Exercise as adjunctive therapy for systemic lupus erythematosus

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To evaluate the safety and effectiveness of structured exercise interventions for adults with systemic lupus erythematosus.

Methods: Criteria for considering studies for this review

Types of studies

We will include randomised controlled trials (RCTs) and quasi‐RCTs. We will include parallel and cross‐over trials, and cluster RCTs, using either non‐intervention or active controls. There will be no language restriction. We will include abstracts and studies with unpublished data.
Types of participants

We will include trials with adults (aged 18 years or greater), diagnosed with SLE according to the study author's report. We will include trials using American College of Rheumatology (ACR) criteria and European League Against Rheumatism (EULAR) criteria, and with systemic disease involving at least two body sites or organ systems. We will include trials that define SLE according to incomplete or partial diagnostic criteria, and provide notes to identify possible weaknesses in selection. We will exclude trials including participants with SLE and another diagnosed condition in different groups (i.e. group one = people with SLE, group 2 = people with rheumatoid arthritis) if the effect of the intervention cannot be determined on the participants with SLE alone. We will include intervention trials without regard to race, gender, or disease duration of participants.

Types of interventions: We will include any RCT that evaluates the effect of an exercise programme compared with usual care (no exercise/wait list control), active control (education/counselling), or placebo in adults with SLE. We will include studies in which exercise is used as an adjunct to pharmacological management if the effect of the exercise can be determined. Exercise interventions may be performed at any intensity, in any environment, and can include an individual type of exercise or a combination of various types. Exercise interventions must be structured, recurring, and prescriptions should include specific dosage information (i.e. frequency, intensity, timing, type). Aerobic exercise may include, but not limited to, walking (treadmill or free), cycling (stationary or free), swimming, or aerobics classes. Range of movement exercise may include Pilates; yoga; tai chi; or active, ballistic, and static stretching. Other forms of exercise such as sports, games, and recreational activities such as dancing, lawn bowls, and Wii fit may also be included. Exercise environments may include water‐ or, land‐based exercise, indoor or outdoor settings, home‐based or community led, supervised or unsupervised, face‐to‐face or telehealth.

Control groups receive usual care (no exercise/wait list control), an active control where participants receive an alternative intervention such as education about exercise or counselling about exercise, or a placebo control.

We will exclude studies if the exercise intervention is not structured (i.e. the exercise intervention does not have a dosage for frequency, intensity, or duration of exercise) or if the exercise intervention is an acute bout of exercise (i.e. one individual session of exercise or one exercise test).
Types of outcome measures

Studies will not be excluded on basis of outcome reporting.

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