Aerobic fitness, fatigue, and physical disability in systemic lupus erythematosus. A pilot study on the effects of exercise in patients with systemic lupus erythematosus. Assessments of fatigue and disease activity in patients with systemic lupus erythematosus enrolled in the Phase 2 clinical trial with blisibimod Effects of dehydroepiandrosterone on fatigue and well-being in women with quiescent systemic lupus erythematosus: a randomised controlled trial Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise. Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity, and quality of life in patients with systemic lupus erythematosus. Placebo-controlled randomized clinical trial of fish oil’s impact on fatigue, quality of life, and disease activity in Systemic Lupus Erythematosus Factors determining participation in prevention trials among systemic lupus erythematosus patients: a qualitative study.
OBJECTIVE To measure aerobic fitness , muscle strength , fatigue , and physical disability in patients with systemic lupus erythematosus ( SLE ) . METHODS Ninety-three patients with SLE and 41 sedentary controls were recruited into the study . Aerobic fitness was assessed by monitoring peak and submaximal oxygen uptake , heart rate , duration of exercise , and perceived exertion during a treadmill-walking test . Strength was measured using voluntary isometric quadriceps contraction . Symptomatic measures included physical and mental fatigue , mood , sleep , and functional incapacity . RESULTS Compared to sedentary controls patients with SLE had significantly reduced levels of aerobic fitness ( mean VO2peak SLE patients , 23.2 ml/kg/min vs controls , 29.6 ml/kg/min ; p < 0.001 ) and reduced exercise capacity ( mean exercise duration SLE patients , 10.4 min vs controls , 13.1 min ; p < 0.001 ) . The SLE patients also had reduced muscle strength ( mean maximum voluntary quadriceps contraction SLE patients , 298 N vs controls , 376 N ; p = 0.003 ) . Resting lung function was also significantly worse in the SLE patients ( mean FEV , SLE patients , 2.6 l vs controls , 2.9 l ; p = 0.002 ) . Fatigue ( p < 0.001 ) , depressed mood ( p < 0.001 ) , poor sleep quality ( p < 0.001 ) , and functional incapacity ( p < 0.001 ) were all significantly greater in the SLE patients . Linear regression models suggested that physical disability correlated with aerobic fitness ( p < 0.001 ) , fatigue ( p = 0.005 ) , body mass index ( p = 0.01 ) , and depression ( p = 0.05 ) and that fatigue correlated with depression ( p < 0.001 ) . CONCLUSION Patients with SLE were less fit with reduced exercise capacity , reduced muscle strength , more fatigue , and greater disability compared to sedentary controls . Treatments developed to manage depression and improve aerobic fitness should be considered in the overall treatment of fatigue and disability in SLE OBJECTIVE A pilot study was design ed to assess the efficacy and safety of different exercise therapies on  patient-reported fatigue and functional status .  METHODS Ten patients with systemic lupus erythematosus ( SLE ) were r and omly placed in either an aerobic exercise group ( group 1 : n = 5 ) or a range of motion/muscle strengthening ( ROM/MS ) exercise group ( group 2 : n = 5 ) . Outcome measures assessed at baseline and the end of the study were fatigue , functional status , disease activity , cardiovascular fitness , isometric strength , bone mineral density ( BMD ) of the lumbar spine and femoral neck , and parathyroid hormone and osteocalcin as representative bone biochemical markers for bone resorption and bone formation , respectively . RESULTS Both aerobic and ROM/MS types of exercise were safe and did not worsen SLE disease activity . Patients in both exercise groups showed some improvement in fatigue , functional status , cardiovascular fitness , and muscle strength . Both groups showed increased bone turnover , but BMD was unchanged . Eighty percent of the patients met the compliance st and ard for the study . CONCLUSIONS This pilot study shows the feasibility of exercise for SLE patients . The potential value of this approach shows promise in the routine management of these patients This report evaluates the effects of blisibimod ( A-623 , AMG 623 ) , a potent and selective inhibitor of B-cell activating factor ( BAFF ) , on patient-reported fatigue and disease activity in the Phase 2b PEARL-SC clinical trial in patients with systemic lupus erythematosus ( SLE ) . A total of 547 individuals who met the American College of Rheumatology ( ACR ) classification criteria for SLE , were positive for anti-double-str and ed DNA or antinuclear antibodies , and had a Safety of Estrogens in Lupus Erythematosus National Assessment -Systemic Lupus Erythematosus Disease Activity Index ( SELENA-SLEDAI ) score ≥6 at baseline , were r and omized to receive placebo or blisibimod for at least 24 weeks . Patient self-reported fatigue was evaluated using the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale , and disease activity was evaluated using Physician ’s Global Assessment , SELENA-SLEDAI , and British Isles Lupus Assessment Group Score . Statistically