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

Abstract

Introduction: Exercise 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.

Methods: Nineteen 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).

Results: The 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.

Conclusion: A 3-month aerobic exercise training was safe and capable of ameliorating the cardiorespiratory capacity and the autonomic function in C-SLE patients.

Trial registration: NCT01515163.

Figures

Figure 1

Flow diagram of the patients. C-SLE, childhood-onset systemic lupus erythematosus.

Figure 2

Cardiorespiratory measurements before (PRE) and after (POST) the exercise training. Dotted lines represent mean data from the healthy control group at baseline. (A) Chronotropic reserve. (B) Absolute change in heart rate at the first minute after exercise (ΔHRR1). (C) Absolute change in heart rate at the second minute after exercise (ΔHRR2). TR C-SLE, trained patients with childhood-onset systemic lupus erythematosus; NT C-SLE, non-trained patients with childhood-onset systemic lupus erythematosus. Means with different letters are significantly different from each other: a, significant difference when compared with the healthy control group; b, no significant difference when compared with the healthy control group.

Figure 3

Cardiorespiratory measurements before (PRE) and after (POST) the exercise training. Dotted lines represent mean data from the healthy control group at baseline. (A) Peak oxygen consumption (VO2 peak). (B) Relative change in heart rate (Δ%) between rest and the ventilatory anaerobic threshold (VAT). (C) Relative change in heart rate (Δ%) between rest and the respiratory compensation point (RCP). (D) Relative change in heart rate (Δ%) between rest and peak exercise (Peak). TR C-SLE, trained patients with childhood-onset systemic lupus erythematosus; NT C-SLE, non-trained patients with childhood-onset systemic lupus erythematosus. Means with different letters are significantly different from each other: a, significant difference when compared with the healthy control group; b, no significant difference when compared with the healthy control group.