By Beata Nowak PT, DPT

1. Beata Nowak PT, DPT

2. What is SLE
 Systemic 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.

3. 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.

4. Exercises goals
 improve range of motion and reduce joint stiffness
 strengthen tendons, ligaments and muscles to stabilize joints
 help 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

5. Types of Exercises
 Three 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.

6. ROM exercises
 Range-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

7. 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.

8. Aerobic exercises
 The 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.

9. 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.

10. 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.


11. 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)

12. 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.

13. Fatigue, myositis and muscle
weakness
 Lupus 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.

14. 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.

15. 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.

16. Activity/exercise schedule
 It 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.

17. 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.

18. Important question to ask
yourself
 1. 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?


19. 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.

20. Principle of Energy
Conservation
 Avoid 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.

21. Principles of Energy
Conservation
 Proper working conditions
 1. 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

22. Principle of Energy
conservation
 Do 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

23. References
 http://www.livestrong.com/article/341962-exercise-with-lupus-
myositis/#ixzz27bKGsvTX
 Exercise and Lupus: Effects and Guidelines by Dale Marhefka, P.T.,
Saddleback Memorial Medical Center, and Laura Price, S.P.T.,
Chapman University; October 2000.