significant improvements in FACIT-Fatigue score were observed among individuals r and omized to blisibimod , especially in the 200 mg QW group where favorable effects on disease activity with blisibimod compared to placebo were observed as early as Week 8 . The mean improvement from baseline of 6.9 points at Week 24 , compared with 4.4 points with placebo , met the criteria for minimal clinical ly important improvement difference defined for patients with SLE . Despite concomitant improvements in FACIT-Fatigue , SLE Responder Index ( SRI ) and SLE biomarkers ( reported previously ) , FACIT-Fatigue score correlated only weakly with disease activity . While poor correlation between fatigue and disease activity is not new , the observation that correlation remains poor despite concurrent population improvements in disease and fatigue brings a new facet to our underst and ing of SLE Objective Dehydroepi and rosterone ( DHEA ) has been reported to improve fatigue and reduced well-being . Both are major problems in patients with systemic lupus erythematosus ( SLE ) , even with quiescent disease . Low serum DHEA levels are common in SLE . The present work investigates the effects of DHEA administration on fatigue , well-being and functioning in women with inactive SLE . Methods In a double-blind , r and omised , placebo-controlled study , 60 female patients with inactive SLE received 200 mg oral DHEA or placebo . Primary outcome measures were general fatigue , depressive mood , mental well-being and physical functioning . Assessment s were made before treatment , after 3 , 6 and 12 months on medication , and 6 months after cessation of treatment . Results Patients from the DHEA and placebo group improved on general fatigue ( p<0.001 ) and mental well-being ( p=0.04 ) . There was no differential effect of DHEA .  The belief that DHEA had been used was a stronger predictor for improvement of general fatigue than the actual use of DHEA ( p=0.04 ) . Conclusions The trial does not indicate an effect of daily 200 mg oral DHEA on fatigue and well-being , and therefore DHEA treatment is not recommended in unselected female patients with quiescent SLE . Clinical Trials Registration Number OBJECTIVE To test the efficacy of a grade d aerobic exercise programme in treating  fatigue in systemic lupus erythematosus . METHODS Ninety-three patients with systemic lupus erythematosus without active disease in any major organ were r and omized , using a minimization protocol , to 12 weeks of grade d exercise therapy , relaxation therapy or no intervention . RESULTS Analysis by intention to treat showed that 16 of the 33 ( 49 % ) patients in the exercise group rated themselves as ' much ' or ' very much ' better compared with eight out of 29 ( 28 % ) in the relaxation group and five out of 32 ( 16 % ) in the control group ( chi2=8.3 , df=2 , P=0.02 ) . Fatigue improved significantly on one out of three measures after exercise therapy and there was a trend for fatigue to improve on all measures after exercise . CONCLUSION These findings support the use of appropriately prescribed grade d aerobic exercise in the management of patients with fatigue and systemic lupus erythematosus OBJECTIVE To determine if supervised cardiovascular training improves exercise tolerance , aerobic capacity , depression , functional capacity , and quality of life in patients with systemic lupus erythematosus ( SLE ) . METHODS Sixty women with SLE ( ages 18 - 55 years ) were evaluated using Short Form 36 , visual analog scale for pain , scale for fatigue , Beck Depression Inventory , and Health Assessment Question naire ( HAQ ) , and participated in a training protocol of incremental load on a treadmill with computed gas metabolic analysis .  Maximum oxygen consumption ( VO(2max ) ) and anaerobic threshold VO(2 ) were calculated with a SensorMedics Vmax29C analyzer ( Sensor Medics , Yorba Linda , CA ) , and heart rate was measured by electrocardiogram . Patients were divided into 2 groups : a training group ( 41 patients ) that participated in the supervised cardiovascular training program and a control group ( 19 patients ) that did not participate in the program . All variables were analyzed at baseline and after 12 weeks for both groups . The training program occurred in the morning for 60 minutes , 3 times a week for 12 weeks . Statistical analysis included Wilcoxon 's rank sum test , Mann-Whitney U test , chi-square test , and Fisher 's exact test . P values < 0.05 were considered to be statistically significant . RESULTS The 2 groups were homogeneous and comparable at baseline . The training group showed a significant improvement of aerobic capacity measured by anaerobic threshold VO(2 ) ( 14.67 + /- 3.03 versus 17.08 + /- 3.35 ml/kg/minute , P < 0.001 ) . Comparison of the training group and control group after 12 weeks showed a significant difference relating to VO(2max ) ( 24.31 + /- 4.61 versus 21.21 + /- 3.88 ml/kg/minute , P = 0.01 ) and anaerobic threshold VO(2 ) ( 17.08 + /- 3.35 versus 13.66 + /- 2.82 ml/kg/minute , P < 0.0001 ) . After cardiovascular training , we found a significant improvement of Beck inventory score ( 8.37 + /- 12.79 versus 2.90 + /- 3.00 , P < 0.001 ) and HAQ score ( 0.14 + /- 0.21 versus 0.06 + /- 0.19 , P < 0.01 ) in the training group . CONCLUSION This study showed significant improvement in exercise tolerance , aerobic capacity , quality of life , and depression after a supervised cardiovascular training program in patients with SLE Introduction A recent metabolomic screen of sera from patients with Systemic Lupus Erythematosus ( SLE ) found reduction of antioxidants and substrates for energy generation . These metabolic alterations may underlie one of the most common features of SLE - fatigue . The metabolomic studies also noted reduced omega-3 fatty acids , which are powerful anti- oxidants . This deficiency may be causally related to oxidative stress , inflammation , disease activity , and fatigue in SLE . Supplementation of omega-3 fatty acids using fish oil in SLE has been shown to reduce oxidative stress in other studies . The objective of this study is to evaluate the effect of fish oil supplementation on clinical measures of fatigue , quality of life , and disease activity as part of a r and omized clinical trial . Methods Fifty SLE patients recruited in outpatient clinics were r and omized 1:1 to fish oil supplementation or olive oil placebo , and blinded to their treatment group . At baseline and after 6 months of treatment , R AND Short Form-36 ( R AND SF-36 ) , Fatigue Severity Scale ( FSS ) , SLE Disease Activity Index ( SLEDAI ) , and Physician Global Assessment ( PGA ) were completed ; serum was also collected for soluble mediator analysis . Results Thirty-two patients completed the study .  PGA improved significantly in the fish oil group compared with the placebo group ( p = 0.015 ) . The R AND SF-36 Energy/fatigue and Emotional well-being scores demonstrated improvement trends ( p = 0.092 and 0.070 ) . No clear difference was seen in FSS and SLEDAI ( p = 0.350 and p = 0.417 ) . Erythrocyte sedimentation rate and serum IL-12 were reduced ( p = 0.008 and p = 0.058 ) ; while serum IL-13 was increased by fish oil supplementation ( p = 0.033 ) . Conclusions In this r and omized , placebo-controlled 6-month trial , SLE patients r and omized to fish oil supplementation demonstrated improvement in their PGA , R AND SF-36 , and some circulating inflammatory markers . Trial registration Clinical Trials.gov Identifier : NCT02021513 ( registered 13 December 2013 ) OBJECTIVE A feasibility study for a trial of strategies for the prevention of atherosclerosis in patients with systemic lupus erythematosus ( SLE ) was stopped because of inadequate recruitment . There is little underst and ing of the factors influencing patients ' decisions about participation in prevention trials . Our goal was to determine factors that patients with SLE consider in deciding about participating in prevention trials , to uncover concerns about SLE trials , and to investigate how study design and purpose affect participation decisions . METHODS We conducted focus groups with trial participants ( n = 13 ) , trial non participants ( n = 8) , and a group of patients with diabetes ( n = 9 ) . We conducted telephone interviews with SLE patients who refused participation in the trial and the focus groups ( n = 10 ) . A trained facilitator elicited factors influencing participation decisions . Transcripts were coded and grouped into themes using grounded theory . RESULTS Demographic characteristics of the groups were similar . Seven factors emerged as important in decision making : current health status , study design , physician involvement , personal benefit , altruism , time , and incentives . These factors were considered by individuals who elected to participate and those who did not , but weighed differently . Among the trial participants , good health status , encouragement from one 's physician , and desires to learn and to contribute stimulated participation . Reasons for nonparticipation included current health status , medication and r and omization concerns , and personal factors . CONCLUSION We observed that similar factors were weighed differently by participants and non participants . Our results suggest that strategies such as health education , enlistment of personal physicians , and limitation of time requirements may enhance recruitment of patients with SLE into clinical prevention trials
The subgroup analysis indicated that 12 weeks of exercise training and exercise under a supervised setting significantly benefited fatigue .
Linking Evidence to Action : The pooled data indicate that 12 weeks of an aerobic exercise program that is supervised by health professionals could reduce fatigue and increase vitality for patients with SLE .
Background : Fatigue is the most common and unpleasant symptom of patients with systemic lupus erythematosus ( SLE ) .
However , there is limited information regarding how exercise affects fatigue .
Aims : The purpose of this study is to review and synthesize the current knowledge concerning the effectiveness of exercise training for treating fatigue  among adults with SLE .
The characteristics of beneficial exercise training are further evaluated .