Exercise and physical activity in systemic lupus erythematosus: A systematic review with meta-analyses

• Published in: Seminars in arthritis and rheumatism Vol. 47; no. 2; pp. 204 - 215
• Main Authors: O′Dwyer, Tom, Durcan, Laura, Wilson, Fiona
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2017
• Subjects: Exercise; Exercise - physiology; Health Status; Humans; Lupus Erythematosus, Systemic - physiopathology; Physical activity; Physical Fitness - physiology; Quality of Life; Rheumatology; Systematic review; Systemic lupus erythematosus; Systematic review; Systemic lupus erythematosus; Exercise; Physical activity; Rheumatology
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2017.04.003

Abstract Systemic lupus erythematous (SLE) associates with enhanced cardiovascular (CV) risk frequently unexplained by traditional risk factors. Physical inactivity, common in SLE, likely contributes to the burden of CV risk and may also be a factor in co-morbid chronic fatigue. This systematic review evaluates whether exercise has a deleterious effect on disease activity in SLE, and explores effects on CV function and risk factors, physical fitness and function, and health-related measures. Materials& Methods A systematic review, with meta-analyses, was conducted; quasi-randomised and randomised controlled trials in SLE comparing at least one exercise group to controls were included. MEDLINE/PubMed, EMBASE, PEDro, AMED, CINAHL, The Cochrane Central Register of Controlled Trials and relevant conference abstracts were searched. Random-effects meta-analyses were used to pool extracted data as mean differences. Heterogeneity was evaluated with Chi2 test and I2 , with p -values < .05 considered significant. Results The search identified 3068 records, and 31 full-texts were assessed for eligibility. Eleven studies, including 469 participants, were included. Overall risk of bias of these studies was unclear. Exercise interventions were reported to be safe, while adverse effects were rare. Meta-analyses suggest that exercise does not adversely affect disease activity, positively influences depression, improves cardiorespiratory capacity, and reduces fatigue, compared to controls. Exercise programmes had no significant effects on CV risk factors compared to controls. Conclusion Therapeutic exercise programmes appear safe, and do not adversely affect disease activity. Fatigue, depression, and physical fitness were improved following exercise-based interventions. A multi-modal approach may be suggested, however the optimal exercise protocol remains unclear.