Exercise in lupus should be individually tailored, professionally supervised
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Key takeaways:
- For patients with systemic lupus erythematosus, physical activity should come from shared decision making, with expected benefits clearly explained.
- Training should be adapted for each person and supervised.
Aerobic and resistance training are recommended for patients with systemic lupus erythematosus, but should be tailored to the individual and, ideally, supervised by a professional, according to recommendations published in RMD Open.
“Despite the clear potential benefits, incorporating physical activity and exercise into the lives of persons living with SLE presents unique challenges,” Julien Blaess, of the Hôpitaux Universitaires de Strasbourg, in France, and colleagues wrote. “Compared with generic recommendations for physical activity and exercise in people with inflammatory arthritis and osteoarthritis, tailored recommendations are warranted by taking into account the potential SLE disease-specific considerations and challenges such as joint involvement, photosensitivity, as well as certain comorbidities.”
To draft recommendations for the use of physical activity and exercise in SLE, Blaess and colleagues formed an international task force, which included a three-member steering committee, a panel of 17 experts from rheumatology, physiotherapy and other backgrounds, and two patients with SLE. Following a systematic literature review, the steering committee generated preliminary questions and statements, which were refined in the wider group. Then a Delphi process was used to achieve consensus.
The process ultimately culminated in three overarching principles and 15 specific recommendations.
The overarching principles were focused on the use of shared decision-making around physical activity and exercise, as well as making sure patients understand the benefits. The principles are:
- The decision to engage in physical activity and exercise should be the result of a shared decision between patients living with SLE and their physician.
- The expected benefits of physical activity and exercise should be explained to patients living with SLE.
- The absence of contraindications to physical activity and exercise should be communicated to other health care providers of patients living with SLE, such as the doctor, nurse and physiotherapist.
The specific recommendations include:
- In case of outdoor activity, adapted measures such as photoprotection are necessary, and use of adequate clothing against cold is recommended if Raynaud’s phenomenon is present.
- For better personalization, exercise programs should be supervised by qualified professionals, such as physiotherapists or professionals trained in adapted physical activity.
- In case of lupus flare, potential contraindication to physical activity and exercise should be reassessed.
- A medical evaluation should be performed before starting exercise in SLE in order to identify potential contraindications and allow for personalized adaptations following physical abilities, preferences and comorbidities, with the aim of adherence to practice over the long term.
- Each exercise session should start with a warm-up at low-to-moderate intensity and should end with a cooling-down period, including stretching.
- Exercise programs should be performed in three to five sessions each week and include both aerobic and resistance training exercises.
“These tailored recommendations take into account the fluctuating nature of SLE, overall health and capacities from a holistic point of view, including the presence of potential comorbidities, allowing individuals with SLE to engage in physical activity and exercise that suits their abilities, preferences and needs while supporting their overall health and wellbeing,” Blaess and colleagues wrote. “By implementing these recommendations into clinical practice, health care professionals can optimize SLE care and empower patients to live active and healthy lives.”
Perspective
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Daniel J. Wallace, MD, FACP, MACR
An international group of 12 experts and two patients performed a literature review to come up with 12 recommendations using a Delphi consensus regarding exercise and physical activity in patients with systemic lupus erythematosus.
They reinforced what is already known and concluded that photosensitivity must be taken into account for outdoor activities, active synovitis warrants special considerations that would warrant isometric activities more than isotonic activities, strengthening and stretching are useful, and, lastly, that exercise is helpful for lupus and can minimize osteoporosis and muscle atrophy.
This is the first time that these principles have been formally codified and present useful guidelines for physical activity in patients with SLE.
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