Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 19;4(4):CD014816.
doi: 10.1002/14651858.CD014816.pub2.

Exercise as adjunctive therapy for systemic lupus erythematosus

Stephanie Frade  1   2 , Sean O'Neill  3   4 , David Greene  2 , Elise Nutter  1 , Melainie Cameron  1   5   6
Affiliations

Exercise as adjunctive therapy for systemic lupus erythematosus

Stephanie Frade et al. Cochrane Database Syst Rev. .

Abstract

Background: Systemic lupus erythematosus (SLE) is a rare, chronic autoimmune inflammatory disease with a prevalence varying from 4.3 to 150 people in 100,000, or approximately five million people worldwide. Systemic manifestations frequently include internal organ involvement, a characteristic malar rash on the face, pain in joints and muscles, and profound fatigue. Exercise is purported to be beneficial for people with SLE. For this review, we focused on studies that examined all types of structured exercise as an adjunctive therapy in the management of SLE.

Objectives: To evaluate the benefits and harms of structured exercise as adjunctive therapy for adults with SLE compared with usual pharmacological care, usual pharmacological care plus placebo and usual pharmacological care plus non-pharmacological care.

Search methods: We used standard, extensive Cochrane search methods. The latest search date was 30 March 2022.

Selection criteria: We included randomised controlled trials (RCTs) of exercise as an adjunct to usual pharmacological treatment in SLE compared with placebo, usual pharmacological care alone and another non-pharmacological treatment. Major outcomes were fatigue, functional capacity, disease activity, quality of life, pain, serious adverse events, and withdrawals due to any reason, including any adverse events.

Data collection and analysis: We used standard Cochrane methods. Our major outcomes were 1. fatigue, 2. functional capacity, 3. disease activity, 4. quality of life, 5. pain, 6. serious adverse events, and 7. withdrawals due to any reason. Our minor outcomes were 8. responder rate, 9. aerobic fitness, 10. depression, and 11. anxiety. We used GRADE to assess certainty of evidence. The primary comparison was exercise compared with placebo.

Main results: We included 13 studies (540 participants) in this review. Studies compared exercise as an adjunct to usual pharmacological care (antimalarials, immunosuppressants, and oral glucocorticoids) with usual pharmacological care plus placebo (one study); usual pharmacological care (six studies); and another non-pharmacological treatment such as relaxation therapy (seven studies). Most studies had selection bias, and all studies had performance and detection bias. We downgraded the evidence for all comparisons because of a high risk of bias and imprecision. Exercise plus usual pharmacological care versus placebo plus usual pharmacological care Evidence from a single small study (17 participants) that compared whole body vibration exercise to whole body placebo vibration exercise (vibrations switched off) indicated that exercise may have little to no effect on fatigue, functional capacity, and pain (low-certainty evidence). We are uncertain whether exercise results in fewer or more withdrawals (very low-certainty evidence). The study did not report disease activity, quality of life, and serious adverse events. The study measured fatigue using the self-reported Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-Fatigue), scale 0 to 52; lower score means less fatigue. People who did not exercise rated their fatigue at 38 points and those who did exercise rated their fatigue at 33 points (mean difference (MD) 5 points lower, 95% confidence interval (CI) 13.29 lower to 3.29 higher). The study measured functional capacity using the self-reported 36-item Short Form health questionnaire (SF-36) Physical Function domain, scale 0 to 100; higher score means better function. People who did not exercise rated their functional capacity at 70 points and those who did exercise rated their functional capacity at 67.5 points (MD 2.5 points lower, 95% CI 23.78 lower to 18.78 higher). The study measured pain using the SF-36 Pain domain, scale 0 to 100; lower scores mean less pain. People who did not exercise rated their pain at 43 points and those who did exercise rated their pain at 34 points (MD 9 points lower, 95% CI 28.88 lower to 10.88 higher). More participants from the exercise group (3/11, 27%) withdrew from the study than the placebo group (1/10, 10%) (risk ratio (RR) 2.73, 95% CI 0.34 to 22.16). Exercise plus usual pharmacological care versus usual pharmacological care alone The addition of exercise to usual pharmacological care may have little to no effect on fatigue, functional capacity, and disease activity (low-certainty evidence). We are uncertain whether the addition of exercise improves pain (very low-certainty evidence), or results in fewer or more withdrawals (very low-certainty evidence). Serious adverse events and quality of life were not reported. Exercise plus usual care versus another non-pharmacological intervention such as receiving information about the disease or relaxation therapy Compared with education or relaxation therapy, exercise may reduce fatigue slightly (low-certainty evidence), may improve functional capacity (low-certainty evidence), probably results in little to no difference in disease activity (moderate-certainty evidence), and may result in little to no difference in pain (low-certainty evidence). We are uncertain whether exercise results in fewer or more withdrawals (very low-certainty evidence). Quality of life and serious adverse events were not reported.

Authors' conclusions: Due to low- to very low-certainty evidence, we are not confident on the benefits of exercise on fatigue, functional capacity, disease activity, and pain, compared with placebo, usual care, or advice and relaxation therapy. Harms data were not well reported.

