Lupus, Systemic Erythematosus (SLE)

Overview of SLE

SLE is a chronic inflammatory autoimmune disorder that can affect any system of the body. The body's production of antibodies suppresses the immune response and damages tissues. Clients with SLE typically present with a history of chronic fatigue, obesity, and ischemic heart disease.¹ They may present with a complex of signs and symptoms that may require numerous medical test to monitor. They may have chronic fatigue and sleep disturbances, causing them to tend to rest, even though pain and weakness do not limit activities. Endurance impairments develop owing to limited activities and changes to the cardiovascular system.¹ Renal problems can result in hypertension and edema in the extremities.

Comorbidities to Consider

• Clients may develop cardiovascular conditions, arthralgias, neuropathies, and chronic fatigue.

Client Examination

Keys to Examination of Clients

• Regularly assess heart rate, blood pressure, and respiratory rate when starting clients on an exercise program.

Recommended Baseline Testing of Fitness Levels

• Use a walking test to assess aerobic capacity tests.

• Measure fatigue by using the Fatigue Severity Score or a visual analog scale.²

Exercise Prescription

Type: Walking, treadmill walking, stationary cycling, and swimming^1,3

Intensity: Start at low intensities

Duration: 20–30 minutes

Frequency: Three times per week

Getting Started

Aerobic exercises can be progressed by increasing the duration of the treatment sessions as this will help improve the client's tolerance to exercise activities and can result in improved tolerance to more daily activities.¹ Clients with severe manifestations or flare-ups of SLE will need to pace activities to conserve energy and may be unable to maintain a consistent exercise program. Clients with SLE may have photosensitivities that may limit or preclude exercise programs outdoors. Clients with neuropsychiatric manifestations should be monitored for cognitive dysfunctions and may need precautions for seizures. Aerobic activities at 70% to 80% of maximum heart rate for 30 to 40 minutes three times a week have been shown to result in a significant improvement in aerobic capacity, exercise tolerance, and quality-of-life measurements.⁴ A heart rate monitor is recommended to ensure the client is maintaining an adequate intensity of exercise. Swimming or water exercises require periodic checks of heart rate levels to ensure an adequate intensity of exercise. Resistance exercises can be performed with low weights with two to three sets of 12 repetitions using muscle groups whose weakness is limiting daily activities.

References