title: Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity, and quality of life in patients with systemic lupus erythematosus. A pilot study on the effects of exercise in patients with systemic lupus erythematosus. Interpreting estimates of treatment effects: implications for managed care. Aerobic fitness, fatigue, and physical disability in systemic lupus erythematosus. Effectiveness of minimally supervised home aerobic training in patients with systemic rheumatic disease. Persistence of unmet need for care among people with systemic lupus erythematosus: a longitudinal study Reliability of the PEDro scale for rating quality of randomized controlled trials. Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise.
abstract: OBJECTIVE To determine if supervised cardiovascular training improves exercise tolerance , aerobic capacity , depression , functional capacity , and quality of life in patients with systemic lupus erythematosus ( SLE ) . METHODS Sixty women with SLE ( ages 18 - 55 years ) were evaluated using Short Form 36 , visual analog scale for pain , scale for fatigue , Beck Depression Inventory , and Health Assessment Question naire ( HAQ ) , and participated in a training protocol of incremental load on a treadmill with computed gas metabolic analysis .  Maximum oxygen consumption ( VO(2max ) ) and anaerobic threshold VO(2 ) were calculated with a SensorMedics Vmax29C analyzer ( Sensor Medics , Yorba Linda , CA ) , and heart rate was measured by electrocardiogram . Patients were divided into 2 groups : a training group ( 41 patients ) that participated in the supervised cardiovascular training program and a control group ( 19 patients ) that did not participate in the program . All variables were analyzed at baseline and after 12 weeks for both groups . The training program occurred in the morning for 60 minutes , 3 times a week for 12 weeks . Statistical analysis included Wilcoxon 's rank sum test , Mann-Whitney U test , chi-square test , and Fisher 's exact test . P values < 0.05 were considered to be statistically significant . RESULTS The 2 groups were homogeneous and comparable at baseline . The training group showed a significant improvement of aerobic capacity measured by anaerobic threshold VO(2 ) ( 14.67 + /- 3.03 versus 17.08 + /- 3.35 ml/kg/minute , P < 0.001 ) . Comparison of the training group and control group after 12 weeks showed a significant difference relating to VO(2max ) ( 24.31 + /- 4.61 versus 21.21 + /- 3.88 ml/kg/minute , P = 0.01 ) and anaerobic threshold VO(2 ) ( 17.08 + /- 3.35 versus 13.66 + /- 2.82 ml/kg/minute , P < 0.0001 ) . After cardiovascular training , we found a significant improvement of Beck inventory score ( 8.37 + /- 12.79 versus 2.90 + /- 3.00 , P < 0.001 ) and HAQ score ( 0.14 + /- 0.21 versus 0.06 + /- 0.19 , P < 0.01 ) in the training group . CONCLUSION This study showed significant improvement in exercise tolerance , aerobic capacity , quality of life , and depression after a supervised cardiovascular training program in patients with SLE OBJECTIVE A pilot study was design ed to assess the efficacy and safety of different exercise therapies on  patient-reported fatigue and functional status .  METHODS Ten patients with systemic lupus erythematosus ( SLE ) were r and omly placed in either an aerobic exercise group ( group 1 : n = 5 ) or a range of motion/muscle strengthening ( ROM/MS ) exercise group ( group 2 : n = 5 ) . Outcome measures assessed at baseline and the end of the study were fatigue , functional status , disease activity , cardiovascular fitness , isometric strength , bone mineral density ( BMD ) of the lumbar spine and femoral neck , and parathyroid hormone and osteocalcin as representative bone biochemical markers for bone resorption and bone formation , respectively . RESULTS Both aerobic and ROM/MS types of exercise were safe and did not worsen SLE disease activity . Patients in both exercise groups showed some improvement in fatigue , functional status , cardiovascular fitness , and muscle strength . Both groups showed increased bone turnover , but BMD was unchanged . Eighty percent of the patients met the compliance st and ard for the study . CONCLUSIONS This pilot study shows the feasibility of exercise for SLE patients . The potential value of this approach shows promise in the routine management of these patients How should health care professionals choose among the many therapies cl aim ed to be efficacious for treating specific disorders ? The practice of evidence -based medicine provides an answer . Advocates of this approach urge health care professionals to base treatment choices on the best evidence from systematic research on both the efficacy and adverse effects of various therapeutic alternatives . Ideally , health care professionals would compare different treatments by referring to r and omized , double-blind , head-to-head trials that compared the treatment options . Although individual medications are typically well research ed when these placebo-controlled studies are performed , studies that directly compare treatments are rare . In the absence of direct head-to-head trials , other evidence comes from indirect comparisons of two or more therapies by examining individual studies involving each treatment . This article provides an introductory review of methods of such indirect comparisons of therapies across studies , provides examples of how these methods can be used to make treatment decisions , and presents a general overview of relevant issues and statistics for readers interested in underst and ing these methods more thoroughly OBJECTIVE To measure aerobic fitness , muscle strength , fatigue , and physical disability in patients with systemic lupus erythematosus ( SLE ) . METHODS Ninety-three patients with SLE and 41 