PubMed Disclaimer

Conflict of interest statement

SF: none.

SO: none.

EN: none.

DG: none.

MC: none.

Figures

1
1
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Exercise plus usual pharmacological care versus placebo plus usual pharmacological care (exercises versus placebo), Outcome 1: Fatigue (FACIT fatigue, score 0–52, lower scores indicate less fatigue)
1.2
1.2. Analysis
Comparison 1: Exercise plus usual pharmacological care versus placebo plus usual pharmacological care (exercises versus placebo), Outcome 2: Functional capacity (SF‐36 Function Capacity domain, score 0–100, higher scores indicate better functional capacity)
1.3
1.3. Analysis
Comparison 1: Exercise plus usual pharmacological care versus placebo plus usual pharmacological care (exercises versus placebo), Outcome 3: Pain (SF‐36 Pain domain, score 0–100, lower scores indicate less pain)
1.4
1.4. Analysis
Comparison 1: Exercise plus usual pharmacological care versus placebo plus usual pharmacological care (exercises versus placebo), Outcome 4: Withdrawals for any reason
2.1
2.1. Analysis
Comparison 2: Exercise plus usual pharmacological care versus usual pharmacological care alone (exercise versus usual care alone), Outcome 1: Fatigue (Fatigue Severity Scale, score 1–7, lower score indicates less fatigue)
2.2
2.2. Analysis
Comparison 2: Exercise plus usual pharmacological care versus usual pharmacological care alone (exercise versus usual care alone), Outcome 2: Functional capacity (SF‐36 Physical Function domain, score 0–100, higher scores indicate better functional capacity)
2.3
2.3. Analysis
Comparison 2: Exercise plus usual pharmacological care versus usual pharmacological care alone (exercise versus usual care alone), Outcome 3: Disease activity (various scales, lower scores indicate less disease activity)
2.4
2.4. Analysis
Comparison 2: Exercise plus usual pharmacological care versus usual pharmacological care alone (exercise versus usual care alone), Outcome 4: Pain (SF‐36 Pain domain, score 0–100, lower scores indicate less pain)
2.5
2.5. Analysis
Comparison 2: Exercise plus usual pharmacological care versus usual pharmacological care alone (exercise versus usual care alone), Outcome 5: Withdrawals for any reason
2.6
2.6. Analysis
Comparison 2: Exercise plus usual pharmacological care versus usual pharmacological care alone (exercise versus usual care alone), Outcome 6: Aerobic capacity (peak oxygen uptake, higher scores indicate better aerobic capacity)
2.7
2.7. Analysis
Comparison 2: Exercise plus usual pharmacological care versus usual pharmacological care alone (exercise versus usual care alone), Outcome 7: Depression (various scales, lower score indicates less depression)
2.8
2.8. Analysis
Comparison 2: Exercise plus usual pharmacological care versus usual pharmacological care alone (exercise versus usual care alone), Outcome 8: Anxiety (HADS Anxiety, score 0–21, lower score indicates less anxiety)
3.1
3.1. Analysis
Comparison 3: Exercise plus usual pharmacological care versus another non‐pharmacological intervention plus usual pharmacological care (exercise versus active control), Outcome 1: Fatigue (various scales, lower score indicate less fatigue)
3.2
3.2. Analysis
Comparison 3: Exercise plus usual pharmacological care versus another non‐pharmacological intervention plus usual pharmacological care (exercise versus active control), Outcome 2: Functional capacity (various scales, higher scores indicate better functional capacity)
3.3
3.3. Analysis
Comparison 3: Exercise plus usual pharmacological care versus another non‐pharmacological intervention plus usual pharmacological care (exercise versus active control), Outcome 3: Disease activity (various scales, lower scores indicate less disease activity)
3.4
3.4. Analysis
Comparison 3: Exercise plus usual pharmacological care versus another non‐pharmacological intervention plus usual pharmacological care (exercise versus active control), Outcome 4: Pain (various scales, lower score indicates less pain)
3.5
3.5. Analysis
Comparison 3: Exercise plus usual pharmacological care versus another non‐pharmacological intervention plus usual pharmacological care (exercise versus active control), Outcome 5: Withdrawals for any reason
3.6
3.6. Analysis
Comparison 3: Exercise plus usual pharmacological care versus another non‐pharmacological intervention plus usual pharmacological care (exercise versus active control), Outcome 6: Aerobic capacity (peak oxygen uptake, higher scores indicate better aerobic capacity)
3.7
3.7. Analysis
Comparison 3: Exercise plus usual pharmacological care versus another non‐pharmacological intervention plus usual pharmacological care (exercise versus active control), Outcome 7: Depression (BDI, score 0–63, lower scores indicate less depression)
3.8
3.8. Analysis
Comparison 3: Exercise plus usual pharmacological care versus another non‐pharmacological intervention plus usual pharmacological care (exercise versus active control), Outcome 8: Anxiety (HADS Anxiety, score 0–21, lower score indicates less anxiety)
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD014816

