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Internal Warfare

American Fitness, July, 2001 by Raya Tahan

EXERCISE PROVES TO BE A POWERFUL WEAPON IN THE BATTLE AGAINST LUPUS.

Many people new to exercise agree that getting started was the most difficult part of their fitness program. However, people suffering with lupus face special challenges when trying to incorporate exercise in their lives. Symptoms of this autoimmune disease range from inflamed joints and debilitating pain to itchy rashes and depression. Lupus patients often feel hungry and struggle with the scale because they take medication that triggers weight gain. Some lupus patients have trouble finding a workout routine that doesn't exacerbate these symptoms or generate other negative side effects.

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Researchers have yet to identify the cause of lupus, which usually strikes women of childbearing age. It's a mysterious, chronic illness in which the body's immune system attacks its own healthy tissues. Most people know little or nothing about it, although more than one million Americans have it and more will be diagnosed during early adulthood. For some patients, lupus is mild, for others, it's fatal. It can strike the joints, muscles, skin, nervous system, internal organs or a combination of bodily systems.

According to the Lupus Foundation of America, lupus manifests itself in three forms: systematic I. erythematosus (SLE), discoid I. erythematosus (DLE) and drug-induced lupus. Systemic I. erythematosus lupus is the most severe type. It attacks almost any part of the body and can be life-threatening. Discoid I. erythematosus lupus causes rashes and lesions on the skin, usually on the face and upper part of the body. Drug-induced lupus is unique in that it is caused by a reaction to medication and symptoms usually disappear when the patient stops taking the adverse medicine.

Despite their unique hardships with exercise, lupus patients benefit tremendously from it. Although exercise does not directly improve immune function, it does prevent or minimize symptoms like fatigue, muscle weakness and depression. Keeping in mind the following general guidelines, lupus sufferers have everything to gain by taking part in regular, responsible exercise.

CONSULT YOUR DOCTOR

"Each case of lupus is very different from person to person," says Virginia Ladd, president of the American Autoimmune Related Diseases Association and, herself, a longtime lupus sufferer. "The patient should always discuss the specifics of an exercise program with their physician before starting."

EXERCISE REGULARLY

"Exercise improves joint mobility, muscle strength and function, thus producing less pain," explains Dr. Rosalind Ramsey-Goldman, the lead author of a National Institutes of Health pilot study on the effects of exercise in lupus patients. "The lupus patients reported less fatigue and overall felt much better. One year later they regretted [not continuing to exercise] because, in retrospect, they had felt much better during the study," she adds.

Because steroids are one of the main stays of treatment, some patients develop osteoporosis or thin bones. While steroids slow a hyperactive immune system, they also strip the body of calcium. Muscle stimulation and weightbearing exercise increase bone mass and thus offset this type of bone loss.

Exercise can also protect lupus sufferers from the adverse effects of steroids by improving density of the spine. However, they must remember that if their medication includes steroids, their bones might be compromised and vulnerable to fractures. This means avoiding workouts that put too much impact on the joints. "We found that lupus patients had a five-fold increased risk of self-reported symptomatic fractures," Ramsey-Goldman reports.

According to Ramsey-Goldman, exercise also improves balance, which could reduce the frequency of falls or make falling less dangerous for lupus patients with weak bones. "There is evidence that even one-to-three 10-minute sessions, three-to-five times per week is good," she says. "Consistency is good and doing something is better than nothing."

ARTHRITIS RELIEF

Arthritis is common in the lupus population, therefore, doctors encourage any fitness program that keeps joints flexible and mobile. "There are ways to make joints function better," says Dr. Michael Belmont, who heads the Hospital for Joint Diseases at New York University Medical Center. "Arthritis means there's inflammation [within a joint.] While there's no evidence that exercise reduces inflammation, it does make the muscles around the joints healthier. When joints are not inflamed, exercise will keep them flexible and strong" he says. Belmont, a pioneer in lupus research, recommends a minimum of 20 to 30 minutes of exercise, three-to-four times per week. "There is scientific validation that, just as in the healthy population, exercise can increase energy and reduce pain."

TRY DIFFERENT EXERCISES

Lupus patients should do a combination of aerobic exercises, weightlifting and stretching, Ramsey-Goldman advises. Claudia Pagano, R.N., author of Lupus: What's It All About? (a collection of stories by lupus patients and their doctors), recommends that lupus patients participate in a moderate exercise program that includes low impact activities (like walking and swimming), functional exercises (designed to combat imbalance and improve posture), range-of-motion exercises (to increase flexibility and joint mobility), modified strength training, water exercise (reduces stress to joints and enhances circulation), mind/body exercises or movement therapies (such as yoga and t'ai chi).

Internal Warfare

American Fitness, July, 2001 by Raya Tahan

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