Effects of exercise interventions on core health outcomes in patients with SLE: systematic review and meta-analysis

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OBJECTIVES: This meta-analysis evaluated the effects of exercise interventions on key health outcomes in adults with SLE, including fatigue, physical function, aerobic capacity, disease activity, depression and pain. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we systematically searched four databases up to February 2025 for randomised controlled trials (RCTs) in adults diagnosed with SLE according to the American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) criteria. Eligible studies examined aerobic, resistance or combined exercise as the sole intervention. Meta-analyses were conducted using Hedges' g, the Risk of Bias 2 (ROB-2) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system used to assess bias and evidence quality. RESULTS: Twelve RCTs involving 470 participants were included. Exercise showed small-to-moderate improvements in fatigue (g=-0.53, 95% CI -0.81 to -0.25, p<0.001), physical function (g=0.46, 95% CI 0.23 to 0.68, p<0.001), aerobic capacity (g=0.47, 95% CI 0.22 to 0.71, p<0.001), depression (g=-0.36, 95% CI -0.64 to -0.09, p=0.01) and pain (g=-0.53, 95% CI -0.86 to -0.20, p<0.001), with no significant change in disease activity (g=0.18, 95% CI -0.16 to 0.51, p=0.30). Subgroup analyses suggested greater benefits with moderate-intensity programmes lasting 8-12 weeks. GRADE rated the evidence as moderate for fatigue, physical function, depression and pain, and low for other outcomes. CONCLUSION: Exercise is an effective non-pharmacological therapy in SLE management, improving several physical and psychological outcomes. Individualised, moderate-intensity and supervised programmes are recommended. Further research should optimise intervention protocols and evaluate long-term safety. PROSPERO REGISTRATION NUMBER: CRD420251115953.

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