Similar articles

See all similar articles

Cited by

References

References to studies included in this review

Abrahão 2016 {published data only}
    1. Abrahão MI, Gomiero AB, Peccin MS, Grande AJ, Trevisani VF. Cardiovascular training vs. resistance training for improving quality of life and physical function in patients with systemic lupus erythematosus: a randomized controlled trial. Scandinavian Journal of Rheumatology 2016;45:197-201. - PubMed
Avaux 2016 {published data only}
    1. Avaux M, Hoellinger P, Nieuwland-Husson S, Fraselle V, Depresseux G, Houssiau FA. Effects of two different exercise programs on chronic fatigue in lupus patients. International Journal of Clinical and Laboratory Medicine 2016;71(6):403-6. - PubMed
Benatti 2015 {published data only}
    1. Benatti FB, Miossi R, Passareli M, Nakandakare ER, Perandini L, Lima FR, et al. The effects of exercise on lipid profile in systemic lupus erythematosus and healthy individuals: a randomized trial. Rheumatology International 2015;35(1):61-9. - PubMed
Benatti 2018 {published data only}
    1. Benatti FB, Miyake CN, Dantas WS, Zambelli VO, Shinjo SK, Pereira RM, et al. Exercise increases insulin sensitivity and skeletal muscle AMPK expression in systemic lupus erythematosus: a randomized controlled trial. Frontiers in Immunology 2018;9(906):1-10. - PMC - PubMed
Bostrom 2016 {published data only}
    1. Bostrom C, Elfving B, Dupre B, Opava CH, Lundberg IE, Jansson E. Effects of a one-year physical activity programme for women with systemic lupus erythematosus – a randomized controlled study. Lupus 2016;25(6):602-16. - PubMed
Daltroy 1995 {published data only}
    1. Daltroy LH, Robb-Nicholson C, Iversen MD, Wright EA, Liang MH. Effectiveness of minimally supervised home aerobic training in patients with systemic rheumatic disease. British Journal of Rheumatology 1995;34(11):1064-9. - PubMed
Dos Reis‐Neto 2013 {published data only}
    1. Dos Reis-Neto ET, Da Silva AE, Monteiro CM, De Camargo LM, Sato EI. Supervised physical exercise improves endothelial function in patients with systemic lupus erythematosus. Rheumatology 2013;52(12):2187-95. - PubMed
Hashemi 2022 {published data only}
    1. Hashemi S, Habibagahi Z, Heidari M, Abdollahpour-Alitappeh M, Karimic MH. Effects of combined aerobic and anaerobic exercise training on cytokine profiles in patients with systemic lupus erythematosus (SLE): a randomized controlled trial. Transplant Immunology 2022;70:1-6. - PubMed
Kao 2021 {published data only}
    1. Kao VP, Wen HJ, Pan YJ, Pai CS, Tsai ST, Su KY. Combined aerobic and resistance training improves physical and executive functions in women with systemic lupus erythematosus. Lupus 2021;30(6):946-55. - PubMed
Keramiotou 2020 {published data only}
    1. Keramiotou K, Anagnostou C, Kataxaki E, Galanos A, Sfikakis PP, Tektonidou MG. The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial. Rheumatic and Musculoskeletal Diseases 2020;6(1):1-10. - PMC - PubMed
Lopes‐Souza 2021 {published data only}
    1. Lopes-Souza P, Dionello CF, Bernardes-Oliveira CL, Moreira-Marconi E, Marchon RM, Teixeira-Silva Y, et al. Effects of 12-week whole-body vibration exercise on fatigue, functional ability and quality of life in women with systemic lupus erythematosus: a randomized controlled trial. Journal of Bodywork & Movement Therapies 2021;27:191-9. - PubMed
Miossi 2012 {published data only}
    1. Miossi R, Benatti FB, Pinto AL, Lima FR, Borba EF, Prado DM, et al. Using exercise training to counterbalance chronotropic incompetence and delayed heart rate recovery in systemic lupus erythematosus: a randomized trial. Arthritis Care & Research 2012;64(8):1159-66. - PubMed
Tench 2003 {published data only}
    1. Tench CM, McCarthy J, McCurdie I, White PD, D'Cruz DP. Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise. British Society for Rheumatology 2003;42:1050-4. - PubMed

