To study the effects of a one-year physical activity programme on aerobic capacity, physical activity and health-related quality of life (HRQL) in patients with systemic lupus erythematosus (SLE) by a randomized control design.
Methods
Thirty-five women with low or moderate disease activity and organ damage were randomized to intervention (I) or control (C) group. The intervention during months 0–3 consisted of education, supervised aerobic exercise at high intensity and individual coaching, as well as self-managed physical activity at low-to-moderate intensity. During months 4–12, the physical activity was self-managed and the coaching was successively reduced over time. Outcome measures included: maximal oxygen uptake (VO2 max) from a bicycle ergometer test, self-reported physical activity and HRQL (SF-36).
Results
VO2 at sub-max. and max. increased, independent of group, during the one-year study period (main effect of time p < 0.0001). VO2 max. increased between baseline and month 3 (p < 0.0001), between months 3 and 6 (p = 0.01) and the increase was sustained at month 12 (ns). Frequency of physical activity at high intensity also increased, independent of group, during the study period. It was increased at months 3, 6 and 12 compared to baseline (p = 0.02, p < 0.001, p = 0.03). Improvement in mental health between baseline and month 6 (p = 0.002) was seen for the I-group, not the C-group (p = 0.03). Disease activity and organ damage did not change.
Conclusions
Physical activity and aerobic capacity increased after supervised exercise and coaching, and the improvement was sustained during the one-year programme. However, no interactions between the group differences were seen, which suggests that repeated measurements could motivate to increased physical activity and thereby to increased aerobic capacity. As sub-max. VO2 increased over time, training-induced changes in VO2 on-kinetics could be another explanation. Little influence on HRQL was seen after the programme. The study indicates that physical activity at high intensity over one year is tolerated by patients with mild to moderate SLE.
BruceINUrowitzMBGladmanDDIbañezDSteinerG. Risk factors for coronary heart disease in women with Systemic Lupus Erythematosus. The Toronto risk factor study. Arthitis Rheum2003; 48: 3159–3167.
2.
ManziSMeilahnENRairieJE. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol1997; 145: 408–415.
3.
GoldbergRJUrowitzMBIbañezDNikpourMGladmanDD. Risk factors for development of coronary artery disease in women with Systemic Lupus Erythematosus. J Rheumatol2009; 36: 2454–2461.
4.
HaskellWLLeeIMPateRR. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc2007; 39: 1423–1434.
5.
Physical activity guidelines advisory committee report, 2008. To the secretary of Health and Human Services. Part A: executive summary. Nutr Rev2009; 67: 114–120.
6.
GarberCEBlissmerBDeschenesMR. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc2011; 43: 1334–1359.
7.
LakkaTAVenäläinenJMRauramaaRSalonenRTuomilehtoJSalonenJT. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infraction in men. N Engl J Med1994; 330: 1549–1554.
8.
MurtaghEMNicholsLMohammedMAHolderRNevillAMMurphyMH. The effect of walking on risk factors for cardiovascular disease: An updated systematic review and meta-analysis of randomised control trials. Prev Med2015; 72C: 34–43.
9.
MoraSCookNBuringJERidkerPMLeeIM. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation2007; 116: 2110–2118.
10.
Ekblom-BakEHelléniusMLEkblomOEngströmMEkblomB. Independent associations of physical activity and cardiovascular fitness with cardiovascular risk in adults. Eur J Cardiovasc Prev Rehabil2010; 17: 175–180.
11.
StocktonKAKandiahDAParatzJDBennellKL. Fatigue, muscle strength and vitamin D status in women with systemic lupus erythematosus compared to healthy controls. Lupus2012; 21: 271–278.
12.
BalsamoSdos Santos-NetoL. Fatigue in systemic lupus erythematosus: An association with reduced physical fitness. Autoimmun Rev2011; 10: 514–518.
13.
BalsamoSda MotaLMde CarvalhoJF. Low dynamic muscle strength and its associations with fatigue, functional performance, and quality of life in premenopausal patients with systemic lupus erythematosus and low disease activity: a case-control study. BMC Musculoskelet Disord2013; 14: 263.
14.
AyánCMartínV. Systemic lupus erythematosus and exercise. Lupus2007; 16: 5–9.
15.
BoströmCDupréBTengvarPJanssonEOpavaCHLundbergIE. Aerobic capacity correlates to self-assessed physical function but not to overall disease activity or organ damage in women with systemic lupus erythematosus with low-to-moderate disease activity and organ damage. Lupus2008; 17: 100–104.
16.
ErikssonKSvennungssonEKarreskogH. Physical activity in patients with systemic lupus erythematosus and matches controls. Scand J Rheumatol2012; 41: 290–297. .
17.
TuressonCMattesonEL. Cardiovascular risk factors, fitness and physical activity in rheumatic diseases. Curr Opin Rheumatol2007; 19: 190–196.
18.
