Benefits & risks of physical activity in patients with Systemic Lupus Erythematosus: a systematic review of the literature

ElsevierVolume 58, February 2023, 152128Seminars in Arthritis and RheumatismAuthor links open overlay panelAbstractIntroduction

Most patients with Systemic Lupus Erythematosus (SLE) have limited levels of physical activity (PA). The aim of this systematic review was to examine the evidence regarding the benefits and potential risks of PA in SLE.

Methods

We searched the medical literature on MEDLINE (via PubMed) from inception to March 2022 using the Medical Subject Headings (MeSH) terms “Exercise” and “Lupus Erythematosus, Systemic” as well as free text combinations such as “physical activity”. We also searched the reference lists of retrieved studies. Two authors independently assessed all studies identified by the search for inclusion in the review and independently extracted data.

Results

A total of 40 articles (2291 SLE patients) published between 1989 and 2022 were included in this systematic review. Compared to the general population, SLE patients had low levels of PA, with 11% to 29.8% objectively meeting World Health Organization (WHO) recommendations. SLE patients also had impaired aerobic capacities (VO2max ranging from 18.8 to 25.78 ml/kg/min). Aerobic programs had significant benefits on global aerobic capacity and estimated cardiovascular risk while resistance training programs improved strength and function in SLE. Fatigue, depression and Health-Related Quality of life improved significantly following PA training. No severe adverse event was reported across included studies.

Conclusion

Aerobic and resistance training programs had clear benefits and were well tolerated in SLE patients with stable disease. There is currently no universal recommendations about PA in SLE. Dedicated recommendations informed by this systematic review are needed to promote physical activity and its benefits in SLE patients.

Introduction

Systemic lupus erythematosus (SLE) is an autoimmune systemic disease with an incidence of 0.3 to 5.1 per 100 000 per year in Europe and a prevalence of 6.5 to 85 per 100 000 [1]. Significant fatigue is reported by two-thirds of patients with SLE and severe fatigue by one-third [2] and its treatment remains an unmet need. Additionally, SLE patients have an increased cardiovascular risk compared to the general population, with a high incidence of metabolic syndrome [3] due to the frequent use of glucocorticoids to control disease activity [4]. Sedentary SLE patients have higher brachial and carotid systolic blood pressure, increased aortic augmentation index and aortic wave reflection compared to healthy controls [5]. Also, sedentary SLE patients have greater levels of inflammatory markers such as CRP, IL-12 and TNF-α compared to physically active SLE patients and healthy controls [5]. The significant benefits of physical activity (PA) on global morbidity and mortality have been largely demonstrated in the general population. This has led the WHO to recommend 150–300 min of moderate-intensity or 75–150 min of vigorous-intensity PA (or some equivalent combination of moderate-intensity and vigorous-intensity) aerobic physical activity per week to all adults [6]. In SLE, it has been shown that most patients spend significant time in sedentary activities and therefore do not reach these WHO targets for PA [7,8]. During the past years, several trials have evaluated the impact of PA in SLE patients. The aim of this systematic review was to examine the evidence regarding the benefits and potential risks of PA in SLE patients. These findings will subsequently be used for the development of international recommendations on physical activity in SLE patients.

Section snippetsMaterial and methods

This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Given that the study did not involve primary data collection or analysis, the study was considered exempt from ethical committee review. We searched MEDLINE (via PubMed) from inception to 07 March 2022 for studies about physical activity and SLE in English without additional filter. The search strategy used the MeSH terms “Exercise” and “Lupus

Results

The flow diagram for study selection is depicted in Fig. 1. A total of 419 potentially eligible references were identified using the described search strategy, from which 330 were excluded based on their titles and abstracts. The remaining 89 papers were subsequently considered for full text review. We excluded 49 references because they did not meet our inclusion criteria. Finally, 40 articles published between 1989 and 2022 were included for further analysis. Thirteen studies were randomized

Discussion

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. Moreover, PA appeared generally safe in SLE patients with inactive disease, stable treatment and without significant coronaropathy.

Of outstanding importance, SLE patients have low levels of PA and spent major time on

Conclusion

Although several studies have demonstrated both the benefits and safety of PA in chronic diseases such as SLE, many physicians still have some reluctances about PA. Larger scale promotion of PA in chronic diseases is needed. Therapeutic patient education sessions supervised by a specialist physician can be an opportunity to promote a multidisciplinary approach with participation of nurses, dieticians, physiotherapists, psychologists and PA educators. These sessions enable patients to have a

Data availability

The datasets generated during and/or analysed during the current study are available in the medical literature on MEDLINE (via PubMed) from inception to March 2022 using the MeSH terms “Exercise” and “Lupus Erythematosus, Systemic” as well as free text combinations such as “physical activity”.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

Julien Blaess: Conceptualization, Formal analysis, Data curation, Writing – original draft, Writing – review & editing. Thibaut Goepfert: Data curation, Writing – review & editing. Sophie Geneton: Writing – review & editing. Elise Irenee: Writing – review & editing. Hugo Gerard: Writing – review & editing. Félix Taesch: Writing – review & editing. Christelle Sordet: Writing – review & editing. Laurent Arnaud: Conceptualization, Formal analysis, Writing – original draft, Writing – review &

Competing Interests

The authors declare that they have no competing interests.

Acknowledgments

The authors wish to thank Ms Baumgaertner for her invaluable assistance for the preparation of the manuscript.

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