References to studies excluded from this review

Abrahao 2009 {published data only}
    1. Abrahao MI, Montenegro-Rodrigues R, Marangoni RG, Peccin S, Trevisani VFM. Impact of physical activity program in systemic lupus erythematosus. Accession Number: 70373838. In: Arthritis and Rheumatism. Vol. 10. 2009.
    1. Abrahão MI, Gomiero AB, Peccin MS, Grande AJ, Trevisani VF. Cardiovascular training vs. resistance training for improving quality of life and physical function in patients with systemic lupus erythematosus: a randomized controlled trial. Scandinavian Journal of Rheumatology 2016;45:197-201. - PubMed
Ahn 2015 {published data only}
    1. Ahn GE, Chmiel JS, Dunlop DD, Helenowski IB, Semanik PA, Song J, et al. Self-reported and objectively measured physical activity in adults with systemic lupus erythematosus. Arthritis Care & Research 2015;67(5):701-7. - PMC - PubMed
Barnes 2010 {published data only}
    1. Barnes JN, Nualnim N, Sugawara J, Tanaka H. Habitual exercise is associated with reduced arterial stiffness in systemic lupus erythematosus. Faseb Journal 2010;24(11):1194-200. - PubMed
Bogdanovic 2015 {published data only}
    1. Bogdanovic G, Stojanovich L, Djokovic A, Stanisavljevic N. Physical activity program is helpful for improving quality of life in patients with systemic lupus erythematosus. Journal of Experimental Medicine 2015;237(3):193-9. - PubMed
Bostrom 2013 {published data only}
    1. Bostrom C. Exercise therapy in systemic lupus erythematosus. Annals of the Rheumatic Diseases 2013;71:39.
Cenedeze 2016 {published data only}
    1. Cenedeze MA, Benatti FB, Lima F, Borba E, Bonfa E, Sa-Pinto AL, et al. Effects of acute aerobic exercise on leukocyte inflammatory gene expression in systemic lupus erythematosus. Exercise Immunology Review 2016;22:64-80. - PubMed
Chapman 2020 {published data only}
    1. Chapman M, Gupta S, Chu J, Naqi M, Manna Z, Mazhar MA, et al. Aerobic exercise improves fatigue and quality of life in women with systemic lupus erythematosus (preliminary analysis). Arthritis & Rheumatology 2020;72(Suppl 10):1.
Clarke‐Jenssen 2005 {published data only}
    1. Clarke-Jenssen AC, Fredriksen PM, Lilleby V, Mengshoelz AM. Effects of supervised aerobic exercise in patients with systemic lupus erythematosus: a pilot study. Arthritis & Rheumatism (Arthritis Care & Research) 2005;53(2):308-12. - PubMed
Da Silva 2013 {published data only}
    1. Da Silva AE, Dos Reis-Neto ET, Da Silva NP, Sato EI. The effect of acute physical exercise on cytokine levels in patients with systemic lupus erythematosus. Lupus 2013;22(14):1479-83. - PubMed
De Carvalho 2005 {published data only}
    1. De Carvalho MR, Sato EI, Tebexreni AS, Heidecher RT, Schenkman S, Neto TL. Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity, and quality of life in patients with systemic lupus erythematosus. Arthritis & Rheumatism 2005;53(6):838-44. - PubMed
Gavilan‐Carrera 2020 {published data only}
    1. Gavilan-Carrera B, Vargas-Hitos JA, Morillas-de-Laguno P, Rosales-Castillo A, Sola-Rodriguez S, Callejas-Rubio JL, et al. Effects of 12-week aerobic exercise on patient-reported outcomes in women with systemic lupus erythematosus. Disability and Rehabilitation 2020;44(10):1863-71. - PubMed
Gordon 2017 {published data only}
    1. Gordon BB, Kaufman K, Hicks ST, Norfleet JA, Cleveland RJ, Callahan LF, et al. Walk SLE – a pilot study exploring Walk with Ease (WWE), a self-directed walking program, in lupus patients. Arthritis and Rheumatology 2017;69:Suppl 10.
Haglo 2021 {published data only}
    1. Haglo H, Wang ED, Berg OK, Hoff J, Helgerud J. Smartphone-assisted high-intensity interval training in inflammatory rheumatic disease patients: randomized controlled trial. JMIR mHealth and uHealth 2021;9(10):1-16. - PMC - PubMed
Hasni 2021 {published data only}
    1. Hasni S, Chapman M, Feng R, Ahmad A, Gupta S, Naqi M, et al. A 12-week aerobic exercise training program in women with systemic lupus erythematosus (SLE) improves fatigue, mitochondrial dysfunction and associated interferon gene signature [abstract]. Arthritis and Rheumatology 2021;73:Suppl 10.
