Lupus Treatment/Rehabilitation

Beata Nowak PT, DPT

What is SLESystemic lupus erythematous (SLE) is a

chronic inflammatory connective tissue disease with variable manifestations that can affect almost any organ system in the body. It most often develops in women during their childbearing years. Currently, there is no cure for lupus, but treatment can reduce symptoms.

What SLE causes Lupus symptoms of joint pain, joint stiffness

and fatigue often cause people to reduce their daily activities or stop exercising altogether, which can make symptoms worse.

A supervised exercise program of gentle flexibility, strength and endurance training benefits many people with lupus, especially when combined with heat modalities.

Exercises goalsimprove range of motion and reduce joint stiffnessstrengthen tendons, ligaments and muscles to

stabilize jointshelp maintain strong bones and avoid the osteoporosis

often caused by drugs commonly prescribed to treat inflammation caused by lupus

improve or maintain cardiac health because heart disease is the leading cause of death in people with lupus

reduce the tendency to gain weight because extra pounds put more stress on inflamed joints

improve sleep patterns, mood and general outlook on life by releasing endorphins and decreasing stress

Types of ExercisesThree Main Types of Exercise

People with lupus often benefit from a balanced exercise program including different types of exercise.  Three main types of exercise that should be included in your exercise program are range-of-motion, strengthening, and endurance exercises.

ROM exercisesRange-of-motion (ROM) exercises reduce stiffness and help

keep your joints flexible.  ROM is the normal amount your joints can be moved in certain directions.  There are two types of ROM exercises: passive range-of-motion and active range-of-motion.

 Useful during a flare, passive range-of-motion (PROM)

exercises involve someone assisting with performance of the movement and there is no muscle contraction.  An example using the shoulder flexion exercise would be someone moving your arm forward and above your head.

 Active range-of-motion (AROM) exercises are useful

immediately following a flare.  They involve you performing the movement without assistance throughout the full range of movement.  A muscle contraction is present in this type.  The shoulder flexion example would be actively raising your arm forward and above your head

Strength exercises The second main type of exercise, strengthening exercises, help

maintain or increase muscle strength.  Strong muscles help keep your joints stable.  Two common types of strengthening exercises for people with lupus are isometric exercises, in which you tighten the muscle but do not move the joint, and resistive isotonic exercises in which the joint is moved.

  In an isometric exercise, there is no joint movement, the overall

muscle length stays the same, and a muscle contraction is present.  These exercises are useful for joint strengthening with joint protection.  In the shoulder flexion, facing a wall, you would place your fist firmly against the wall and push forward.

  Resistive isotonic exercises involve performing a movement with some

form of external resistance (i.e. theraband, free weights, machines).  A muscle contraction is present and this type is indicated for high level strengthening.  In the shoulder flexion exercise, you would have a weight in your hand and raise your arm forward and above your head.

Aerobic exercisesThe third main type of exercise is aerobic or

endurance exercises which improve cardiovascular fitness.  They make your lungs more efficient and give you more stamina so that you can work longer without tiring as quickly.  Some of the most beneficial endurance exercises for people with lupus are walking, water exercises, and riding a stationary bicycle.

Individualized Approach to exercises

lupus must be approached on an individual basis and exercising with lupus is not without risk, therapist can design a program of exercises appropriate to level of fitness and pain after consulting with your physician.

Get Started -  Discuss exercise plans with your doctor. -  Start with supervision from a physical therapist or

qualified athletic trainer. -  Apply heat to sore joints (optional). -  Stretch and warm up with ROM exercises. -  Start strengthening exercises slowly and gradually

progress to small weights, theraband, weight machines, etc.

-  Use cold packs after exercising (optional). -  Add aerobic exercise. -  Consider appropriate recreational exercise (after doing

ROM, strengthening, and aerobic exercise). -  Ease off if joints become painful, inflamed, or red. -  Choose the exercise program you enjoy most and make it

a habit.  

How Much Exercise is Too Much?

 People with lupus should adjust their exercise

program when they notice any of the following signs of too much exercise:

 -  Unusual or persistent fatigue-  Increased weakness-  Decreased ROM-  Increased joint swelling-  Continuing pain (greater than 2 hours after

exercising)

What To Do During a Flare

Exercises that seem easy one day may be too much on days when your joints are more painful and swollen.  When this happens, cut back on the number of exercises and gradually add more when your tolerance increases.  If you notice a significant decline in your performance, talk to your doctor or therapist immediately.

