Staying active is the key to improving outcomes
When your rheumatologist asks you, “Are you getting enough exercise?” what’s your response? For many with lupus, the answer may be “no.” It’s not lack of desire that’s holding people back, though. Research has shown that people with lupus believe in the benefits of physical activity. But they have concerns about becoming overly fatigued, being overexposed to sunlight, and getting injured during exercise.
Yet, those concerns likely come second to the fact that many with lupus experience muscle weakness and muscle pain that can be severe. The muscles are the most common target of lupus inflammation, and many people are unable to complete basic exercises, such as leg lifts while seated, or a simple stretching routine. This lack of activity, though, can lead to eventual disability.
To better understand the relationship between muscle strength and the factors that can lead to physical disability in lupus, James S. Andrews, MD; Patricia P. Katz, PhD; and fellow researchers at the University of California, San Francisco, and the Veterans Affairs Medical Center in San Francisco conducted a study of 146 women with lupus. They measured the women’s leg muscle strength with knee extension and flexibility exercises and by chair-stand time—the time it takes to stand up from a standard chair without using one’s arms, sit back down, and repeat five times. Participants also were asked to self-evaluate their level of physical disability and to list their ability or inability to perform the activities that mattered most to them.
After making correlations between muscle strength (a muscle’s ability to do work and perform tasks, like standing up or lifting a box), muscle mass (how much muscle there is), and disability scores, the researchers analyzed the effect of lower leg muscle strength and mass on the disability scores.
What they found is that the lower a woman’s leg strength, the more physical disability she reported—even when differences in other factors, such as lupus activity, depression, and muscle mass, were taken into account. “While this trend has been seen in other groups, like the elderly, this is the first time it has shown this to be the case for a larger group of individuals with lupus,” says Andrews. “It makes sense that the more muscle mass you have, the stronger you are and the less disabled you are,” he says. “But the really exciting finding was that a woman’s muscle strength has a bigger impact on her physical performance than her overall muscle mass does.”
This suggests that by improving a woman’s strength, health care providers can help improve or even prevent physical disability. “Physical functioning is a major determinant of health-related quality of life. Thus, if we improve physical functioning, we can make an impact on overall quality of life for women with lupus,” Andrews says.
Co-authors Andrews and Katz stress that people with lupus need to remain active—for many reasons. “Physical activity—such as walking, swimming, cycling—will improve cardiovascular health as well as muscle strength. This is an important benefit for people with lupus because their risk of having heart problems is higher than the general population,” Katz says. “Physical activity is also effective in helping mood. It’s even recommended by the American Psychiatric Association as a first-line treatment for people with lower levels of depression. Increasing physical activity also appears to have benefits in reducing fatigue and improving sleep.”
Katz points to walking as a simple way for people to increase their physical activity levels. She notes that many of the pedometers and/or activity monitors and smartphones on the market offer online links to help people monitor their activity over time or set up activity “buddies” or networks.
“Something as simple as walking most days of the week for 15–20 minutes can have a major impact, not only in preserving physical function, but also in improving overall health,” says Andrews.
The Centers for Disease Control and Prevention recommends muscle-strengthening activities two days per week for adults and three days per week for youth. Find out more on the CDC website. Your physician (and pediatrician) should always be involved in decisions about the best ways to stay active.