Isenberg 1981 {published data only}
    1. Isenberg DA, Crisp AJ, Morrow WJ, Newham D, Snaith ML. Variation in circulating immune-complex levels with diet, exercise, and sleep – a comparison between normal controls and patients with systemic lupus erythematosus. Annals of the Rheumatic Diseases 1981;40(5):466-9. - PMC - PubMed
Mak 2020 {published data only}
    1. Mak A. Physical exercise and systemic lupus erythematosus. Rheumatology 2020;59(5):921-2. - PubMed
Martinez 2021 {published data only}
    1. Martinez J, Chan L, Hasni S, Keyser R, Chin L. Effects of aerobic exercise training on fatigability in women with systemic lupus erythematosus. Medicine and Science in Sports and Exercise 2021;53(8):438.
Martinez‐Rosales 2020 {published data only}
    1. Martinez-Rosales E, Sola-Rodriguez S, Vargas-Hitos JA, Gavilan-Carrera B, Rosales-Castillo A, Hernandez-Martinez A, et al. Heart rate variability in women with systemic lupus erythematosus: association with health-related parameters and effects of aerobic exercise. International Journal of Environmental Research and Public Health 2020;17(24):1-14. - PMC - PubMed
    1. Soriano-Maldonado A, Morillas-de-Laguno P, Sabio JM, Gavilan-Carrera B, Rosales-Castillo A, Montalban-Mendez C, et al. Effects of 12-week aerobic exercise on arterial stiffness, inflammation, and cardiorespiratory fitness in women with systemic lupus erythematosus: non-randomized controlled trial. Journal of Clinical Medicine 2018;7(12):1-17. - PMC - PubMed
Perandini 2014 {published data only}
    1. Perandini LA, Sales-De-Oliveira D, Mello SB, Camara NO, Benatti FB, Lima FR, et al. Exercise training can attenuate the inflammatory milieu in women with systemic lupus erythematosus. Journal of Applied Physiology 2014;117(6):639-47. - PubMed
Ramsey‐Goldman 2000 {published data only}
    1. Ramsey-Goldman R, Schilling EM, Dunlop D, Langman C, Greenland P, Thomas RJ, et al. A pilot study on the effects of exercise in patients with systemic lupus erythematosus. Arthritis Care and Research 2000;13(5):262-9. - PubMed
Sheikh 2019 {published data only}
    1. Sheikh SZ, Kaufman K, Gordon BB, Hicks S, Love A, Walker J, et al. Evaluation of the self-directed format of Walk With Ease in patients with systemic lupus erythematosus: the Walk-SLE Pilot Study. Lupus 2019;28(6):764-70. - PubMed
Sieczkowska 2022 {published data only}
    1. Sieczkowska SM, Astley C, Marques IG, Iraha AY, Franco TC, Ihara BP, et al. A home-based exercise program during COVID-19 pandemic: perceptions and acceptability of juvenile systemic lupus erythematosus and juvenile idiopathic arthritis adolescents. Lupus 2022;31(4):443-56. - PMC - PubMed
Soriano‐Maldonado 2018 {published data only}
    1. Soriano-Maldonado A, Morillas-de-Laguno P, Sabio JM, Gavilan-Carrera B, Rosales-Castillo A, Montalban-Mendez C, et al. Effects of 12-week aerobic exercise on arterial stiffness, inflammation, and cardiorespiratory fitness in women with systemic lupus erythematosus: non-randomized controlled trial. Journal of Clinical Medicine 2018;7(12):1-17. - PMC - PubMed
Tench 2002 {published data only}
    1. Tench C, Bentley D, Vleck V, McCurdie I, White P, D'Cruz D. Aerobic fitness, fatigue, and physical disability in systemic lupus erythematosus. Journal of Rheumatology 2002;29(3):474-81. - PubMed
Youssef 2021 {published data only}
    1. Youssef MK. Effect of training on health outcome including fatigue, depression and quality of life in patients with systemic lupus erythromatosus. Beni-Suef University Journal of Basic and Applied Sciences 2021;10(90):1-8.
Yuen 2011 {published data only}
    1. Yuen HK, Holthaus K, Kamen DL, Sword DO, Breland HL. Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: a pilot study. Lupus 2011;20(12):1293-9. - PMC - PubMed
Zeppieri‐Caruana 2018 {published data only}
    1. Zeppieri-Caruana M. Improved quality of life and decreased symptoms of lupus with diet, exercise, and functional medicine [abstract]. Arthritis and Rheumatology 2018;70(Suppl 9):-.

