Background/Purpose: Systemic lupus erythematous (SLE) associates with accelerated mortality, frequently attributable to cardiovascular (CV) causes, which is not fully explained by traditional CV risk factors. Individuals with SLE  are commonly sedentary with many percieved barriers to exercise. Physical inactivity likely contributes to the burden of CV risk and may also be a significant factor in co-morbid chronic fatigue, poor sleep and fibromyalgia. This meta-analysis evaluates whether exercise has a deleterious effect on disease activity in SLE, and assesses the impact of exercise on cardiorespiratory fitness and fatigue.

Methods: A systematic review and meta-analysis was conducted, including quasi-randomised and randomised controlled trials in SLE comparing at least one exercise group to controls. Studies were retrieved by searching MEDLINE/PubMed, EMBASE, PEDro, AMED, CINAHL and The Cochrane Central Register of Controlled Trials for keywords and medical subject headings relating SLE and exercise. Relevant conference abstracts and reference lists of included studies were manually searched. Two reviewers independently determined study eligibility and assessed risk of bias (Cochrane Risk of Bias tool). Data were extracted using a standardised template.  Random-effects meta-analyses were used to pool extracted data as mean differences (MD). Heterogeneity was evaluated with Chi² test and I², with  p-values < .05 considered significant.

Results: The search strategy produced 2980 records. Titles and abstracts screening identified 30 full-texts for eligibility appraisal. Of these, seven were suitable for inclusion in the meta-analyses. Studies included 178 participants and 125 controls; mean age ranged from 31.2 to 52.9 years, and disease duration from 2.5 to 17.9 years. Median (IQR) duration of the interventions was 12 (0) weeks. All interventions included aerobic components, and three also included strength training. There was a high risk of bias relating to blinding of participants and personnel; remaining domains were largely under-reported, with the overall risk of bias unclear. Fig. 1 summarises meta-analyses results. Disease activity was not significantly changed following exercise interventions (MD 0.01; 95% CI, -0.54 to 0.56). Fatigue (MD 0.61; 95% CI, 0.04 to 1.17) and aerobic capacity (MD 1.85 ml/kg/min; 95% CI, 1.12 to 2.57) were significantly improved.

Conclusion: This meta-analysis demonstrates that exercise significantly improves cardiorespiratory fitness and disease-related fatigue in individuals with SLE, without adversely affecting disease activity. This review suggests that exercise may be safely prescribed in this population. Longitudinal studies examining the effects of exercise on CV risk factors in this population are recommended based on the promising findings of this meta-analysis.