I have a client that struggles with Lupus. I don’t know how to train her because too much strain causes stress on her muscles, but if she doesn't do resistance training, her Lupus gets worse. Can you please help me?
Lupus is the name given to a group of chronic autoimmune diseases, long-term illness where the body uses its own immune system to attack itself. There are three types: SLE (Systematic Lupus Erythematosus), which is the most common type, where the immune system attacks the healthy tissues, DLE (Discoid Lupus Erythematosus) and SCLE (Subacute Cultaneous Lupus), which is more rare but develops to SLE in 10% of victims. The symptoms are mainly skin rashes and sun sensitivity. Internal organs are not attacked in these forms.
As your client's symptoms mainly sound like SLE, and as this is the one that has most to do with exercise, I will address the question as if it is SLE.
SLE is the body’s immune system attacking its own tissues, which in turn causes them to become swollen and painful (inflammation). This inflammation can happen in the skin, muscles and joints. The heart, lungs, kidneys, blood vessels or nervous system can also be attacked by the immune system. SLE is similar to rheumatoid arthritis in that it flare ups. When it does, it attacks the connective tissue such as ligaments as well as the muscles.
Regular exercise is advised as it can help prevent flare ups, reduce pain and maintain body strength. The exercise guidelines you should follow are similar to those of rheumatoid arthritis:
- Exercise consistently and on a regular basis.
- Build fitness levels up gradually. Take your time when progressing your clients exercise program.
- Exercise when the symptoms are least distressing. Do not train your client during flare ups.
- Do not over do it. Use your client’s body as a guide to exercise volume, and let her tell you how hard she can work. Stop whenever your client feels discomfort or shows signs of training too hard.
- Do not train a client if she has a hot joint. Swollen joints will feel worse if you train them.
- Make sure the movements are smooth and steady exercises. Choose exercises that allow the client to control her breathing. Also, avoid impact exercises that may compromise the joints. Rest periods are vital.
Work closely with a physiotherapist and doctor to keep your programs precise and also help you increase your knowledge on this subject. Resistance training should be focused on strengthening the joints in periods of remission.
(I would like to thank my colleague Rick Johns, MCSP, Dip, RG, RT for his valuable contribution to this answer. JH)