Aerobic Exercise is Safe and Effective in Systemic Sclerosis

Abstract

Several studies have established that systemic sclerosis patients have a reduced exercise capacity when compared to healthy individuals. It is relevant to evaluate whether aerobic exercise in systemic sclerosis patients is a safe and effective intervention to improve aerobic capacity. Seven patients without pulmonary impairment and seven healthy controls were enrolled in an 8-week program consisting of moderate intensity aerobic exercise. Patients and controls had a significant improvement in peak oxygen consumption (19.72±3.51 vs. 22.27±2.53 and 22.94±4.70 vs. 24.55±3.00, respectively, p=0.006), but difference between groups was not statistically significant (p=0.149). This finding was reinforced by the fact that at the end of the study both groups were able to perform a significantly higher exercise intensity when compared to baseline, as measured by peak blood lactate (1.43±0.51 vs. 1.84±0.33 and 1.11±0.45 vs. 1.59±0.25, respectively, p=0.01). Patients improved the peak exercise oxygen saturation comparing to the baseline (84.14±9.86 vs. 90.29±5.09, p=0.048). Rodnan score was similar before and after the intervention (15.84±7.84 vs.12.71±4.31, p=0.0855). Digital ulcers and Raynaud's phenomenon remained stable. Our data support the notion that improving aerobic capacity is a feasible goal in systemic sclerosis management. The long term benefit of this intervention needs to be determined in large prospective studies.

Key words

oxygen consumption - oxygen saturation - blood lactate - quality of life

References

• 1 Alkotob ML, Soltani P, Sheatt, MA, Katsetos MC, Rothfield N, Hager WD, Foley RJ, Silverman DI. Reduced exercise capacity and stress induces pulmonary hypertension in patients with scleroderma.  Chest. 2006;  130 176-181
• 2 Blom-Bülow B, Jonson B, Bauer K. Factors limiting exercise performance in progressive systemic sclerosis.  Semin Arthritis Rheum. 1983;  2 174-181
• 3 Daltroy L, Robb-Nicholson C, Iversen M, Wright M, Liang H. Effectiveness of minimally supervised home aerobic training in patients with systemic rheumatic disease.  Br J Rheumatol. 1995;  34 1064-1069
• 4 De Jong Z, Vlieland TP. Safety of exercise in patients with rheumatoid arthiritis.  Curr Opin Rheumatol. 2005;  17 177-182
• 5 Ferri C, Valentini G, Cozzi F, Sebastiani M, Michelassi C, La Montagna G, Bullo A, Cazzato M, Tirri E, Storino F, Giuggioli D, Cuomo G, Rosada M, Bombardieri S, Todesco S, Tirri G. Systemic Sclerosis Study Group of the Italian Society of Rheumatology (SIR-GSSSc). Systemic sclerosis: demographic, clinical, and serologic features and survival in 1 012 Italian patients.  Medicine (Baltimore). 2002;  81 139-153
• 6 Fleck MPA, Lousada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. Application of the Portuguese version of the instrument for the assessment of quality of life of the World Health Organisation (WHOQOL-100).  Rev de Saude Publica. 1999;  33 198-205
• 7 Franklin BA. Clinical Exercise Testing. In: Franklin BA ACSM's Guideline for Exercise Testing and Prescription. Philadelphia: Lippincott Williams & Wilkins 2000: 91-114
• 8 Jacobs I. Blood lactate implications for training and sports performance.  Sports Med. 1986;  3 10-25
• 9 LeRoy EC. Systemic Sclerosis (scleroderma). In: Wyngaarden JB, Smith LH Jr, eds. Cecil textbook of medicine. Philadelphia: Saunders 1988: 2018-2033
• 10 Mannerkorpi K. Exercise in fibromyalgia.  Curr Opin Rheumatol. 2005;  17 190-194
• 11 Morelli S, Ferrante L, Sgreccia A, Eleuteri ML, Perrone C, De Marzio P, Balsano F. Pulmonary hypertension is associated with impaired exercise performance in patients with systemic sclerosis.  Scand J Rheumatol. 2000;  29 236-242
• 12 Oliveira NC, Sabbag LMS, Ueno LM, Souza RBC, Borges CL, Pinto ALS, Lima FR. Reduced exercise capacity in systemic sclerosis patients without pulmonary involvement.  Scand J Rheumatol. 2007;  36 458-461
• 13 Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease.  Scand J Med Sci Sports. 2006;  16 3-63
• 14 Roveda F, Middlekauff HR, Rondon MUPB, Reis SF, Souza M, Nastari L, Barreto ACP, Krieger EM, Negrão CE. The effects of exercise training on sympathetic neural activation in advanced heart failure.  J Am Coll Cardiol. 2003;  42 854 860
• 15 Schwaiblmair M, Behr J, Fruhmann G. Cardiorespiratory responses to incremental exercise in patients with systemic sclerosis.  Chest. 1996;  110 1520-1525
• 16 Stenstrom CH, Minor MA. Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis.  Arthritis Rheum. 2003;  49 428-434
• 17 Strömbeck B, Jacobsson LT. The role of exercise in the rehabilitation of patients with systemic lupus erythematosus and patients with primary Sjögren's syndrome.  Curr Opin Rheumatol. 2007;  19 197-203
• 18 Subcommittee for Scleroderma Criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee . Preliminary criteria for the classification of systemic sclerosis (scleroderma).  Arthritis Rheum. 1980;  23 581-590
• 19 Sudduth CD, Strange C, Cook WR, Miller KS, Baumann M, Collop NA, Silver RM. Failure of the circulatory system limits exercise performance in patients with systemic sclerosis.  Am J Med. 1993;  95 413-418
• 20 Tench C, McArthy J, McCurdle I, White P, D’Cruz D. Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise.  Rheumatology (Oxford). 2003;  42 1050-1054
• 21 The Whoqol Group . The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties.  So Sci Med. 1998;  46 1569-1585
• 22 Turesson C, Matteson EL. Cardiovascular risk factors, fitness and physical activity in rheumatic diseases.  Curr Opin Rheumatol. 2007;  19 190-196
• 23 Valentini G, Della Rossa A, Bombardieri S, Bencivelli W, Silman AJ, D’Angelo S, Cerinic MM, Belch JF, Black CM, Bruhlmann P, Czirják L, De Luca A, Drosos AA, Ferri C, Gabrielli A, Giacomelli R, Hayem G, Inanc M, McHugh NJ, Nielsen H, Rosada M, Scorza R, Stork J, Sysa A, van den Hoogen FH, Vlachoyiannopoulos PJ. European Scleroderma Study to define disease activity criteria for systemic sclerosis. II Identification of disease activity variables and development of preliminary activity indexes.  Ann Rheum Dis. 2001;  60 592-598
• 24 Villalba WO, Sampaio-Barros PD, Pereira MC, Cerqueira EM, Leme  Jr  CA, Marques-Neto JF, Paschoal IA. Six-minute walk test for the evaluation of pulmonary disease severity in scleroderma patients.  Chest. 2007;  131 217-222

Correspondence