Supervised Walking Benefits Women with Primary Sjögren’s, Study Finds

A supervised walking program, practiced three times a week for 16 weeks, safely improves cardiorespiratory fitness and exercise capacity while reducing fatigue in women with primary Sjögren’s syndrome, a clinical study found.

The study, “Supervised walking improves cardiorespiratory fitness, exercise tolerance, and fatigue in women with primary Sjögren’s syndrome: a randomized-controlled trial,” was published in the journal Rheumatology International.

People with primary Sjögren’s syndrome have reduced levels of physical activity and cardiorespiratory fitness; many also complain of pain and fatigue and present with depressive symptoms, compromising their quality of life.

Patients often say that fatigue is their greatest problem, affecting up to 70% of them.

Although a link seems to exist between low physical activity and more severe fatigue in these patients, the underlying causes of fatigue are still unknown; effective strategies to relieve it have yet to be found.

Considering the increasing evidence that exercise can improve physical ability, reduce fatigue, pain and depression in many autoimmune rheumatic diseases, a team of researchers set out to evaluate the effects of regular aerobic exercise in people with primary Sjögren’s syndrome.

Aerobic exercise is a type of physical activity that provides cardiovascular conditioning. It increases the heart rate and the body’s use of oxygen, improving a person’s physical fitness.

Researchers conducted a randomized, controlled trial (NCT02370225) to determine the safety and effectiveness of a supervised walking program in women with primary Sjögren’s syndrome. This was the first clinical study of this kind to evaluate the effect of exercise in Sjögren’s syndrome patients.

Forty-five patients were recruited from the Federal University of Espírito Santo in Brazil. They were randomized to a training group (23) or a control group (22). Those with severe difficulties in walking or who had performed regular physical activity in the six weeks before the trial were excluded.

Subjects in the training group took part in a supervised walking program three times a week for 16 weeks. Each session was preceded by a warm-up, followed by a period of 20 to 50 minutes of walking.

Patients were told to maintain their pace while walking to attain a target heart rate, determined for each at the beginning of the study; it corresponded to 80% of the greatest heart rate reached in a maximal exercise test on the treadmill.

Exercise duration was increased over time, starting at 20 minutes in the first two weeks and adding five minutes per week up to a maximum of 50 minutes, which was maintained until the end.

Patients in the control group were told not to perform any kind of regular exercise.

The primary outcome measure, or study endpoint, was the change in patient-reported fatigue (FACIT fatigue scores) between the study’s start and after 16 weeks of supervised walking.

Other clinical outcomes assessed were aerobic capacity (maximum oxygen uptake, peak heart rate, and distance walked in a treadmill exercise), disease activity (EULAR Sjögren’s Syndrome Disease Activity Index), patient perception of symptoms (EULAR Sjögren’s Syndrome Patient Reported Index), depression (BDI inventory) and quality of life (SF-36 survey).

Overall, there was good adherence to the exercise program, with a mean 72% compliance rate for the complete program.

After 16 weeks, the walking program had significantly enhanced the cardiorespiratory fitness of patients in the training group, compared with the control group. This improvement was reflected by a larger maximal volume of oxygen uptake (VO2max).

Patients having regular exercise also were able to walk larger distances 16 weeks after, which reflected a better exercise capacity. Those on training reported a greater and clinically significant relief in fatigue, compared to patients not doing exercise.

Moreover, the reductions in fatigue experienced by those in the training group were significantly associated with improvements in their cardiorespiratory fitness as well as in physical and mental components of their quality of life.

A group analysis also showed those who experienced the greatest improvements in fitness, meaning a higher than 15% increase in VO2max, felt a significant reduction in fatigue and depression.

“These findings suggest an important role of physical fitness in the [disease mechanisms] of the fatigue in pSS,” researchers stated.

Also, more patients (95.4%) in the training group rated themselves as clinically improved, compared with patients who did not receive the exercise program (62%).

Noticeably, disease activity remained stable in both patient groups, indicating that patients with primary Sjögren’s syndrome can safely undergo physical training. Also, no serious adverse events with exercise were reported.

Blood markers of inflammation and muscle damage were not elevated by the exercise program, suggesting that a longer program or an increase in exercise intensity could be performed in the future.

The trial’s results show that “aerobic exercise is a potentially useful intervention enhancing cardiorespiratory fitness and reducing fatigue, and [can] possibly also reduce the risks of developing secondary chronic disease, such as cardiovascular diseases, diabetes, depression, and anxiety,” researchers concluded.