References to studies awaiting assessment

Boedecker 2020 {published data only}
    1. Boedecker SC, Philippi KF, Neuberger E, Schmidt S, Pfirrmann D, Haller N, et al. Twelve-week internet-based individualized exercise program in adults with systemic lupus erythematosus: protocol for a randomized controlled trial. Journal of Medical Internet Research Protocols 2020;9(11):1-11. - PMC - PubMed

Additional references

Abrahão 2016
    1. Abrahão MI, Gomiero AB, Peccin MS, Grande AJ, Trevisani VF. Cardiovascular training vs. resistance training for improving quality of life and physical function in patients with systemic lupus erythematosus: a randomized controlled trial. Scandinavian Journal of Rheumatology 2016;45:197-201. - PubMed
Ali 2018
    1. Ali A, Sayyed Z, Ameer MA, Arif AW, Kiran F, Iftikhar A, et al. Systemic lupus erythematosus: an overview of the disease pathology and its management. Cureus 2018;10:1-13. - PMC - PubMed
Askanase 2012
    1. Askanase A, Shum K, Mitnick H. Systemic lupus erythematosus: an overview. Social Work in Health Care 2012;51(7):576-86. - PubMed
Bogdanovic 2015
    1. Bogdanovic G, Stojanovich L, Djokovic A, Stanisavljevic N. Physical activity program is helpful for improving quality of life in patients with systemic lupus erythematosus. Tohoku Journal of Experimental Medicine 2015;237:193-9. - PubMed
Bossingham 2003
    1. Bossingham D. Systemic lupus erythematosus in the far north of Queensland. Lupus 2003;12(4):327-31. - PubMed
Boström 2016
    1. Boström C, Elfving B, Dupré B, Opava CH, Lundberg IE, Jansson E. Effects of a one-year physical activity programme for women with systemic lupus erythematosus – a randomized controlled study. Lupus 2016;25:602-16. - PubMed
Brunner 2010
    1. Brunner HI, Higgins GC, Klein-Gitelman MS. Minimal clinically important differences of disease activity indices in childhood-onset systemic lupus erythematosus. Arthritis Care & Research (Hoboken) 2010;62(7):950-9. - PMC - PubMed
Button 2013
    1. Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, et al. Power failure: why small sample size undermines the reliability of neuroscience. Nature Reviews. Neuroscience 2013;14(5):365-76. - PubMed
Campbell 2020
    1. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis Without Meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ 2020;368:1-6. - PMC - PubMed
Carvalho 2005
    1. Carvalho MR, Sato EI, Tebexreni AS, Heidecher RT, Schenkman S, Neto TL. Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity, and quality of life in patients with systemic lupus erythematosus. Arthritis and Rheumatism 2005;53(6):838-44. - PubMed
Da Hora 2019
    1. Da Hora TC, Lima K, Maciel RR. The effect of therapies on the quality of life of patients with systemic lupus erythematosus: a meta-analysis of randomized trials. Advance Rheumatology 2019;59(34):1-8. - PubMed
Deeks 2020
    1. Deeks JJ, Higgins JP, Altman DG. Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.1 (updated September 2020). Cochrane, 2020. Available from training.cochrane.org/handbook/archive/v6.1.
Del Pino‐Sedeno 2016
    1. Del Pino-Sedeno T, Trujillo-Martin MM, Ruiz-Irastorza G, Cuellar-Pompa L, Pascual-Medina AM, Serrano-Aguilar P, et al. Effectiveness of nonpharmacologic interventions for decreasing fatigue in adults with systemic lupus erythematosus: a systematic review. Arthritis Care & Research 2016;68(1):141-8. - PubMed
Dos Reis‐Neto  2013
    1. Dos Reis-Neto ET, Da Silva AE, Monteiro CM, De Camargo LM, Sato EI. Supervised physical exercise improves endothelial function in patients with systemic lupus erythematosus. Rheumatology 2013;52:2187-95. - PubMed
Doward 2009
    1. Doward LC, McKenna SP, Whalley D, Tennant A, Griffiths B, Emery P, et al. The development of the L-QoL: a quality-of-life instrument specific to systemic lupus erythematosus. Annals of the Rheumatic Diseases 2009;68:196-200. - PubMed
FACIT group
    1. FACIT group. The Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) scale: summary of development and validation. www.facit.org/FACITOrg/Questionnaires (accessed prior to 1 October 2021).
Fanouriakis 2019
    1. Fanouriakis A, Kostopoulou M, Alunno A, Aringer M, Bajema I, Boletis JN, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Annals of the Rheumatic Diseases 2019;78:736-45. - PubMed
Furie 2009
    1. Furie RA, Petri MA, Wallace DJ, Ginzler EM, Merrill JT, Stohl W, et al. Novel evidence-based systemic lupus erythematosus responder index. Arthritis & Rheumatology 2009;61(9):1143-51. - PMC - PubMed
Ghogomu 2014
    1. Ghogomu EA, Maxwell LJ, Buchbinder R, Rader T, Pardo Pardo J, Johnston RV, et al. Updated method guidelines for Cochrane Musculoskeletal Group systematic reviews and meta-analyses. Journal of Rheumatology 2014;41(2):194-205. - PubMed
Goligher 2008
    1. Goligher EC, Pouchot J, Brant R, Kherani RB, Aviña-Zubieta JA, Lacaille D, et al. Minimal clinically important difference for 7 measures of fatigue in patients with systemic lupus erythematosus. Journal of Rheumatology 2008;35:635-42. - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015. Available from www.gradepro.org.
Gu 2020
    1. Gu C, Zhao R, Zhang X, Gu Z, Zhou W, Guo J, et al. A meta-analysis of secondary osteoporosis in systemic lupus erythematosus: prevalence and risk factors. Archives of Osteoporosis 2020;15(1):1-12. - PubMed
