Evaluation of the self-directed format of Walk With Ease in patients with systemic lupus erythematosus: the Walk-SLE Pilot Study

Abstract

Objective To conduct a proof-of-concept pilot evaluation of the self-directed format of Walk With Ease (WWE), a 6-week walking program developed for adults with arthritis, in patients with systemic lupus erythematosus (SLE). Methods This was a single arm, 6-week pre- and post-evaluation of the self-directed WWE program to assess feasibility, tolerability, safety, acceptability, and effectiveness. Adult patients with physician-diagnosed SLE were recruited to participate during regularly scheduled visits to an academic rheumatology clinic. Self-reported outcomes of pain, stiffness, and fatigue were assessed by visual analog scales (VAS) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-fatigue) scale at baseline and at completion of the 6-week program. Patients also completed a satisfaction survey at the end of the program. Multivariate linear regression models were used to calculate mean changes between baseline and 6-week follow-up scores, adjusting for covariates. Mean change scores were used to estimate effect sizes (ES). Results At 6 weeks, 48 of the 75 recruited participants completed the WWE program. Participants experienced modest improvements in stiffness and fatigue (ES = 0.12 and ES = 0.23, respectively, for VAS scores; ES = 0.16 for FACIT-fatigue score) following the intervention. The majority of participants reported satisfaction with the program (98%) and benefitted from the workbook (96%). Conclusions The self-directed format of WWE appears to reduce stiffness and fatigue in patients with SLE. It also seems to be a feasible and acceptable exercise program to patients with SLE. Larger studies are needed to confirm these findings.

Twelve-Week Internet-Based Individualized Exercise Program in Adults With Systemic Lupus Erythematosus: Protocol for a Randomized Controlled Trial

“…Previous studies [20,21] indicate that exercise can lead to various benefits in patients with systemic lupus erythematosus due to an increased aerobic capacity, exercise tolerance, and quality of life as well as decreased depressive symptoms and symptoms of fatigue. These positive effects were achieved in supervised as well as unsupervised exercise programs [15,[17][18][19]22,37,38]. In addition, it has been repeatedly discussed whether physical activity leads to an increase in lupus disease activity-an increase in autoantibodies, an increase in the consumption of complement factors, and an exacerbation of clinical symptoms such as arthralgia and myalgia.…”

“…However, patients with systemic lupus erythematosus frequently suffer from fatigue in their daily life, so the burden of being physically active is much higher than it is for healthy patients. But when the patients are physically active, a reduction in fatigue could already be observed after a walking program of 6 weeks [22]. Thus, an individually adapted training program (based on training status and time of training) could be continuously and easily used by patients and to positively support permanent use.…”

“…Several studies have shown that physical exercise is well tolerated in systemic lupus erythematosus [21]. Cycling, running, and walking were shown to be effective and well tolerated in patients with systemic lupus erythematosus [14,18,21,22], while progressive resistance training with elastic bands is considered to be a safe method to improve muscle strength [23]; however, cardiovascular training seems to have a better effect on the quality of life of patients than resistance training does [24].…”

The Barriers of Systemic Lupus Erythematosus that Affect Self-Efficacy for Physical Activity

“…Musculoskeletal pain affects 50-61% of lupus patients, with morning stiffness affecting about half and fatigue affecting up to 60-90% of people with lupus (Sheikh et al 2019).…”

“…This study also showed that other than musculoskeletal manifestations and cardiopulmonary involvement, fatigue, fibromyalgia, and depression had been presented as barriers to physical activity for people with lupus (2021) Previous research involving prescribing aerobic physical activity to individuals with lupus showed statistically significant improvements in body pain reduction, fatigue, and quality of life. So, in a study conducted by Sheikh et al (2019), the researchers wanted to evaluate the effectiveness of a six-week walking program for individuals with lupus. The researchers for this study used self-reported questionnaires to receive the participants' feedback on the walking program and how it has impacted their quality of life.…”