Home-Based High-Intensity Interval Training in Systemic Lupus Erythematosus (MIGHT-SLE)

Exercise and Muscle Biology in Systemic Lupus Erythematosus

Systemic lupus erythematosus, or SLE, is a chronic autoimmune disease that can cause persistent fatigue, muscle pain, reduced physical function, and impaired quality of life, even when the disease is otherwise clinically stable. The biological mechanisms contributing to these symptoms are not fully understood. Abnormal energy production within skeletal muscle and increased fat accumulation within the muscle may contribute to fatigue and reduced physical performance in people with SLE.

This pilot study will evaluate the effects of a 16-week personalized, home-based exercise program in 20 adults with stable SLE and clinically significant fatigue. The program will include three exercise sessions per week: bodyweight high-intensity interval training, strength training, and walking-based interval training. Sessions will be adapted to each participant's fitness, mobility, symptoms, and exercise tolerance. Some sessions will be supervised remotely by video, while others will be completed independently using personalized recorded instructions.

Participants will undergo assessments before and after the 16-week program. These assessments will examine skeletal muscle mitochondrial function, fat accumulation within the thigh muscles, physical performance, fatigue, quality of life, and blood-based markers of mitochondrial function and inflammation.

The study will help determine whether a personalized home-based exercise program can improve muscle health and physical function in people with SLE and will provide information needed to design larger future studies.

Study Overview

• Status: Not yet recruiting
• Conditions: Fatigue; Exercise Training; Systemic Lupus Erthematosus
• Intervention / Treatment: Behavioral: Personalized Home-Based High-Intensity Interval Training

Detailed Description

This is a single-arm, pilot, proof-of-concept study evaluating the clinical and biological effects of a 16-week personalized, home-based high-intensity interval training program in 20 adults with stable systemic lupus erythematosus and persistent fatigue and/or muscle pain.

SLE-related fatigue is common and may persist despite adequate control of inflammatory disease activity. Skeletal muscle mitochondrial dysfunction may impair cellular energy production and contribute to fatigability and exercise intolerance. In addition, intermuscular adipose tissue, defined as fat located within the muscle compartment, is increased in some people with SLE and may be associated with systemic inflammation, fatigue, and reduced physical function.

The exercise intervention will include three sessions per week:

One bodyweight high-intensity interval training session One strength-training session One walking-based high-intensity interval training session

Exercise duration and intensity will increase gradually during the 16-week intervention. The program will be personalized according to each participant's baseline fitness, mobility, exercise preferences, SLE manifestations, pain, and exercise tolerance. Exercise sessions will alternate between remotely supervised video sessions and self-directed sessions using individualized prerecorded videos. Participants will use a heart-rate monitor during exercise, and the study team will conduct regular check-ins to support adherence and safety. Exercise intensity may be reduced or modified if a participant develops increased pain, joint symptoms, or an SLE flare.

Participants will complete study assessments at baseline and after the 16-week intervention. Skeletal muscle mitochondrial function will be assessed noninvasively using phosphorus-31 magnetic resonance spectroscopy. The primary measure of mitochondrial function will be phosphocreatine recovery following a brief standardized muscle exercise.

Magnetic resonance imaging of the thigh will be used to quantify intermuscular adipose tissue and muscle composition. Additional imaging may assess abdominal and liver fat.

Physical performance will be evaluated using the six-minute walk test and the 30-second sit-to-stand test. Participants will also complete questionnaires assessing fatigue, fatigability, mobility, overall health, cognitive function, and SLE-related quality of life.

Blood and other biological samples will be collected before and after the intervention. Laboratory analyses will evaluate circulating markers of mitochondrial function, inflammation, and inflammasome activation. Exploratory analyses may include gene expression, proteomic, genetic, urine, and microbiome studies for participants who provide the required consent.

The study will compare each participant's measurements before and after the exercise intervention. The primary outcomes will evaluate changes in skeletal muscle mitochondrial function and intermuscular adipose tissue. Secondary and exploratory analyses will evaluate changes in physical performance, fatigue, quality of life, inflammatory markers, and other biological measures.

