Background Systemic lupus erythematosus (SLE) is associated with musculoskeletal complaints, fatigue and reduced quality of life. Physical exercise can play a crucial role in the treatment of rheumatic diseases, optimizing both physical and mental health.
Objectives To characterize physical activity (PA) and its impact on SLE patients.
Methods 85 SLE outpatients (92% female; age 44.2±12.5; 57.5% with SLEDAI score ≤5, 42.5% with SLEDAI score ≥6) were included in this study. The following questionnaires were utilized: painDETECT, visual analog scale for pain (VAS 0 - 100 mm), short-form health survey (SF - 36, quality of life), the FACIT-Fatigue Scale and the Health Assessment Questionnaire (HAQ - DI). PA was assessed for every patient using the long form of International Physical Activity Questionnaire (IPAQ - LF) and the Metabolic Equivalent of Task (MET) minutes per week (min/wk) (physiological measurement expressing calories of physical activities). The participants were classified in 3 groups according to the PA levels conferring to the guidelines of IPAQ. Physical inactivity was defined as fewer than 150 min/week spent in moderate or vigorous physical activities. Furthermore, the patient reasons “to be not physical active” and their opinion regarding the influence of PA on disease-related symptoms (on a scale of 0–10) were obtained.
Results 10.6% of SLE patients were physically inactive (525.2±277.3 MET-Min/wk), 31.8% had a moderate physical activity, and 57.6% were physically active. Physical inactivity was associated with higher fatigue (FACIT-F, p<0.04) and lower “vitality” (SF-36, p<0.03) scores. Moreover, the subjective impact of fatigue on PA was significantly higher in physically inactive patients compared to physically active patients (the patient's score: 7.75±1.25 vs. 5.5±0.94, p<0.04). Moderate and severe pain (more than 40 mm VAS) was also associated with physical inactivity (OR 12.38, 95% CI 1.69 to 144.3, p=0.0056). In contrast, HAQ-DI was not related to levels of PA. Although physical inactivity correlated with a higher total disease activity score (SLEDAI ≥6) (OR 9.9, 95% CI 2.1 to 49.9, p=0.0056), neither of the single SLEDAI items and organ manifestations including musculoskeletal manifestations was associated with physical inactivity. Interestingly, the study could not detect any statistical difference in organ manifestations and SLEDAI scores between patients with moderate and high PA. According to the patient's report, the main SLE-related reasons “not to be physically active” for all three groups were “lupus flare” (35.6%), “fatigue” (26.9%) as well as “joint complaints” (15.7%). The main general barriers for PA were “comorbidity” (35,6%) and “lack of motivation” (26,9%). Furthermore, the subjective impact of “bad weather conditions” on physical activity was significantly greater in physically inactive patients compared with the two other groups (the patient's report: 6.58±2.3 vs. 3.49±0.7, p<0.03).
Conclusions The main reason for the patients not to be physically active was fatigue and pain. The study also indicates that not only somatic symptoms could decrease the levels of PA in SLE patients. Further research on psychological factors is needed. The study underlines the need for management strategies that specifically target physical activity as a part of an overall SLE management program.
Disclosure of Interest None declared
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