Background/Purpose: Patients with systemic lupus erythematosus (SLE) are at increased risk for atherosclerotic cardiovascular disease (ASCVD). As sedentary behavior and lack of physical activity are known ASCVD risk factors, we evaluated habitual physical activity levels among SLE patients using accelerometry. We also investigated the association between SLE disease characteristics and the amount of habitual physical activity and sedentary behavior performed by SLE patients.

Methods: For this cross-sectional study, patients were recruited from an SLE clinic at a single academic medical center. All participants met the ACR classification criteria for SLE. Validated instruments were used to measure disease activity (SLEDAI-2K), organ damage [SLICC/ACR Damage Index (SDI)], and functional status (HAQ). Laboratory data included ESR and serum CRP. Habitual physical activity was measured using triaxial accelerometers worn during waking hours for seven consecutive days. Minutes per day of sedentary time, light activity, and moderate-vigorous physical activity (MVPA) were recorded. SLE disease characteristics associated with time spent performing MVPA and time in sedentary behavior were identified using multivariable linear regression, adjusting for demographic factors including age, sex, race, and education.

Results: There were 109 SLE patients (92% female) with mean (SD) age 52.3 (14.5) years, SLEDAI-2K 2.1 (2.4), and SDI 1.5 (2.1). High levels of sedentary behavior were observed [mean (SD) sedentary time 10.1 (1.2) hours/day], accounting for 78.6% of total accelerometer wear time. Mean (SD) MVPA was low [32.6 (22.5) minutes/day]. Only 13/109 participants (11.9%) met the Canadian Physical Activity Guidelines for MVPA (≥ 150 minutes/week in 10 minute bouts). In univariable linear regression, SLE disease characteristics significantly associated with MVPA performance included the SDI (β = -0.184; p=0.006), HAQ (β = -0.207; p=0.001), SLEDAI-2K (β = -0.183; p=0.004), and ESR (β = -0.208; p=0.004). In multivariable analysis, both the HAQ (β = -0.191; p=0.002) and SLEDAI-2K (β = -0.175; p=0.005) remained significantly associated with time spent performing MVPA. Specifically, higher HAQ and SLEDAI-2K scores were associated with lower MVPA performance. After adjustment for MVPA performance, none of the SLE disease characteristics we evaluated were significantly associated with time spent in sedentary behavior.

Conclusion: SLE patients demonstrate suboptimal levels of habitual MVPA, as well as high sedentary behavior. Our results highlight the potential negative impact of disease activity and functional disability on habitual physical activity in SLE. The findings identify a subgroup of SLE patients at increased risk for physical inactivity and will help inform the design of effective interventions to improve habitual physical activity levels in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-disease-characteristics-on-habitual-physical-activity-and-sedentary-behavior-among-patients-with-systemic-lupus-erythematosus-sle/