Using exercise training to counterbalance chronotropic incompetence and delayed heart rate recovery in systemic lupus erythematosus: A randomized trial

Abstract

Objective. To evaluate the efficacy of a 3-month exercise training program in counteracting the chronotropic incompetence and delayed heart rate recovery in patients with systemic lupus erythematosus (SLE). Methods. A 12-week randomized trial was conducted. Twenty-four inactive SLE patients were randomly assigned into 2 groups: trained (T; n ‫؍‬ 15, 3-month exercise program) and nontrained (NT; n ‫؍‬ 13). A sex-, body mass index-, and age-matched healthy control (C) group (n ‫؍‬ 8) also underwent the exercise program. Subjects were assessed at baseline and at 12 weeks after training. Main measurements included the chronotropic reserve (CR) and the heart rate (HR) recovery (⌬HRR) as defined by the difference between HR at peak exercise and at both the first (⌬HRR1) and second (⌬HRR2) minutes after the exercise test. Results. Neither the NT SLE patients nor the C group presented any change in the CR or in ⌬HRR1 and ⌬HRR2 (P > 0.05). The exercise training program was effective in promoting significant increases in CR (P ‫؍‬ 0.007, effect size [ES] 1.15) and in ⌬HRR1 and ⌬HRR2 (P ‫؍‬ 0.009, ES 1.12 and P ‫؍‬ 0.002, ES 1.11, respectively) in the SLE T group when compared with the NT group. Moreover, the HR response in SLE patients after training achieved parameters comparable to the C group, as evidenced by the analysis of variance and by the Z score analysis (P > 0.05, T versus C). Systemic Lupus Erythematosus Disease Activity Index scores remained stable throughout the study. Conclusion. A 3-month exercise training program was safe and capable of reducing the chronotropic incompetence and the delayed ⌬HRR observed in physically inactive SLE patients.

Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy

“…In line with these observations, Miossi et al [79] described improvements in chronotropic responses during exercise as the result of a 3-month exercise training programme (resistance and endurance training) in patients with systemic lupus erythematosus. Keteyian et al [35] showed that exercise training for a duration of 24 weeks resulted in an increase in peak HR and HR reserve during exercise testing, as well as partial reversal of CI, in patients with heart failure.…”

“…Moreover, exercise training positively affects baroreceptor sensitivity and HR variability [18]. It is thus speculated that improved chronotropic responses during exercise testing, as a result of endurance exercise training, are related to increases in b-adrenergic receptor sensitivity and improved nervous system parasympathetic-sympathetic balance [18,32,35,79,80]. In addition, improvements in chronotropic responses during exercise testing seem to correlate with improvements in VO 2 peak and cardiac output [18,32,35,79,80].…”

Exercise as an anti-inflammatory therapy for rheumatic diseases—myokine regulation

“…Unchanged or improved inflammatory markers ■ Unchanged or improved disease activity scores and markers of systemic inflammation (erythrocyte sedimentation rate and C-reactive protein) in response to aerobic, 72 Improved cardiovascular function ■ Improved endothelial function and lipid profile in response to aerobic 80 and aerobic plus resistance exercise programmes, 106 and shown by cross-sectional studies 80,103,104,106 ■ Improved autonomic function in response to aerobic plus resistance exercise programmes in in adult SLE 108 and in response to aerobic exercise programmes in juvenile-onset SLE 82,108 Unchanged or decreased levels of inflammatory markers ■ No changes in disease activity scores or markers of systemic inflammation (erythrocyte sedimentation rate and C-reactive protein) in response to aerobic plus resistance exercise in adult SLE 106,108 and to aerobic exercise programmes in adult [78][79][80][81] and juvenile-onset SLE 81 ■ Unchanged or improved levels of selected proinflammatory and anti-inflammatory cytokines and soluble receptors at rest and after exercise (IL-6, IL-10, IFN-γ, TNF, sTNFR1, sTNFR2) in response to aerobic exercise programmes 78…”

Impaired Aerobic Capacity in Systemic Lupus Erythematosus Patients: What are the Physiological Mechanisms

“…In addition, a randomized controlled trial study by Prado et al [22] demonstrated an increase in chronotropic response (∆ heart rate response rest-peak exercise) in childhood-SLE patients after three-month aerobic exercise training. Likewise, Miossi et al [39] showed an improvement in chronotropic reserve after an exercise training program in women with SLE.…”