Upper Limb Exercise Improves Functional Skills and Quality of Life in SLE Patients, Clinical Study Shows

Upper limb exercise lowers pain and improves hand function, daily activity performance, and quality of life in people with systemic lupus erythematosus (SLE), according to a pilot clinical trial.

The trial’s results, “The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial,” were published in the journal RMD Open.

People with SLE often experience fatigue, joint and/or muscle pain, and muscle weakness, which can significantly affect their ability to complete daily tasks and work activities.

A previous review study concluded that full body exercise was safe and improved physical fitness in SLE patients, while lessening fatigue and depression.

Several studies have highlighted the therapeutic benefits of upper limb exercise on hand and daily functioning, as well as on quality of life in rheumatic disorders such as rheumatoid arthritis, psoriatic arthritis, and osteoarthritis. Whether this type of exercise promotes the same benefits in people with SLE is undetermined.

A team at National and Kapodistrian University of Athens, in Greece, conducted a 24-week pilot clinical trial (NCT03802578) to evaluate the clinical impact of upper limb exercise in participants with SLE.

Researchers assessed changes in patients’ ability to perform daily activities using two validated, self-administered measures: the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Health Assessment Questionnaire (HAQ). In both measures, high scores indicate greater disability.

Other assessments included grip and pinch strength, as well as dexterity (skill) of the dominant hand, pain — using a visual analogue scale — and quality of life — using the Lupus Quality of Life questionnaire.

The trial included 62 adults with SLE with joint pain in the hand and/or arm, and difficulties in performing activities of daily living (DASH score higher than 10). A stable therapy regimen for at least three months and the absence of physiotherapy in the prior month were also used as factors for eligibility.

Participants were randomly assigned to receive either a daily 30-minute upper limb exercise session at home in addition to routine care (32 patients), or routine care alone (30 patients), for 12 weeks.

The strengthening and stretching exercise program, given by a hand therapist, included nine exercises for the upper extremities with a stick, 10 exercises for the fingers, and 11 exercises against resistance with a therapeutic putty. An initial assessment enabled tailoring the program to each patient’s strength, pain level, and flexibility.

Patients in both groups were given four sessions of training in different methods to perform daily activities, use of aids, joint protection, and energy conservation.

There were no statistical differences at the study’s start in mean age (43.3 years in the exercise group and 48.8 years in the control group), nor in demographics or disease and treatment-related parameters.

A total of 30 patients (93.8%) in the exercise group completed the 12-week exercise program, and 28 (87.5%) were re-evaluated at 24 weeks. All participants in the non-exercise group completed the 24-week study.

Results at 12 and 24 weeks showed that patients who received the upper limb exercise program had significant improvements in all measures. The most significant improvement was in the ability to perform everyday activities, with a more than two-fold reduction in DASH and HAQ scores.

Researchers noted that 24-week scores of all measures were generally equal or better than those at 12 weeks, suggesting that the program’s effects lasted beyond the exercise period.

Those not receiving the exercise program also showed a significant improvement in hand skills and in pain reduction, possibly from the training sessions given to both groups, the scientists said.

Across all measures, including grip and pinch strength, the changes were significantly greater in the exercise group than in controls, and the exercise program was also safe and well-tolerated.

“In conclusion, the introduction of a 30-min session of therapeutic exercise for the upper limbs, as an adjunct to routine care, can improve hand function, dexterity, performance of activities of daily life, and quality of life in patients with SLE,” the researchers wrote.