Exercise training in childhood-onset systemic lupus erythematosus: a controlled randomized trial

Danilo Ml Prado,Clovis A Silva,Rosa Mr Pereira,Hamilton Roschel,Ana P Hayashi,Ana L De Sá-Pinto,Eloisa Bonfá,Fabiana B Benatti,Adriana Me Sallum,Bruno Gualano

doi:10.1186/ar4205

Abstract

IntroductionExercise training has emerged as a promising therapeutic strategy to counteract physical dysfunction in adult systemic lupus erythematosus. However, no longitudinal studies have evaluated the effects of an exercise training program in childhood-onset systemic lupus erythematosus (C-SLE) patients. The objective was to evaluate the safety and the efficacy of a supervised aerobic training program in improving the cardiorespiratory capacity in C-SLE patients.MethodsNineteen physically inactive C-SLE patients were randomly assigned into two groups: trained (TR, n = 10, supervised moderate-intensity aerobic exercise program) and non-trained (NT, n = 9). Gender-, body mass index (BMI)- and age-matched healthy children were recruited as controls (C, n = 10) for baseline (PRE) measurements only. C-SLE patients were assessed at PRE and after 12 weeks of training (POST). Main measurements included exercise tolerance and cardiorespiratory measurements in response to a maximal exercise (that is, peak VO2, chronotropic reserve (CR), and the heart rate recovery (ΔHRR) (that is, the difference between HR at peak exercise and at both the first (ΔHRR1) and second (ΔHRR2) minutes of recovery after exercise).ResultsThe C-SLE NT patients did not present changes in any of the cardiorespiratory parameters at POST (P > 0.05). In contrast, the exercise training program was effective in promoting significant increases in time-to-exhaustion (P = 0.01; ES = 1.07), peak speed (P = 0.01; ES = 1.08), peak VO2 (P = 0.04; ES = 0.86), CR (P = 0.06; ES = 0.83), and in ΔHRR1 and ΔHRR2 (P = 0.003; ES = 1.29 and P = 0.0008; ES = 1.36, respectively) in the C-SLE TR when compared with the NT group. Moreover, cardiorespiratory parameters were comparable between C-SLE TR patients and C subjects after the exercise training intervention, as evidenced by the ANOVA analysis (P > 0.05, TR vs. C). SLEDAI-2K scores remained stable throughout the study.ConclusionA 3-month aerobic exercise training was safe and capable of ameliorating the cardiorespiratory capacity and the autonomic function in C-SLE patients.Trial registrationNCT01515163.

Highlights

Exercise training has emerged as a promising therapeutic strategy to counteract physical dysfunction in adult systemic lupus erythematosus
Exercise training has emerged as a potential non-pharmacological therapeutic strategy to counteract physical dysfunction in adult Systemic lupus erythematosus (SLE) [8,9,14,15,16], no studies have been conducted with childhood-onset systemic lupus erythematosus (C-SLE) patients
We recently demonstrated that a threemonth supervised aerobic training program was effective in improving the aerobic capacity and the physical function of a 15-year-old boy with C-SLE associated with secondary antiphospholipid syndrome [25]

Summary

Introduction

Exercise training has emerged as a promising therapeutic strategy to counteract physical dysfunction in adult systemic lupus erythematosus. SLE patients commonly present a reduced exercise capacity and physical function [8,9,10,11,12], which may further increase CVD and mortality risk [13] In this context, exercise training has emerged as a potential non-pharmacological therapeutic strategy to counteract physical dysfunction in adult SLE [8,9,14,15,16], no studies have been conducted with C-SLE patients. It is well-known that exercise-induced adaptations largely differ between adults and children This holds true for a variety of training variables, including (but not limited to) maximal aerobic capacity, mechanical efficiency and economy of movement, anaerobic capacity, exercise recovery, cardiovascular response, strength, immune response, morphological adaptations, detraining, metabolic responses, thermal regulation, etcetera. In light of these factors, one may suggest that the exercise training-induced outcomes found in the adult SLE population cannot be promptly generalized to C-SLE, warranting studies in this specific population

Objectives

Methods

Results

Discussion

Conclusion