Physical Activity Benefits People With SLE, but Many Do Not Meet WHO Guidelines

Physical activity (PA) has clear and abundant benefits for people with systemic lupus erythematosus (SLE), according to a new systematic review published in Seminars in Arthritis and Rheumatism, but the study also found the patient group tends to exercise at lower rates than the general public.

About two-thirds of people with SLE report significant fatigue, and people with the autoimmune disease are also at a heightened risk of cardiovascular disease, explained the authors. Patients who are sedentary tend to have worse cardiovascular symptoms and higher levels of inflammatory markers, they added.

In the general population, exercise has been shown to significantly reduce morbidity and mortality, and in recent years, investigators have attempted to quantify whether and how much PA might affect outcomes in people with SLE. In the new report, they sought to consolidate the existing research in order to clarify the potential benefits of exercise in this patient group.

“These findings will subsequently be used for the development of international recommendations on PA in SLE patients,” the authors added.

They searched existing medical and scientific databases, looking for studies that evaluated exercise or PA in people with SLE, and they identified 40 relevant studies that met inclusion criteria; they published between 1989 and 2022 and included 2291 participants with SLE. The analysis produced several key themes related to the actual level of PA in people with SLE and the potential benefits of such activity.

First, the authors said, the data suggest exercise is not a priority for many people with SLE.

“Available evidence suggests that SLE patients generally have low levels of PA compared to the general population and are commonly not reaching the WHO (World Health Organization) recommendations for PA,” they wrote.

The WHO recommends 150 to 300 minutes of moderate-intensity exercise or 75 to 150 minutes of vigorous PA per week for adults in the general population, the authors noted.

The data in the studies suggest that just 11% to 29.8% of people with SLE met the current WHO recommendations. According to self-reported questionnaires used in studies, people with SLE had a median of 60 to 132 minutes per week of moderate to vigorous PA—but the median sedentary time was roughly triple that.

“The main reasons reported for not doing any PA were poor fitness (65%) followed by pain (41%) and fatigue (8%),” the authors added.

Yet, the data also showed that people with SLE stood to gain significantly from meeting the WHO goals.

“Aerobic programs had significant benefits on global aerobic capacity and estimated cardiovascular risk while resistance training programs improved strength and function in SLE,” the authors found. In addition, fatigue, depression, and health-related quality of life were improved among people with SLE who exercised.

The studies showed no evidence that PA led to severe adverse events in people with SLE.

Although the data about the benefits of SLE are consistent, the researchers said one reason some people with SLE might avoid exercise is because their physicians are reluctant to recommend PA out of fear of adverse events. The authors said better education about PA and promotion of exercise could help; in particular, multidisciplinary patient education programs can be one way for specialists to promote exercise and educate other providers, such as nurses, physical therapists, and dieticians.

“Heterogeneity in studies design and outcomes have led physicians not to consider PA among the first line of treatment in SLE,” they wrote. “Therefore, dedicated recommendations informed by this systematic review are needed to promote PA and its benefits in SLE patients.”

Reference

Blaess J, Goepfert T, Geneton S, et al. Benefits & risks of physical activity in patients with Systemic Lupus Erythematosus: a systematic review of the literature. Published online November 19, 2022. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2022.152128