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The Effects of Aerobic Training in

Populations with Systemic Lupus Erythematosus

Lyndsay Ruckle

Doctoral of Physical Therapy

ruckl1lk@cmich.edu

Central Michigan University

November 13, 2017

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Systemic Lupus Erythematosus (SLE) is a “chronic autoimmune disease that can damage

any part of the body (skin, joints, and/or organs). ‘Chronic’ means that the signs and symptoms

tend to last longer than six weeks and often for many years.1” SLE is an autoimmune disorder

where the body cannot differentiate between viruses/bacteria and a person’s healthy living tissue.

“As a result, it creates autoantibodies that attack and destroy healthy tissue. These autoantibodies

cause inflammation, pain, and damage in various parts of the body.1” Common signs and systems

of SLE include extreme fatigue, painful and swollen joints, fever, pain in the chest with

breathing, and much more. One possible treatment intervention that may have positive effects for

populations with SLE is aerobic training. Aerobic training could potentially decrease pain,

decrease fatigue, and decrease pain in the chest with breathing. Throughout this paper, several

studies will be examined to determine if aerobic training would be an effective and

recommended intervention for populations diagnosed with SLE.

As mentioned above, common signs and symptoms of SLE include extreme fatigue,

painful and swollen joints, fever, pain in the chest with breathing, abnormal blood clotting,

swelling around distal extremities and eyes, and several more. The common goals across all

examined studies is to determine if aerobic training could be an effective “non-pharmacological

therapeutic strategy to counteract physical dysfunction in adult SLE,2” and concur “that exercise

might be followed by improvements in cardiovascular capacity and physical function.3” The last

common goal is “to determine if…cardiovascular training improves exercise tolerance, aerobic

capacity, depression, functional capacity, and quality of life in patients with [SLE].4”
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The first study examined regarding aerobic training within SLE populations was

performed by Prado et al. The intervention lasted over a period of twelve weeks with moderate-

intensity aerobic training occurring twice a week. “Training sessions comprised [of] a 5-minute

warm-up followed by 20 to 50 minutes of treadmill aerobic training (a 10-minute increment in

the aerobic training volume was applied every four weeks), and 5 minutes of cool-down on the

treadmill at a low speed followed by stretching exercises.2” The aerobic intensity was determined

based on the individuals heart rate and ventilatory anaerobic threshold. After the aerobic training

intervention, the results displayed significant improvements in time-to-exhaustion, peak speed,

peak VO2, and an overall decrease in resting heart rate. “The main finding of this study is that a

supervised aerobic exercise training program was safe and effective in improving the

cardiorespiratory capacity in [child-onset] SLE patients,” as well as “beneficial effects of a three-

month exercise program on exercise tolerance, aerobic conditioning, and quality of life in SLE

patients…2” This study supports aerobic training as an effective intervention for populations

diagnosed with SLE.

Another study evaluating the effects of aerobic training in populations with SLE was

performed by Clarke-Jensen et al. The intervention lasted twelve weeks with aerobic training

happening three times a week. The aerobic training program included “walking on a treadmill at

an intensity of 70% of the patients' maximum heart rate… The patients walked at a comfortable

self-selected speed (from 3.5–5.5 km/hour). The inclination of the treadmill was adjusted (from

0% to 2%) to achieve the desired heart rate.3” The sessions gradually increased from twenty-five

minutes to forty minutes, which included a five minute warmup and a five minute cool down.

This study revealed that aerobic training did not exacerbate symptoms of fatigue, pain, or
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physical function. Participants had overall decreased pain scores, decreased fatigue, and

improvements in VO2 max. Almost all patients improved in physical function scores according to

the Modified Health Assessment Questionnaire (MHAQ) and the Medical Outcomes Study 36-

Item Short-Form questionnaire (SF-36). According to this study, aerobic training would be an

effective intervention for symptom relief in populations with SLE.

P. de Carvalho et al. performed a study focusing on aerobic training and determining if

“cardiovascular training improves exercise tolerance, aerobic capacity, depression, functional

capacity, and quality of life in patients with [SLE].4” The aerobic training session lasted for sixty

minutes; sessions occurred three times a week for twelve weeks. The results of the study

concluded that “The training group showed a significant improvement of aerobic capacity [and]

showed a significant difference relating to VO2 max and anaerobic threshold VO2.4” This study

also concluded that the training group had “significant improvement in exercise tolerance,

aerobic capacity, quality of life, and depression.4” This study demonstrates that aerobic training

would be an effective intervention for populations diagnosed with SLE.

The last study to be examined was performed by Yuen and Bagley and focused on

managing symptoms associated with SLE. The intervention included thirty-minute aerobic

sessions, three to five days a week, for a total of twelve weeks. Aerobic training included “a

variety of aerobic activities, including walking and cycling, with and without resistance

training…” because a variety of activities “…improved all [quality of life] variables.5” An

additional aspect to the study looked at the effects of a regular stretching program in accordance

with aerobic training. The results of the study determined that aerobic training can increase

aerobic capacity, increase maximal oxygen consumption, decrease fatigue, improved sleep
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quality, decrease anxiety, and decrease depression. All of these factors were determined by the

SF-36 and Fatigue Severity Scale (FSS). Aerobic training successfully influenced the symptoms

of SLE, thus resulting in a decreased chance of morbidity and mortality. This study supports an

aerobic training intervention for those with SLE and diminishing associated symptoms.