sedentary controls were recruited into the study . Aerobic fitness was assessed by monitoring peak and submaximal oxygen uptake , heart rate , duration of exercise , and perceived exertion during a treadmill-walking test . Strength was measured using voluntary isometric quadriceps contraction . Symptomatic measures included physical and mental fatigue , mood , sleep , and functional incapacity . RESULTS Compared to sedentary controls patients with SLE had significantly reduced levels of aerobic fitness ( mean VO2peak SLE patients , 23.2 ml/kg/min vs controls , 29.6 ml/kg/min ; p < 0.001 ) and reduced exercise capacity ( mean exercise duration SLE patients , 10.4 min vs controls , 13.1 min ; p < 0.001 ) . The SLE patients also had reduced muscle strength ( mean maximum voluntary quadriceps contraction SLE patients , 298 N vs controls , 376 N ; p = 0.003 ) . Resting lung function was also significantly worse in the SLE patients ( mean FEV , SLE patients , 2.6 l vs controls , 2.9 l ; p = 0.002 ) . Fatigue ( p < 0.001 ) , depressed mood ( p < 0.001 ) , poor sleep quality ( p < 0.001 ) , and functional incapacity ( p < 0.001 ) were all significantly greater in the SLE patients . Linear regression models suggested that physical disability correlated with aerobic fitness ( p < 0.001 ) , fatigue ( p = 0.005 ) , body mass index ( p = 0.01 ) , and depression ( p = 0.05 ) and that fatigue correlated with depression ( p < 0.001 ) . CONCLUSION Patients with SLE were less fit with reduced exercise capacity , reduced muscle strength , more fatigue , and greater disability compared to sedentary controls . Treatments developed to manage depression and improve aerobic fitness should be considered in the overall treatment of fatigue and disability in SLE The effectiveness of an exercise prescription and unsupervised home exercise programme was tested on 37 subjects with rheumatoid arthritis and 34 with systemic lupus erythematosus . Subjects were r and omly assigned to control or stationary bicycling at home , using loaned bicycles . Exercise subjects ( with bicycles ) did better than controls , but not significantly , on all outcome d measures ( exercise tolerance test , fatigue , depression and helplessness ) at 3 months . Bicycles were recl aim ed at 3 months and all subjects in both groups given instructions for home exercise . Exercise in the second 3 months was predicted primarily by baseline exercise habits and fatigue . It is concluded that although safe , unsupervised home exercise programmes may benefit few patients . Future research should address methods of stimulating and maintaining unsupervised exercise programmes in patients with systemic rheumatic disease Purpose The extent and variability of unmet care needs over time of people with systemic lupus erythematosus ( SLE ) has not been previously reported . A prospect i ve study was undertaken to determine the variability over time of such needs . Method A 97-item SLE needs question naire ( SLENQ ) was completed on two occasions 6 months apart by 233 members of a lupus support association . Levels of unmet need for each individual , and a mean symptom score were calculated . Results Overall level of unmet need increased , decreased or stayed the same for 18 % , 37 % , and 45 % of participants respectively . Ninety-four percent of participants at time 1 and 95 % of participants at time 2 reported an unmet need for care for at least one item . The prevalence of unmet need for care remained the same for 82 of the 97 items . The mean unmet need score declined significantly between time 1 ( 0.78 ) and time 2 ( 0.69 ) . The mean unmet need scores were significantly correlated with mean symptom score . Conclusions The results of the study suggest an unacceptable persistence of care needs not being met . There is an ongoing need to identify mechanisms to enhance care delivery so that the care needs of people with SLE are more effectively addressed BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To test the efficacy of a grade d aerobic exercise programme in treating  fatigue in systemic lupus erythematosus . METHODS Ninety-three patients with systemic lupus erythematosus without active disease in any major organ were r and omized , using a minimization protocol , to 12 weeks of grade d exercise therapy , relaxation therapy or no intervention . RESULTS Analysis by intention to treat showed that 16 of the 33 ( 49 % ) patients in the exercise group rated themselves as ' much ' or ' very much ' better compared with eight out of 29 ( 28 % ) in the relaxation group and five out of 32 ( 16 % ) in the control group ( chi2=8.3 , df=2 , P=0.02 ) . Fatigue improved significantly on one out of three measures after exercise therapy and there was a trend for fatigue to improve on all measures after exercise . CONCLUSION These findings support the use of appropriately prescribed grade d aerobic exercise in the management of patients with fatigue and systemic lupus erythematosus
target: The subgroup analysis indicated that 12 weeks of exercise training and exercise under a supervised setting significantly benefited fatigue .
  Linking Evidence to Action : The pooled data indicate that 12 weeks of an aerobic exercise program that is supervised by health professionals could reduce fatigue and increase vitality for patients with SLE .
background: Background : Fatigue is the most common and unpleasant symptom of patients with systemic lupus erythematosus ( SLE ) .
  However , there is limited information regarding how exercise affects fatigue .
  Aims : The purpose of this study is to review and synthesize the current knowledge concerning the effectiveness of exercise training for treating fatigue  among adults with SLE .
  The characteristics of beneficial exercise training are further evaluated .