Exercise Generally Safe, Beneficial for Patients With Lupus

Janis C. Kelly

November 27, 2013

Two new studies from the laboratory of Emilia I. Sato, MD, from the Rheumatology Division, Universidade Federal de São Paulo R Rotucatu, Brazil, support the benefits of physical exercise for patients with systemic lupus erythematosus (SLE).

The first study, by Edgard Torres dos Reis-Neto and colleagues, published online August 22 in Rheumatology, describes improved endothelial function and aerobic capacity in patients with SLE in a supervised exercise group compared with patients not in the exercise group. This is important because of the increased cardiovascular risk associated with SLE, the authors note.

The second study, by Aline Evelyn da Silva and colleagues, published online October 13 and in the December issue of Lupus, showed that unlike the situation in healthy adults, acute physical exercise did not increase the levels of interleukin 6 (IL-6) in patients with SLE.

According to the authors, IL-6, "the first myokine," is produced by skeletal muscle fibers and released into the circulation, where it affects other organs. The authors initiated this study out of concern that disease activity might worsen if exercise increased IL-6 levels in SLE patients, as some researchers have reported a correlation between IL-6 level and SLE disease activity.

The study by Reis-Neto and colleagues included 18 women with SLE assigned to a 16-week exercise group that walked for 1 hour 3 times per week at a heart rate corresponding to the ventilatory 1 threshold. Twenty similar patients were assigned to the control group. The researchers observed no change in the control group at 16 weeks but improved exercise tolerance, maximum speed, and threshold speed in the exercise group, as well as an increase in brachial artery flow-mediated dilation.

The study by da Silva et al showed that although IL-6 levels were higher at baseline in patients with SLE than in healthy control participants, acute physical exercise did not increase IL-6 levels in the patients with SLE. The researchers suggested that this finding, which differs from outcomes in other studies, might have indicated that the IL-6 level was already so high in the patients with SLE that the exercise intervention did not increase it further.

"These studies add to data from multiple studies, including our own work, which show that there is no additional risk to lupus patients from either acute or chronic exercise training. Patients should be doing some kind of exercise unless they have a major contraindiction," Jill N. Barnes, PhD, assistant professor of physiology at the Mayo Clinic in Rochester, Minnesota, told Medscape Medical News.

Dr. Barnes, who was not involved in the current studies, raised 2 concerns about the exercise intervention and the cytokine measurements. "It is very unclear what type of exercise intervention was used or how well-controlled it was," she said. "In addition, the measurements of cytokine levels and for the flow-mediated dilation levels are not consistent with what we see in healthy people and are not consistent with our own published findings."

In an article currently in press, Dr. Barnes and colleagues compared cytokine levels from patients with lupus who were already-active, patients with lupus who were sedentary, and healthy control participants. "The levels in the Sato et al papers were much lower, which leads me to believe that the investigators were not using a high-sensitivity human cytokine kit. The levels reported also raise the question of why their healthy controls would have such high levels of IL-6," Dr. Barnes said.

Carlos Ayan, MD, from the Faculty of Education and Sports Science, University of Vigo, Pontevedra, Spain, who has also studied exercise in SLE had other methodological concerns. "Both are interesting studies, but they were carried out with a small sample made of women willing to exercise. This is not a great limitation, but it should be [taken] into account when reading these findings," Dr. Ayan told Medscape Medical News. Dr. Ayan would also like to see randomized controlled trials comparing the effects of different types of exercise in SLE.

Dr. Barnes added a caveat for clinicians: "It would be a mistake to take a one-size-fits-all approach to the question of exercise in SLE," she warned. "Lupus patients know their bodies better than anyone else does, and it is important to remember that disease expression can change dramatically from day to day. Patients should be encouraged to pay attention to how they are feeling and adjust their daily exercise accordingly."

The authors, Dr. Barnes, and Dr. Ayan have disclosed no relevant financial relationships.

Rheumatology. 2013;52:2187-2195. Abstract

Lupus. 2013;22:1479-1483. Abstract

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