Hay 1993
    1. Hay EM, Bacon PA, Gordon C, Isenberg DA, Maddison P, Snaith ML, et al. The BILAG index: a reliable and valid instrument for measuring clinical disease activity in systemic lupus erythematosus. Quarterly Journal of Medicine 1993;86(7):447-58. - PubMed
Higgins 2011
    1. Higgins JP, Altman DG, Sterne JA. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Higgins 2020a
    1. Higgins JP, Li T, Deeks JJ. Chapter 6: Choosing effect measures and computing estimates of effect. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.1 (updated September 2020). Cochrane, 2020. Available from training.cochrane.org/handbook/archive/v6.1.
Higgins 2020b
    1. Higgins JP, Eldridge S, Li T. Chapter 23: Including variants on randomized trials. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.1 (updated September 2020). Cochrane, 2020. Available from training.cochrane.org/handbook/archive/v6.1.
Isenberg 2000
    1. Isenberg DA, Gordon C, BILAG Group, British Isles Lupus Assessment Group. From BILAG to BLIPS – disease activity assessment in lupus past, present and future. Lupus 2000;9(9):651-4. - PubMed
Kelley 2015
    1. Kelley GA, Kelley KS, Hootman JM. Effects of exercise on depression in adults with arthritis: a systematic review with meta-analysis of randomized controlled trials. Arthritis Research Therapy 2015;17(1):1-22. - PMC - PubMed
Lai 2011
    1. Lai J-S, Beaumont JL, Ogale S, Brunetta P, Cella D. Validation of the Functional Assessment of Chronic Illness Therapy – Fatigue scale in patients with moderately to severely active systemic lupus erythematosus, participating in a clinical trial. Journal of Rheumatology 2011;38(4):672-9. - PubMed
Leong  2005
    1. Leong KP, Kong KO, Thong BY, Koh ET, Lian TY, Teh CL, et al. Development and preliminary validation of a Systemic Lupus Erythematosus-specific Quality-Of-Life instrument (SLEQOL). Rheumatology 2005;44:1267–76. - PubMed
Leung 2011
    1. Leung YY, Zhu TY, Tam LS, Kun EW, Li EK. Minimal important difference and responsiveness to change of the SF-36 in patients with psoriatic arthritis receiving tumor necrosis factor-alpha blockers. Journal of Rheumatology 2011;38(9):2077-9. - PubMed
Lu 2021
    1. Lu M-C, Koo M. Effects of exercise intervention on health-related quality of life in patients with systemic lupus erythematosus: a systematic review and meta-analysis of controlled trials. Healthcare (Basel) 2021;9(1215):1-15. - PMC - PubMed
Manzi 1997
    1. Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA Jr, Jansen-McWilliams L, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. American Journal of Epidemiology 1997;145(5):408-15. - PubMed
Margiotta 2018
    1. Margiotta DP, Basta F, Dolcini G, Batani V, Lo Vullo M, Vernuccio A, et al. Physical activity and sedentary behavior in patients with systemic lupus erythematosus. PLOS One 2018;13(3):1-16. - PMC - PubMed
McElhone 2007
    1. McElhone K, Abbott J, Shelmerdine J, Bruce IN, Ahmad Y, Gordon C, et al. Development and validation of a disease-specific health-related quality of life measure, the LupusQol, for adults with systemic lupus erythematosus. Arthritis & Rheumatology 2007;57:972–9. - PubMed
McElhone 2010
    1. McElhone K, Abbott J, Gray J, Williams A, Teh LS. Patient perspective of systemic lupus erythematosus in relation to health-related quality of life concepts: a qualitative study. Lupus 2010;19:1640-7. - PubMed
McElhone 2016
    1. McElhone K, Abbott J, Sutton C, Mullen M, Lanyon P, Rahman A, et al. Sensitivity to change and minimal important differences of the LupusQoL in patients with systemic lupus erythematosus. Arthritis Care & Research 2016;68:1505-13. - PMC - PubMed
McKenzie 2021
    1. McKenzie JE, Brennan SE, Ryan RE, Thomson HJ, Johnston RV. Chapter 9: Summarizing study characteristics and preparing for synthesis. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from training.cochrane.org/handbook/archive/v6.2.
Metsios 2020
    1. Metsios GS, Moe RH, Kitas GD. Exercise and inflammation. Best Practice Research & Clinical Rheumatology 2020;34(2):1-12. - PubMed
Miossi 2012
    1. Miossi R, Benatti FB, Lúciade de Sá Pinto A, Lima FR, Borba EF, Prado DM, et al. Using exercise training to counter balance chronotropic incompetence and delayed heart rate recovery in systemic lupus erythematosus: a randomized trial. Arthritis Care & Research 2012;64:1159-66. - PubMed
Neill 2006
    1. Neill J, Belan I, Ried K. Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review. Journal Advance Nursing 2006;56(6):617-35. - PubMed
Nikpour 2014
    1. Nikpour M, Bridge JA, Richter S. A systematic review of prevalence, disease characteristics and management of systemic lupus erythematosus in Australia: identifying areas of unmet need. Internal Medicine Journal 2014;44(12a):1170-9. - PubMed
Nordin 2016
    1. Nordin A, Taft C, Lundgren-Nilsson A, Dencker A. Minimal important differences for fatigue patient reported outcome measures – a systematic review. BMC Medical Research Methodology 2016;16(62):1-16. - PMC - PubMed
O'Dwyer 2017
    1. O'Dwyer T, Durcan L, Wilson F. Exercise and physical activity in systemic lupus erythematosus: a systematic review with meta-analyses. Seminars in Arthritis and Rheumatism 2017;47(2):204-15. - PubMed