 Do not do aerobic/endurance or strengthening exercises

when your joints are swollen and painful.  If just one or two joints are swollen or painful, you can adapt your exercises to put less stress on those joints.  For example, if your knee flares up, switch to exercises in the water instead of walking.  Also, next time you exercise, decrease the number of times you do each exercise, or do them more gently.

Stop exercising immediately if you have chest tightness or pain, or severe shortness or breath or if you feel dizzy, faint, or sick to your stomach.

 

Fatigue, myositis and muscle weaknessLupus causes chronic inflammation in the

body. While lupus can create a feeling of overall fatigue, myositis occurs when the inflammation specifically targets the muscles. While this condition typically does not cause any pain, it leads to muscle weakness. The most common risk of exercise is aggravating your lupus by working your joints or muscles too much.  This can happen if you exercise too long .  It is important to start out slow and monitor how the body reacts , especially when patient is beginning an exercise.

Research and SLE Research, published in a 2000 issue of the

British Journal of Rheumatology, which found that myositis patients who took part in 15 minutes of stretching and conditioning exercises along with a 15-minute walk five times a week did not suffer any increase in their disease, and a few participants were able to reduce medication levels. No changes in the inflammatory chemicals were observed. The study had the aim of determining whether or not exercise would have any negative impact on the condition. Research looking at the effects of exercise on myositis has been limited.

Goal : combination of exercises and energy conservation .Living in such a state of chronic distress can

place a tremendous drain on a person’s ability to function psychologically, physically, and emotionally.  It is therefore important to consider alternative methods to reduce or prevent the onset of fatigue.  The goal should be to develop a healthful daily routine including exercise and energy conservation techniques.

Activity/exercise scheduleIt is important to set priorities and maintain

a reasonable schedule.  The recommendation is to develop an activity/rest program based on the fatigue patterns that allow the patient to utilize his/her energy most effectively.   While working on the schedule it is essential to consider fatigue patterns including onset, duration, intensity, and aggravating and alleviating factors.

 

Energy conservation Energy conservation refers to the way activities or tasks

are completed.  Energy is conserved by pacing and work simplification.  The principles of energy conservation are designed to help to reduce the strain the body.

 Pacing is alternating periods of work, activity, therapeutic

exercise and rest in order to avoid fatigue.  Pacing is important because fatigue or over activity can leave patient exhausted .  It allows energy to last through the day and makes it possible to do things that are important.

 

Important question to ask yourself1. Is the task necessary?  Can it be

eliminated?2. Why am I doing this task?3. What purpose does it serve?4. Do I need to do it or can someone else?5. Who can help to do it?6. Where is the best place to do it?7. When should it be done?8. What is the worst possible thing that could

happen if that task is not done? 

Principles of Energy Conservation Avoid rushing 1. Have preplanned work and resting periods

(allow a 30 to 60 minute rest period after each meal and after any particularly strenuous activity).

2. Plan work; make weekly and daily schedules.

3. Spread heavy and light tasks throughout the day.

4. Set priorities and eliminate unnecessary tasks.

 

Principle of Energy ConservationAvoid unnecessary motions 1. Sit instead of stand for any lengthy task (5 minutes

plus).2. Avoid holding or lifting by sliding or using a

wheeled cart.3. Avoid overreaching and bending by arranging work

areas within normal reach.4. Arrange your specific work center with supplies and

equipment at point of first use to minimize extra trips.5. Live simply, avoid unnecessary cluttering of items.6. Use modern labor saving equipment.7. Use good posture to prevent fatigue. 

Principles of Energy ConservationProper working conditions1. Use proper work heights according to job

and the individual.2. Have good ventilation.3. Have good lighting.4. Work in a relaxed manner, e.g. with music.5. Wear comfortable clothes.6. Keep cool

Principle of Energy conservationDo some enjoyable and relaxing activities every day

and reward yourself and perform physically stressful activities during the cooler part of the day or evening.

Do your exercise program in a comfortable environment.

  Don’t overdo it, listen to the body, and rest before you

feel tired.Try to avoid stress in social activities

Referenceshttp://www.livestrong.com/article/341962-exercise-with-lupus-

myositis/#ixzz27bKGsvTXExercise and Lupus: Effects and Guidelines by Dale Marhefka, P.T.,

Saddleback Memorial Medical Center, and Laura Price, S.P.T., Chapman University; October 2000.