Exercise in a child with systemic lupus erythematosus and antiphospholipid syndrome.

UNLABELLED: Exercise training has emerged as a potential therapeutic strategy to counteract the decline in physical function and aerobic capacity in pediatric rheumatic disease. PURPOSE: We report for the first time on the effects of exercise training in juvenile systemic lupus erythematosus (JSLE) and antiphospholipid syndrome (APS). METHODS: A 15-yr-old boy with JSLE and APS treated with warfarin, azathioprine, and prednisone underwent a 12-wk aerobic exercise training program to improve his physical capacity and functioning. Before and after the 12-wk exercise program, the patient was submitted to incremental cardiopulmonary tests to determine VO(2peak), peak and submaximal exercise intensity, and time to exhaustion. In addition, a 6-min square-wave test was performed for assessing metabolic parameters. Functioning was assessed by using the visual analog scale. Laboratory parameters of inflammation were also assessed at baseline and 48 h after the last training session. RESULTS: All the cardiopulmonary parameters (e.g., VO(2max) = +36.0%, time to exhaustion = +67.8%, peak exercise intensity = +16.7%) and the metabolic cost of movement (e.g., energy expenditure = -28.3% to -33.3%, VO(2) = -29.3% to -33.4%) were improved. Both disease activity and cumulative damage scores did not change after the intervention, and no evidence of exercise-induced exacerbation of inflammation was observed. Visual analog scale scores were also improved according to the patients' evaluation (before intervention = 8 vs after intervention = 10), parents' evaluation (before intervention = 8 vs after intervention = 10), and physicians' evaluation (before intervention = 6 vs after intervention = 9). CONCLUSIONS: This is the first evidence that a 12-wk supervised aerobic training program can be safe and effective in improving aerobic conditioning and physical function in a patient with JSLE and APS. In light of these findings, the therapeutic effects of exercise training in pediatric rheumatic diseases merit further investigations.

Vascular occlusion training for inclusion body myositis: a novel therapeutic approach.

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise function and quality of life. Moreover, clinical practice suggests that, unlike other inflammatory myopathies, the majority of IBM patients are not responsive to treatment with immunosuppressive or immunomodulatory drugs to counteract disease progression. Additionally, conventional resistance training programs have been proven ineffective in restoring muscle function and muscle mass in these patients. Nevertheless, we have recently observed that restricting muscle blood flow using tourniquet cuffs in association with moderate intensity resistance training in an IBM patient produced a significant gain in muscle mass and function, along with substantial benefits in quality of life. Thus, a new non-pharmacological approach for IBM patients has been proposed. Herein, we describe the details of a proposed protocol for vascular occlusion associated with a resistance training program for this population.