Because this is a small, uncontrolled pilot study, it is intended to identify preliminary signals of biological and clinical benefit rather than establish definitive efficacy. Results will inform the feasibility, outcome selection, and sample-size planning of future controlled trials of personalized exercise interventions in SLE.

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jose E Rubio, MD; Phone Number: 205-574-9351; Email: JERUBIOMOSQUERA@UABMC.EDU
• Study Contact Backup: Name: Vivian Kawai, MD MPH; Email: vkkawai@uab.edu

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294
      • University of Alabama at Birmingham
      • Contact: JOSE E RUBIO MOSQUERA, MD; Phone Number: 2055749351; Email: JERUBIOMOSQUERA@UABMC.EDU
      • Principal Investigator: JOSE E RUBIO, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18 to 65 years.
• Diagnosis of systemic lupus erythematosus according to the 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology classification criteria.
• Stable, non-organ-threatening systemic lupus erythematosus, defined as a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score of 6 or less at screening, with no active renal or central nervous system involvement.
• Stable background lupus therapy, defined as no initiation of a new disease-modifying antirheumatic drug or biologic therapy and no change in the dose of immunosuppressive therapy within 8 weeks before enrollment.
• Persistent fatigue and/or muscle pain, with a PROMIS Fatigue T-score of 55 or greater.
• Stable prednisone dose, or equivalent glucocorticoid dose, of 5 mg per day or less for at least 12 weeks before enrollment.
• Able to safely participate in a moderate-intensity exercise program.
• Able and willing to provide informed consent.
• Able and willing to comply with the home-based exercise protocol and study procedures.

Exclusion Criteria:

• Prednisone dose greater than 5 mg per day, or receipt of a glucocorticoid burst within 8 weeks before enrollment.
• Pregnancy.
• Severe anemia, defined as hemoglobin less than 10 g/dL.
• Uncontrolled hypothyroidism.
• Severe systemic lupus erythematosus disease activity, defined as a SLEDAI-2K score greater than 8.
• End-stage kidney disease requiring renal replacement therapy or estimated glomerular filtration rate less than 30 mL/min/1.73 m².
• Uncontrolled hypertension, defined as blood pressure greater than 160/100 mmHg.
• Decompensated heart failure.
• Unstable pulmonary disease.
• Neurologic condition that limits exercise performance.
• Uncontrolled diabetes mellitus.
• Severe osteoarthritis that limits safe participation in the exercise intervention.
• Overlap autoimmune disease, including inflammatory myopathy, mixed connective tissue disease, or systemic sclerosis.
• History of solid-organ or bone marrow transplantation.
• Any contraindication to magnetic resonance imaging.
• Inability to fit safely on the magnetic resonance imaging scanner bed.
• Myocardial infarction or cerebrovascular event within the previous 3 months.
• Serious hemorrhage, including cerebral hemorrhage, within the previous 12 months.
• Acute infectious illness within 1 month before enrollment.
• Inability to provide informed consent.
• Inability to adhere to the home-based exercise protocol.
• Current participation in a structured exercise program.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Personalized Home-Based HIIT; Participants will complete a 16-week personalized, home-based exercise program consisting of three sessions per week: one bodyweight high-intensity interval training session, one strength-training session, and one walking-based high-intensity interval training session. The program will be tailored to each participant's physical fitness, mobility, symptoms, and exercise tolerance. Sessions will alternate between remotely video-supervised and self-directed personalized sessions. Heart rate, perceived exertion, adherence, and safety will be monitored throughout the intervention.

