Physical Fitness, Physical Therapy and Lupus

Why You Need Exercise

Maintaining a good baseline level of physical fitness - the highest degree possible for you in view of your personal health - is very important for people with lupus. It can help you:

• minimize loss of function when lupus flares and you can't be as active as usual;
• decrease stress on inflamed joints;
• reduce the impact of heart and lung problems in lupus;
• lessen your susceptibility to fatigue;
• reduce your risk of injury, such as due to falls resulting from weakness.

Further, research has shown that in people with inflammatory arthritis, those who exercise regularly have less inflammation, less fatigue, less pain, and less disability.

Regular exercise can also enhance your sense of well-being.

Before You Start Exercising

People with lupus should always check with their doctor before starting a new exercise program . Also discuss exercise with your doctor when your level of lupus activity changes - or when different drugs are started or discontinued.

This is particularly important if you have such common lupus complications as kidney, heart or lung involvement, since they may reduce your tolerance for exercise or may be exacerbated by an inappropriate exercise program.

Getting Physically Fit

Physical fitness is achieved via a well-rounded exercise program. You need three types of exercise.

1. Strengthening

These exercises may be isometric (involving muscle contraction without motion, such as clenching a fist or tightening your buttocks) or isotonic (muscle contraction with motion, such as bending your knee and raising your lower leg behind you while standing.

In isotonic exercise, you can eliminate gravity (such as doing the knee bending exercise while reclining on your side) or intensify the effects of gravity by adding resistance (such as by strapping a weight around your ankle for the same exercise, or holding free weights in your hands, or using resistive bands or resistance equipment).

Isometric exercise is often recommended for people during a lupus flare because it is very gentle and helps prevent muscle weakening and strength loss.

Isotonic exercise, especially using resistance, builds muscle strength. But keep in mind that doing just a few reps (repetitions) of an exercise at high weight is for muscle builders only. For most people, more reps at lower resistance is usually best. (Fancy equipment is not needed for resistance exercise; just holding a soup can or a water bottle in each hand - increasing the amount of water in it as your strength increases - can be quite effective.)

2. Flexibility

These exercises are particularly important for people with chronic illness because it helps assure that full joint motion is not lost. Flexibility can be achieve through many methods, most commonly range of motion (ROM) exercise and stretching. Pilates and yoga are examples of exercise theories focusing on flexibility and body balance that have become very popular, either as part of or to complement a therapy program.

In ROM exercises, you move a body part through its full range of motion, such as moving your arm in a full circle to exercise the shoulder.

This may be active ROM, in which you do it yourself, assisted ROM, where someone helps you perform the motion, or passive ROM, in which someone moves the arm for you.

When you stretch, you take the body beyond its natural (for you) range to try to increase its range and flexibility. Stretching is important because a flexible muscle can more easily be strengthened; while you should feel effort when stretching, you should not feel pain.

3. Conditioning

These exercises improve your overall endurance, and especially your cardiovascular endurance. Good conditioning exercises include walking, swimming, and biking. (Walking can yield the same benefits as jogging, but without undue stress on the joints.)

The most commonly held belief is that building cardiovascular fitness requires at least 20 to 30 minutes of exercise, at least three times a week, at a level of effort that reaches your "target" heart rate. However, a recent study suggested that it actually takes one hour of exercise a day at target levels in order to achieve the "training effect". More study is needed before that theory can be confirmed or rejected.

In general, your target heart rate is calculated as follows: 220 minus your age in years, multiplied by 70%. For example, for a person age 50, this would be 220-50=170x.70=119 beats per minute. For beginners, another approach is to put in enough effort that you are feeling the work but do not become so breathless that you can't hold a conversation.

You must exercise consistently for at least six weeks before the "training effect" develops, i.e. for the endurance benefits to become established. Then, the exercise becomes "easy."

If you stop exercising for two to three weeks, endurance benefits start to disappear. Although the focus of conditioning exercise is endurance, it does have strengthening benefits as well.

Special Exercise Tips for Lupus

"Overload" means pushing a muscle past its normal capacity. It's a basic principle of exercise and is necessary to increase strength, flexibility and conditioning.

BUT, people with lupus must keep certain protective principles in mind. During remission or when the disease is in a chronic but mild state, a general exercise program for overall fitness is important. However, when lupus flares, exercise may need to be reduced due to joint and muscle inflammation and fatigue. At such times, exercise may need to be limited to isometrics and simple ROM in a pain-free arc. As symptoms subside, you should be able to gradually increase the exercise intensity and duration.

However, ignore the slogan "no pain, no gain." It's just not true. Remember, acute pain is always a warning that you are probably damaging something or causing a worsening of your condition.

Fatigue is another key issue for people with lupus. Regardless of your disease status - full flare, mildly active, or remission - it's important to avoid undue fatigue as much as possible. Over-fatigue can trigger a flare. So don't push yourself beyond reasonable limits.

Corticosteroids (such as prednisone) also can affect exercise plans. Because steroids can weaken tendons and ligaments (which puts them at higher risk for rupture), avoid aggressive strengthening and stretching when you are on long-term steroids, even at a low dose, as well as when you are on high doses for short periods. However, because long-term steroids increase your risk of osteoporosis, regular weight-bearing exercise is even more important because it helps build bone density.

Consistency in exercise is essential. "Use it or lose it." If you don't exercise for more than 10 days, your muscles start to lose capacity. How do you maintain a regular regimen? First, be realistic. Start slowly and shoot for reasonable goals - not the stars. Build up slowly. And do what you find interesting, something you enjoy, or you won't stick with it. When a flare hits, you do need to reduce your exercise - but try not to stop completely, even if you only do ROM

Finally, keep in mind the benefits of consultation with a physical therapist. It can be of great benefit when starting out to receive a personalized basic exercise prescription from a professional, particularly when recovering from a flare.

If your doctor gives you an exercise prescription, you can take it to any physical therapist (within the guidelines of your health insurer, if any). Ideally, you should look for a physical therapist who has experience working with people who have rheumatic diseases. A physical therapist can also teach you basic joint protection principles for your everyday activities. Once you are familiar with these principles and a well-rounded exercise program that is appropriate for your individual situation, you should be able to perform the program on your own, whether at home or in your local health club.

Learn more about the SLE Workshop, a free support and education group held monthly as HSS.

posted 10/17/2002

Summary of a presentation given at The SLE Workshop, a free support and education group held monthly for people with lupus and their families/friends. Summary prepared by Diana Benzaia.