Mc ElhoneKAbbottJTehLS. A review of health related quality of life in systemic lupus erythematosus. Lupus2006; 15: 633–643.
19.
ThumbooJStrandV. Health-related quality of life in patients with systemic lupus erythematosus: an update. Ann Acad Med Singapore2007; 36: 115–122.
20.
BizeRJohnsonJAPlotnikoffRC. Physical activity level and health-related quality of life in the general adult population: a systematic review. Prev Med2007; 45: 401–415.
21.
WarburtonDECharlesworthSIveyANettlefoldLBredinSS. A systematic review of the evidence for Canadás Physical Activity Guidelines for Adults. Int J Behav Nutr Phys Act2010; 7: 39.
22.
BlairSNKampertJBKohlHW 3rd. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA1996; 276: 205–210.
23.
VolkmannERGrossmanJMSahakianLJ. Low physical activity is associated with proinflammatory high-density lipoprotein and increased subclinical atherosclerosis in women with systemic lupus erythematosus. Arthritis Care Res2010; 62: 258–265.
24.
BarnesJNTanakaH. Cardiovascular benefits of habitual exercise in systemic lupus erythematosus: a review. Phys Sportsmed2012; 40: 43–48.
25.
BarnesJNNualnimNDhindsaMRenziCPTanakaH. Macro- and microvascular function in habitually exercising systemic lupus erythematosus patients. Scand J Rheumatol2014; 43: 209–216.
26.
PerandiniLASales-de-OliveiraDMelloSB. Exercise training can attenuate the inflammatory milieu in women with systemic lupus erythematosus. J Appl Physiol2014; 117: 639–647.
27.
dos Reis-NetoETda SilvaAEMonteiroCMde CamargoLMSatoEI. Supervised physical exercise improves endothelial function in patients with systemic lupus erythematosus. Rheumatology (Oxford)2013; 12: 2187–2195.
28.
MiossiRBenattiFBde Sá PintoAL. Using exercise training to counterbalance chronotropic incompetence and delayed heart rate recovery in systemic lupus erythematosus: a randomized trial. Arthritis Care Res2012; 64: 1159–1166.
29.
de CarvalhoMRPSatoEITebexreniASHeidecherRTCSchenkmanSBarros NetoTL. Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity and quality of life in patients with systemic lupus erythematosus. Arthritis Rheum2005; 53: 838–844.
30.
Clarke-JenssenACFredriksenPMLillebyVMengshoelAM. Effects of supervised aerobic exercise in patients with systemic lupus erythematosus: A pilot study. Arthritis Rheum2005; 53: 308–312.
31.
Robb-NicholsonLCDaltroyLEatonH. Effects of aerobic conditioning in lupus fatigue: A pilot study. Br J Rheum1989; 28: 500–505.
32.
TenchCMMcCarthyJMcCurdieIWhitePDĎCruzDP. Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise. Rheumatology2003; 42: 1050–1054.
33.
YuenHKHolthausKKamenDLSwordDOBrelandHL. Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: A pilot study. Lupus2011; 20: 1293–1299.
34.
BertsiasGIoannidisJPBoletisJ. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis2008; 67: 195–205.
35.
BradyTJKrugerJHelmickCGCallahanLFBoutaughML. Intervention programs for arthritis and other rheumatic diseases. Health Educ Behav2003; 30: 44–63.
36.
Vliet VlielandTPvan den EndeCH. Nonpharmacological treatment of rheumatoid arthritis. Curr Opin Rheumatol2011; 23: 259–264.
37.
HurkmansEJvan den BergMHRondayKHPeetersAJle CessieSVlielandTP. Maintenance of physical activity after Internet-based physical activity interventions in patients with rheumatoid arthritis. Rheumatology (Oxford)2010; 49: 167–172.
38.
FjeldsoeBNeuhausMWinklerEEakinE. Systematic review of maintenance of behaviour change following physical activity and dietary interventions. Health Psychol2011; 30: 99–109.
39.
LindnerHMenziesDKellyJTaylorSShearerM. Coaching for behavior change in chronic disease: A review of the literature and the implications for coaching as a self-management intervention. Austr J Prim Health2003; 9: 177–185.
40.
PalmerSTubbsIWhybrowA. Health coaching to facilitate the promotion of health behavior and achievement of health-related goals. Int J Health Promot Educ2003; 41: 91–93.
41.
ConnVSHafdalARMinorMANielsenPJ. Physical activity interventions among adults with arthritis: meta-analysis of outcomes. Sem Arthritis Rheum2008; 37: 307–316.
MichieSAbrahamCWhittingtonCMcAteerJGuptaS. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol2009; 28: 690–701.
44.
TanEMCohenASFriesJF. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1982; 25: 1271–1277.
45.
BanduraA. Human agency in social cognitive theory. Am Psychol1989; 44: 1175–1184.
46.
DzewaltowskiDA. Physical activity determinants: a social cognitive approach. Med Sci Sports Exerc1994; 26: 1395–1399.
47.
