Background/Purpose: Exercise and psychological stress have been shown to produce opposite effects on immunomodulation.  Prior studies in patients with Systemic Lupus Erythematosus (SLE) have demonstrated a decrease in inflammatory cytokine expression with exercise and improved disease activity with psychological stress reduction.  In agreement, our prior study in a murine model of lupus nephritis showed an increase in inflammatory cytokine secretion with psychosocial stress induction, while exercise correlated with decreased inflammation and disease pathology.  Therefore, to translate our previous findings, this study aims to utilize Tai Chi in exploring the effects of moderate exercise and psychological stress reduction on cytokine levels and perceived stress in SLE patients.

Methods: A cohort of 12 SLE patients >18 years of age participated in Tai Chi group classes twice a week and completed a Tai Chi DVD the remaining 5 days for 2.5 months.  Selected participants scored low on a physical activity questionnaire and above average on the perceived stress scale.  They were provided with FitBit activity trackers to monitor activity, sleep and caloric expenditure.  Data collection included bi-weekly blood samples, monthly questionnaires, and weekly FitBit data compared to baseline measurements.

Results: Relative to baseline data, questionnaires revealed a significant increase in metabolic equivalent of task (MET) and physical activity, and a decrease in perceived stress in SLE patients.  FitBit data showed an increase in steps, distance and activity calories, without significant change in body mass index or vigorous activity levels.  Analysis of pro-inflammatory serum cytokines in Tai Chi patients demonstrated a relative suppression of IL-6 by 23% (p=0.05), IL-8 by 30% (p=0.006), IFN-ɣ by 21% (p=0.05) and TNF-α by 11% (Figure 1).

Conclusion: Our results suggest that moderate exercise and psychological stress reduction have clinically detectable immunosuppressive properties.  We see a reduction in pro-inflammatory cytokine expression with Tai Chi along with a decrease in perceived stress levels. Thus, we propose Tai Chi as an adjuvant therapy to current pharmacologic interventions in the treatment of SLE, although larger studies are needed given the limitations herein, including a small sample size and short duration.

Figure 1.  Average decrease in cytokine expression in SLE patients 2.5 months after participation in a Tai Chi exercise program