Behavioral: Personalized Home-Based High-Intensity Interval Training; Participants will complete a 16-week personalized, home-based, moderate- to high-intensity exercise program. The program includes three sessions per week: bodyweight high-intensity interval training, strength training using bodyweight, light weights, or resistance bands, and walking-based high-intensity interval training. Exercise intensity and duration will progress gradually and will be individualized according to baseline fitness, mobility, disease manifestations, pain, and exercise tolerance. Video-supervised sessions with an exercise trainer will alternate with self-directed sessions using personalized prerecorded videos. Participants will use a heart-rate monitor during exercise and will record perceived exertion. The study team will monitor adherence and safety and will conduct regular telephone or text check-ins. Exercise intensity and activities may be modified during increased joint symptoms or an SLE flare.; Other Names: HB-HIIT

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Phosphocreatine Recovery Half-Time at Week 16	Skeletal muscle mitochondrial oxidative capacity will be assessed using phosphorus-31 magnetic resonance spectroscopy (31P-MRS) of the thigh. Following a standardized knee-extension exercise, the phosphocreatine recovery half-time will be calculated in seconds. The recovery half-time is the time required to restore one-half of the phosphocreatine depleted during exercise. A shorter recovery half-time indicates faster recovery and greater skeletal muscle mitochondrial oxidative capacity.	Baseline and Week 16
Change From Baseline in Thigh Intermuscular Adipose Tissue at Week 16	Intermuscular adipose tissue will be quantified from magnetic resonance imaging of the thigh. Intermuscular adipose tissue will be expressed as the percentage of adipose tissue located within the muscle compartment relative to the total muscle compartment. A lower percentage indicates less intermuscular adipose tissue accumulation.	Baseline and Week 16

Collaborators and Investigators

• Sponsor: University of Alabama at Birmingham
• Collaborators: Lupus Research Alliance
• Investigators: Principal Investigator: Jose E Rubio, MD, University of Alabama at Birmingham

Publications and helpful links

General Publications

• Frade S, O'Neill S, Greene D, Nutter E, Cameron M. Exercise as adjunctive therapy for systemic lupus erythematosus. Cochrane Database Syst Rev. 2023 Apr 19;4(4):CD014816. doi: 10.1002/14651858.CD014816.pub2.
• Blaess J, Geneton S, Goepfert T, Appenzeller S, Bordier G, Davergne T, Fuentes Y, Haglo H, Hambly K, Kinnett-Hopkins D, Su KY, Legge A, Li L, Mak A, Padjen I, Sciascia S, Sheikh SZ, Soriano-Maldonado A, Ugarte-Gil MF, Md Yusof MY, Parodis I, Arnaud L. Recommendations for physical activity and exercise in persons living with Systemic Lupus Erythematosus (SLE): consensus by an international task force. RMD Open. 2024 Apr 4;10(2):e004171. doi: 10.1136/rmdopen-2024-004171.

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: July 16, 2026
• First Submitted That Met QC Criteria: July 16, 2026
• First Posted (Actual): July 21, 2026

Study Record Updates

• Last Update Posted (Actual): July 21, 2026
• Last Update Submitted That Met QC Criteria: July 16, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Exercise; Fatigue; SLE
• Additional Relevant MeSH Terms: Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Fatigue; Motor Activity
• Other Study ID Numbers: IRB-300016132; 2026MCA-1496 (Other Grant/Funding Number: Lupus Research Alliance)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

De-identified individual participant data underlying the results reported in publications from this study may be shared with qualified researchers. Shared data may include relevant clinical, patient-reported, physical performance, imaging-derived, and laboratory outcome data, together with the study protocol, statistical analysis plan, and data dictionary, as applicable.

Data sharing will be conducted in accordance with the final IRB-approved protocol, informed consent, Lupus Research Alliance Data Management and Sharing Plan, institutional policies, and applicable privacy regulations. Requests will be reviewed by the study investigators and the University of Alabama at Birmingham. Access may require an approved research proposal, institutional review, and execution of a data use agreement. Direct identifiers will not be shared.

• IPD Sharing Time Frame: Data will be made available after publication of the primary study results and no later than the end of the funded project period, consistent with the approved data-sharing plan. Data may remain available for at least 5 years after initial release, subject to institutional and repository requirements.
• IPD Sharing Access Criteria: Qualified researchers may submit a written request describing the scientific purpose, requested data, proposed analyses, data-security measures, and plans for publication. Requests will be evaluated for scientific merit, participant privacy, consistency with informed consent, and compliance with institutional and funding-agency requirements. An approved data use agreement may be required before access is granted.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No