BaranowskiTPerryCLParcelGHow individuals, environments, and health behaviors interact: social cognitive theory. In: GlanzLKRimerFM (eds). Health behavior and health education: Theory, Research and Practice, 3rd ed. San Francisco, CA: Jossey-Bass, 2002, pp. 246–279.
48.
BrodinNEureniusEJensenINisellROpavaCHThe PARA Study Group. Coaching patients with early rheumatoid arthritis to healthy physical activity: A multicenter, randomized, controlled study. Arthritis Rheum2008; 59: 325–331.
49.
SjöquistESBrodinNLampaJOpavaCHThe PARA Study Group. Physical activity coaching of patients with rheumatoid arthritis in everyday practice: a long term follow-up. Musculoskel Care2011; 9: 75–85.
50.
BorgG. Borg's perceived exertion and pain scales, Champaign, IL: Human Kinetics, USA, 1998, pp. 1–120. .
51.
WassermanKHansenJESueDYStringerWWWhippBJ. Principles of exercise testing and interpretation: Including pathophysiology and clinical applications, 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2004.
52.
Wisén A. Assessment of aerobic capacity a novel rating scale and further development of an exercise test including analysis of gas exchange. Thesis, Lund University, Sweden, 2004.
53.
PateRRPrattMBlairSN. Physical activity and public health. A recommendation from the centers for disease control and prevention and the American college of sports medicine. JAMA1995; 273: 402–7.
54.
BoströmCKarreskogHErikssonKBergströmMSvenungssonE. Reliability and validity of a questionnaire assessing different aspects of physical activity in patients with systemic lupus erythematosus. Ann Rheum Dis2011; Suppl 3: 70, (Abstract).
55.
SullivanMKarlssonJWareJEJr. The Swedish SF-36 Health Survey – I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med1995; 41: 1349–1358.
56.
WareJEJrSherbourneCD. The MOS 36-item short-form health survey (SF-36). I Conceptual framework and item selection. Med Care1992; 30: 473–483.
57.
CastelinoMAbbottJMcElhorneKTehLS. Comparison of the psychometric properties of health-related quality of life measures used in adults with systemic lupus erythematosus: a review of the literature. Rheumatology (Oxford)2013; 52: 684–696.
58.
GriffithsBMoscaMGordonC. Assessment of patients with systemic lupus erythematosus and the use of lupus disease activity indices. Best Pract Res Clin Rheumatol2005; 19: 685–708.
59.
GreenBBMcAfeeTHindmarshMMadsenLCaplowMBuistD. Effectiveness of telephone support in increasing physical activity levels in primary care patients. Am J Prev Med2002; 22: 177–183.
60.
MayerJAJermanovichAWrightBLElderJPDrewJAWilliamsSJ. Changes in health behaviors of older adults: the San Diego Medicare Preventive Health Project. Prev Med1994; 23: 127–133.
61.
AittasaloMMiilunpaloSKukkonen-HarjulaKPasanenM. A randomized intervention of physical activity promotion and patient self-monitoring in primary health care. Prev Med2006; 42: 40–46.
62.
WaseniusNVenojärviMManderoosS. Unfavorable influence of structured exercise program on total leisure-time physical activity. Scand J Med Sci Sports2014; 24: 404–413.
63.
LarkinLGallagherSCrampFBrandCFraserAKennedyN. Behaviour change interventions to promote physical activity in rheumatoid arthritis: a systematic review. Rheum Int2015; 35: 1631–40.
64.
Van den BergMHRondayHKPeetersAJ. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trail. Arthritis Rheum2006; 55: 935–945.
65.
van SluijsEMvan PoppelMNTwiskJWvan MechelenW. Physical activity measurements affected participants’ behavior in a randomized controlled trial. J Clin Epidemiol2006; 59: 404–411.
66.
BouchardCAnPRiceT. Familial aggregation of VO2 max response to exercise training: results from the HERITAGE Family Study. J Appl Physiol1999; 87: 1003–1008.
67.
GormleySESwainDPHighR. Effect of intensity of aerobic training on VO2max. Med Sci Sports Exerc2008; 40: 1336–1343.
68.
HicksonRCBomzeHAHollozyJO. Faster adjustment of O2 uptake to the energy requirement of exercise in the trained state. J Appl Physiol Eviron Exerc Physiol1978; 44: 877–881.
69.
KeyserRERusVMikdashiJAHandwergerBS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus. Arch Phys Med Rehabil2010; 91: 1402–1409.
70.
CarterJBBanisterEWBlaberAP. Effect of endurance exercise on automatic control of heart rate. Sports Med2003; 33: 33–46.
71.
VanheesLLefevreJPhilippaertsR. How to assess physical activity? How to assess physical fitness?Eur J Cardiovasc Prev Rehabil2005; 12: 102–114.
72.
BaumanAPhongsavanPSchoeppeSOwenN. Physical activity measurement – a primer for health promotion. Promot Educ2006; 13: 92–103.
