One of my clients Samantha was recently told that she might have Lupus.
Understandably, there was a mild sense of panic and fear associated with this potential explanation for her various aches and pains.
By the time we chatted about it, she had already read all sorts of things online (don’t we all!) which if anything was adding to her anxiety.
Part of her fear was the thought that she may need to give up her regular exercise.
Samantha lamented that she couldn’t find anything clear about what she should or shouldn’t do if she did indeed have Lupus.
So what does the evidence say about exercise and Lupus?
Before we tackle that question, here is a bit of information about the condition itself.
SLE is an autoimmune disease that can affect almost any organ of the body. The diagnosis of this particular rheumatic disease involves a combination of both clinical manifestations and blood test results. Like many autoimmune diseases, disease activity can fluctuate considerably. Every patient is different, with treatment and management needing an individualised approach dependant on the clinical manifestations and severity of the illness. (Click here to read more about some of the symptoms associated with lupus written by our very own Dr Herman Lau)
Like other rheumatic conditions, lupus can be associated with fatigue, joint/muscle pain, as well as feeling lethargic and weak. These very symptoms can make the thought of exercise (let alone an hour of it!) seem insurmountable for those with lupus.
So what did I tell Samantha?
I started by explaining that we now believe that exercise can have a positive impact on any individual with a rheumatic disease.
Despite there not being a whole heap of research in regards to the type, frequency and volume of exercise that is safe for those with lupus, we know there will likely be some considerable benefits to staying active.
- Reduced risk of cardiovascular events
- Improved sleep quality
- Improved strength and mobility
- Improved mood
So contrary to her fears that her regular physical activity might aggravate her potential inflammatory condition, I explained that exercise can play an important role both
- Directly: by disrupting the vicious cycle of chronic inflammation
- Indirectly: by improving co-morbidities and cardiovascular risk factors.
I re-enforced that due to the fluctuating nature of the illness, symptoms as well as energy levels can vary, so there definitely isn’t a “one size fits all” exercise program for any health practitioner to prescribe.
Despite this, I’ve found that using the following guidelines can provide some guidance as to how we help our clients remain active and fit.
- Start small and build up gradually
This advice is good for anyone who has taken a bit of a break from exercise for whatever reason. But it becomes particularly important for those recently diagnosed with a rheumatic disease like lupus. No effort or amount is too small! Ideally we want to gradually build your muscle and joint capacity but getting started can be the toughest part. Starting in small chunks of activity whether it be walking, stretching or performing postural exercises is also a smart way to go for those who are struggling with fatigue.
- Options, options, options
As I mentioned above, there is no magical formula for our clients to follow when it comes to exercise. However, it makes total sense to build up your activity and strength in a variety of ways so you can vary things based on how you are feeling. Even if you love walking, there may be some days where the weather prevents you from doing so, so perhaps a light stretching session at home could be a nice alternative. Types of hydrotherapy as well as tai-chi are also good options as they are low impact. Ideally, it’s great to work up to developing an activity routine that promotes strength, mobility and aerobic fitness which is suited to your individual needs.
- Learn to monitor and pace yourself
Something we speak a lot about in the clinic is the concept of pacing. It applies to structured exercise, but can also refer to the accumulation of any activity or task. Graded Activity Pacing has been defined as a step by step approach to increasing tissue tolerance (Moseley; Butler 2015). We encourage our clients to become experts in their own bodies! As you become more in tune, you might feel that longer than 30 minutes of walking really effects your fatigue, for example. Or perhaps you might feel better by adding some mobility work into your morning routine as opposed to the evening. By keeping track of what things do or don’t work for you, will help you develop positive patterns of behaviour. It might also assist your GP, Rheumatologist or other health care professional help you manage your condition in the best possible way. Pacing can also be a great way to help manage through and flares. Click here to read a previous blog discussing how to exercise during a flare.
As with many other chronic conditions, exercising with Lupus can be tricky, but here in the clinic we all still believe is can be very worthwhile! Like anything tricky, a successful exercise program will likely require some careful thought, planning, and let’s not forget enjoyment! For these reasons we believe an Accredited Exercise Physiologist is well equipped to help. They would need to work closely with the other members of your health care team, to ensure you are in a position to do so. If you or anyone you know would like more help, drop us a comment below and one of our friendly team will be happy to assist.