regard to symptomatic improvement, there is robust evidence supporting the benefits of exercise on fatigue in patients with lupus. A randomized controlled trial with 93 patients with lupus examining the effects of a 12-week aerobic exercise program on fatigue compared to relaxation therapy (e.g. listening to a relaxation audiotape at least 3 times a week plus a supervised relaxation session every 2 weeks) or no intervention found that 16 of 33 patients in the exercise group (49%) reported their fatigue as “much” or “very improved” compared with 8 of 29 patients in the relaxation group (28%) and 5 of 32 patients (16%) in the control group (p=0.02).⁹ Moreover, the study re-assessed 83 patients (10 were lost to follow-up) three months after the conclusion of the program and found that the exercise group reported improved SF-36 sub-scores in vitality (mean vitality 51±4) compared to relaxation group (41±4) and control group (34±4) (p=0.015) as well as in physical function scale with a median physical scale of 75 (0-100) compared to 0 (0-75) in the relaxation group and 25 (0-50) in the control group (p=0.024). A meta-analysis examining exercise and fatigue in lupus also showed that aerobic exercise was associated with lower fatigue severity scale (FSS) score (mean difference –0.52, [–.91, –.13]), and higher SF-36 scores (mean difference 14.98 [7.45, 22.52])¹⁰.

Additional pilot studies of exercise programs in patients with lupus have found improvements in fatigue when compared to baseline. In one pilot study, 23 patients with lupus were assigned to either an eight-week aerobic exercise program or a control group with no exercise.¹¹ Fatigue was assessed with the Profile of Mood States (POMS), and oxygenation consumption was measured during an exercise tolerance test with a bicycle ergometer. Researchers found a correlation between the change in fatigue based on the POMS fatigue sub-scale and the change in VO₂ max (r=0.5543, p<0.003); however, the difference between the two groups was not statistically significant, likely because there were only 23 patients. Another pilot study on the effect of exercise on patients with lupus randomized 10 women with lupus to either an aerobic exercise group or a muscle strengthening group.¹² After assessment of fatigue with the Fatigue Severity Score (FSS) at baseline and after 6 months, the analysis found a mean decrease in FSS of -0.78 for the aerobic exercise group and -0.47 for the muscle strengthening group, with no significant difference between the two groups.

In summary, evidence suggests that exercise does not appear to worsen lupus disease activity and can help alleviate symptoms as part of a comprehensive management plan. Further studies with larger sample sizes are needed to add to the existing evidence. The 2018 Physical Activity Guidelines recommend all adults within the general population to do 150 to 300 minutes of physical activity per week, with the stipulation that even light physical activity is better than no activity.¹³ Specifically, for lupus patients with significant disease involvement, individualized exercise programs tailored to physical capacity and mobility are important to allow patients to benefit from the physical activity while ensuring that the exercises are adapted to best serve each individual.

 References:

[1] Gwinnutt JM, Wieczorek M, Balanescu A, et al. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Annals of the Rheumatic Diseases. Published Online First: 08 March 2022. doi: 10.1136/annrheumdis-2021-222020

[2] Rodríguez Huerta MD, Trujillo-Martín MM, Rúa-Figueroa Í, et al. Healthy lifestyle habits for patients with systemic lupus erythematosus: A systemic review. Semin Arthritis Rheum. 2016;45(4):463-470. doi:10.1016/j.semarthrit.2015.09.003

[3] O'Dwyer T, Durcan L, Wilson F. Exercise and physical activity in systemic lupus erythematosus: A systematic review with meta-analyses. Semin Arthritis Rheum. 2017;47(2):204-215. doi:10.1016/j.semarthrit.2017.04.003

[4] Lu MC, Koo M. Effects of Exercise Intervention on Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis of Controlled Trials. Healthcare (Basel). 2021;9(9):1215. Published 2021 Sep 15. doi:10.3390/healthcare9091215

[5] dos Reis-Neto, E. T., da Silva, A. E., Monteiro, C. M., de Camargo, L. M., & Sato, E. I. (2013). Supervised physical exercise improves endothelial function in patients with systemic lupus erythematosus. Rheumatology (Oxford, England), 52(12), 2187–2195. https://doi.org/10.1093/rheumatology/ket283

[6] Soriano-Maldonado, A., Morillas-de-Laguno, P., Sabio, J. M., Gavilán-Carrera, B., Rosales-Castillo, A., Montalbán-Méndez, C., Sáez-Urán, L. M., Callejas-Rubio, J. L., & Vargas-Hitos, J. A. (2018). Effects of 12-week Aerobic Exercise on Arterial Stiffness, Inflammation, and Cardiorespiratory Fitness in Women with Systemic LUPUS Erythematosus: Non-Randomized Controlled Trial. Journal of clinical medicine, 7(12), 477. https://doi.org/10.3390/jcm7120477

[7] Boström C, Elfving B, Dupré B, Opava CH, Lundberg IE, Jansson E. Effects of a one-year physical activity programme for women with systemic lupus erythematosus - a randomized controlled study. Lupus. 2016;25(6):602-616. doi:10.1177/0961203315622817

[8] Abrahão MI, Gomiero AB, Peccin MS, Grande AJ, Trevisani VF. Cardiovascular training vs. resistance training for improving quality of life and physical function in patients with systemic lupus erythematosus: a randomized controlled trial. Scand J Rheumatol. 2016;45(3):197-201. doi:10.3109/03009742.2015.1094126

[9] Tench, C. M., McCarthy, J., McCurdie, I., White, P. D., & D'Cruz, D. P. (2003). Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise. Rheumatology (Oxford, England), 42(9), 1050–1054. https://doi.org/10.1093/rheumatology/keg289

[10] Wu ML, Yu KH, Tsai JC. The Effectiveness of Exercise in Adults With Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis to Guide Evidence-Based Practice. Worldviews Evid Based Nurs. 2017;14(4):306-315. doi:10.1111/wvn.12221

[11] Robb-Nicholson LC, Daltroy L, Eaton H, et al. Effects of aerobic conditioning in lupus fatigue: a pilot study. Br J Rheumatol. 1989;28(6):500-505. doi:10.1093/rheumatology/28.6.500

[12] Ramsey-Goldman R, Schilling EM, Dunlop D, et al. A pilot study on the effects of exercise in patients with systemic lupus erythematosus. Arthritis Care Res. 2000;13(5):262-269. doi:10.1002/1529-0131(200010)13:5<262::aid-anr4>3.0.co;2-8

[13] 2018 physical activity guidelines advisory committee scientific report. Washington, D.C.: U.S. Department of Health and Human Services;2018.