After evaluating multiple studies, I believe it can be concluded that aerobic training is a

successful intervention for populations with SLE. In the study performed by Prado et al., the

study demonstrated the beneficial effects on “…exercise tolerance, aerobic conditioning, and

quality of life in SLE patients…2” According to Clarke-Jensen et al., participants had a decrease

in overall pain scores, decreased fatigue, improvements in VO2 max, and improvement in

physical function scores. P. de Carvalho et al. demonstrated “significant improvement of aerobic

capacity [and] showed a significant difference relating to VO2 max and anaerobic threshold

VO2.4” Also, there was significant improvement in depression, exercise tolerance, aerobic

capacity, and quality of life.The last study performed by Yuen and Bagley determined that

aerobic training can increase aerobic capacity, increase maximal oxygen consumption, decrease

fatigue, improve sleep quality, decrease anxiety, and decrease depression. All four articles show

similar results in that aerobic training is a successful intervention to increase the quality of life of

those living with SLE.

As for the recommended duration and frequency of aerobic training, all four studies had

twelve week interventions. As for the session time, Prado et al. had treatment sessions lasting

twenty to fifty minutes, Clarke-Jensen et al. had sessions lasting twenty-five to forty minutes, P.

de Carvalho et al. had sixty minute training sessions, and Yuen and Bagley’s sessions lasted for

thirty minutes. Even though the training session time was variable amongst the studies, the
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average treatment time was around thirty-seven minutes; as long as the training session is near

thirty minutes, positive outcomes should happen. As for the training frequency, three studies had

sessions occurring three times a week and one study had sessions twice a week. The type of

aerobic training was similar amongst all studies with the common aerobic exercise being the

treadmill. Yuen and Bagley also included cycling and water aerobics. Prado et al. and Yuen and

Bagley both incorporated stretching in addition to aerobic training; both studies having positive

outcomes. Since each study had successful outcome measures with their aerobic training

interventions, any combination of duration and frequency will provide symptom relief and

positive health benefits for SLE.

In conclusion, aerobic training is an effective intervention for populations with SLE. My

recommended aerobic training protocol would include thirty to sixty minute training sessions,

depending on how the patient is feeling on the particular day. The patient will train at 60 to 70%

of their maximum heart rate, and training will occur three days a week for a total of twelve

weeks. I would primarily use a treadmill for training due to positive outcomes and results;

however, it would be beneficial to include cycling and water aerobics to provide more variability

and keep training interesting and enjoyable. Hopefully the patient experiences significant

symptom relief and will incorporate aerobic training as a lifestyle to maintain symptom relief and

experience the overall health benefits. “Whatever your level of fitness, exercise helps. But don’t

go it alone…talk to a physical therapist (PT) or occupational therapist (OT), who will evaluate

your flexibility, strength, balance, and overall function and tailor an exercise program that’s right

for you…‘Input from a PT or OT is incredibly valuable,’ says [Dr. Terry] Wahls.1”

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Reference List

1. Lupus Foundation of America. What is lupus? National Resource Center On Lupus. https://
resources.lupus.org/entry/what-is-lupus. Accessed October 21, 2017.

2. Prado DML, Benatti FB, de Sá-Pinto AL, et al. Exercise training in childhood-onset systemic
lupus erythematosus: a controlled randomized trial. Arthritis Research & Therapy.
2013;15:R46. https://arthritis-research.biomedcentral.com/articles/10.1186/ar4205. Accessed
October 25, 2017.

3. Clarke-Jensen AC, Fredriksen PM, Lilleby V, Mengshoel AM. Effects of supervised aerobic
exercise in patients with systemic lupus erythematosus: a pilot study. Arthritis Care &
Research. 2005;53(2):308-312. http://onlinelibrary.wiley.com.cmich.idm.oclc.org/doi/
10.1002/art.21082/full. Accessed October 26, 2017.

4. P. de Carvalho MR, Sato EI, Tebexreni AS, Heidecher RTC, Schenkman S, Barros Neto AS.
Effects of supervised cardiovascular training program on exercise tolerance, aerobic
capacity, and quality of life in patients with systemic lupus erythematosus. Arthritis Care &
Research.53(6);2005:838-844. http://onlinelibrary.wiley.com.cmich.idm.oclc.org/doi/
10.1002/art.21605/full. Accessed October 26, 2017.

5. Yuen EP, Bagley JR. Exercise benefits and considerations for individuals with systemic
lupus erythematosus. Strength and Conditioning Journal. 2016;38(6):69-75. Accessed
October 21, 2017.