What Are Safe Exercises with Lupus?

My doctor recommends exercise for my lupus. I also have rheumatoid arthritis and limited mobility. He has suggested stretching in bed and walking 30 minutes a day. What do you suggest?

I agree with what your doctor recommends. Exercise is good medicine and can help people with lupus in many ways. In one of the earliest studies of the effect of exercise on lupus conducted in 1989, 23 women (lupus occurs more in women than men) bicycled for 30 minutes at 60-80% of their maximum heart rate, three times per week for eight weeks. Their aerobic capacity (endurance) increased by 19%, fatigue diminished, and perhaps most importantly, exercise did not exacerbate the disease (no flares). In a more recent study from 2005, 60 women with lupus ages 18-55 years stretched and walked in the morning for 60 minutes, three times a week for 12 weeks, and showed significant improvement in exercise tolerance, aerobic capacity, quality of life, and depression. Improving exercise tolerance is particularly noteworthy because lupus and rheumatoid arthritis are associated with disability.

In addition to the benefits of walking and stretching that the studies show helps (stretching helps improve range of motion, which is very important when you have arthritis), I recommend other cardiovascular exercises like biking (low impact), dancing, swimming, and water aerobics classes. Water exercises are an excellent option because the movements are nonimpact, slow, rhythmic, and joint range of motion is emphasized. The Arthritis Foundation offers two excellent programs: (1) the Arthritis Foundation Aquatic Program (AFAP), which is a safe and effective water exercise class conducted at YMCA's and recreation center pools all over the country; and (2) the People with Arthritis Can Exercise Too (PACE) program, where trained instructors lead participants in a slow, gentle exercise program designed to increase joint flexibility and muscle strength. There is even a follow-up half-hour PACE videotape for participants to use at home. The PACE program, like AFAP, is also offered at YMCA's and recreation centers located throughout the country. Check the Arthritis Foundation at http://www.arthritis.org for more information and locations in your area. Finally, I also recommend exercises that are associated with stress reduction, like yoga and tai chi, because people with lupus report that stress can precipitate flares and other symptoms of the disease.

Exercise will help you manage lupus and arthritis, but you need to be prudent and follow certain precautions. They are:

1. Avoid outdoor exercise in the sun because sunlight can trigger flares. Cover up by wearing a hat, long-sleeved shirts, and long pants, and use sunscreens with a sun protection factor of at least 15 if you walk or bike outdoors.
2. Listen to your body and exercise when your symptoms are minimal. There are no specifics as to how much you should do or when you should do it and so you need to know your own body and what you can tolerate. Some people with lupus or arthritis can walk for 30 minutes first thing in the morning without a problem while others may not be able to. Everyone is different, and so you need to become an expert about your own body.
3. Start gradually and build up slowly. Starting with too much or increasing too quickly can bring on symptoms. Use the 10% rule to gauge how much to increase; that is, increase the duration and intensity of your workout by 10% per week. For example, increase by one minute if you walk for 10 minutes. Your endurance will improve as you do more. A general rule for assessing your plan is that if you experience pain after your workout that lasts for more than two hours, then you know you did too much. You can expect to have some pain, but it should not persist.
4. Don't exercise if your joints feel hot, swollen, or tender. Exercise will make these symptoms worse. Again, you can expect some pain, but you also need to be safe.
5. Some days will be better than others. Again, pay attention to your body and modify appropriately.
6. Always check with your doctor before you begin an exercise program or make modifications to the exercise prescription he or she already gave you.

I've known many people with arthritis, lupus, and other chronic diseases who manage to exercise regularly despite the pain or inconvenience that their condition presents because they say the benefits are definitely worth it. Exercise can reduce the symptoms of these conditions, increase endurance and strength, improve mood, and mobility, and for my money, the most important benefit of all is the increase in control and quality of life that virtually everyone reports when they exercise regularly.