Page 2020
    1. Page MJ, Higgins JP, Sterne JA. Chapter 13: Assessing risk of bias due to missing results in a synthesis. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.1 (updated September 2020). Cochrane, 2020. Available from training.cochrane.org/handbook/archive/v6.1.
Page 2021
    1. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021;372:1-36. - PMC - PubMed
Perandini 2012
    1. Perandini LA, De Sa-Pinto AL, Roschel H, Benatti FB, Lima FR, Bonfa E, et al. Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases. Autoimmunity Reviews 2012;12(2):218-24. - PubMed
Pescatello 2014
    1. Pescatello LS. ACSM's Guidelines for Exercise Testing and Prescription. 9th edition. Philadelphia (PA): Wolters Kluwer/Lippincott Williams & Wilkins Health, 2014.
Petri 1999
    1. Petri M, Buyon J, Kim M. Classification and definition of major flares in SLE clinical trials. Lupus 1999;8(8):685-91. - PubMed
Petri 2005
    1. Petri M, Kim MY, Kalunian KC, Grossman J, Hahn BH, Sammaritano LR, et al, OC-SELENA Trial. Combined oral contraceptives in women with systemic lupus erythematosus. New England Journal of Medicine 2005;353(24):2550-8. - PubMed
PRISMA Group 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. BMJ 2009;339:b2535. - PMC - PubMed
Ramsey‐Goldman 2000
    1. Ramsey-Goldman R, Schilling EM, Dunlop D, Langman C, Greenland P, Thomas RJ, et al. A pilot study on the effects of exercise in patients with systemic lupus erythematosus. Arthritis Care & Research 2000;13(5):262-9. - PubMed
RevMan Web 2022 [Computer program]
    1. Review Manager Web (RevMan Web). Version 4.12.0. The Cochrane Collaboration, 2022. Available at revman.cochrane.org.
Robb‐Nicholson 1989
    1. Robb-Nicholson LC, Daltroy L, Eaton H, Gall V, Wright E, Hartley LH, et al. Effects of aerobic conditioning in lupus fatigue: a pilot study. British Journal of Rheumatology 1989;28:500-5. - PubMed
Schoenfeld 2013
    1. Schoenfeld R, Kasturi S, Costenbader KH. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Seminars in Arthritis and Rheumatism 2013;43(1):77-95. - PubMed
Schünemann 2020a
    1. Schünemann HJ, Vist GE, Higgins JP, Santesso N, Deeks JJ, Glasziou P, et al. Chapter 15: Interpreting results and drawing conclusions. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.1 (updated September 2020). Cochrane, 2020. Available from training.cochrane.org/handbook/archive/v6.1.
Schünemann 2022b
    1. Schünemann HJ, Vist GE, Higgins JP, Santesso N, Deeks JJ, Glasziou P, et al, on behalf of the Cochrane GRADEing Methods Group. Chapter 15: Interpreting results and drawing conclusions. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.1 (updated September 2020). Cochrane, 2020. Available from training.cochrane.org/handbook/archive/v6.1.
Segasothy 2001
    1. Segasothy M, Phillips PA. Systemic lupus erythematosus in Aborigines and Caucasians in central Australia: a comparative study. Lupus 2001;10:439-44. - PubMed
Sieczkowskaa 2020
    1. Sieczkowskaa SM, Coimbrab DR, Vilarinoa GT, Andrade A. Effects of resistance training on the health-related quality of life of patients with rheumatic diseases: systematic review with meta-analysis and meta-regression. Seminars in Arthritis and Rheumatism 2020;50(2):342-53. - PubMed
Slade 2016
    1. Slade S, Dionne CE, Underwood M, Buchbinder R. Consensus on Exercise Reporting Template (CERT): explanation and elaboration statement. British Journal of Sports Medicine 2016;50:1428-37. - PubMed
Sutanto 2013
    1. Sutanto B, Singh-Grewal D, McNeil HP, O'Neill S, Craig JC, Jones J, et al. Experiences and perspectives of adults living with systemic lupus erythematosus: thematic synthesis of qualitative studies. Arthritis Care & Research 2013;65(11):1752-65. - PubMed
Sveaas 2017
    1. Sveaas SH, Smedslund G, Birger HK, Dagfinrud H. Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis. British Journal of Sports Medicine 2017;51:1065-72. - PubMed
Tench 2003
    1. Tench CM, McCarthy J, McCurdie I, White PD, D'Cruz DP. Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise. Rheumatology 2003;42(9):1050-4. - PubMed
Wu 2017
    1. Wu M-L, Yu K-H, Tsai J-C. The effectiveness of exercise in adults with systemic lupus erythematosus: a systematic review and meta-analysis to guide evidence-based practice. Worldviews on Evidence-Based Nursing 2017;14(4):306-15. - PubMed
Yorganci 2020
    1. Yorganci E, Evans CJ, Johnson H, Barclay S, Murtagh FE, Yi D, et al. Understanding usual care in randomised controlled trials of complex interventions: a multi-method approach. Palliative Medicine 2020;34(5):667-79. - PMC - PubMed
Yuen 2014
    1. Yuen HK, Cunningham MA. Optimal management of fatigue in patients with systemic lupus erythematosus: a systematic review. Therapeutics and Clinical Risk Management 2014;10:775-8. - PMC - PubMed

References to other published versions of this review

Frade 2021
    1. Frade S, O'Neill S, Greene D, Cameron M. Exercise as adjunctive therapy for systemic lupus erythematosus. Cochrane Database of Systematic Reviews 2021, Issue 10. Art. No: CD014816. [DOI: 10.1002/14651858.CD014816] - DOI - PMC - PubMed

Publication types

Supplementary concepts