Exercise and Brain Health

If you have lupus, an autoimmune condition that can affect many of the body’s organs and systems, it’s important to do whatever you can to protect your physical and mental health. Now, new research shows that even a small amount of physical activity can make a big difference.

A study published in the journal Arthritis Care & Research found that lupus patients who don’t engage in physical activity have triple the risk of developing depression as more active patients. Even small amounts of light exercise can help protect you from depression. “Any physical activity/exercise is better than nothing,” says study coauthor Patricia Katz, PhD, Professor of Medicine and Health Policy at the University of California San Francisco.

Lupus patients, who often have to cope with pain, fatigue, and various limitations, are especially prone to feeling depressed. Up to half of people with systemic lupus erythematosus (SLE) will experience this mood disorder at some point in their lives, compared to 17 percent of the general U.S. population.

Researchers at the University of California San Francisco noted that physical inactivity increases the odds of depression among Americans in general, and decided to investigate whether lack of exercise might also contribute to this problem among lupus patients.

To measure “inactivity,” the study authors asked if study participants agreed with the statement: “I rarely or never do physical activities.” They chose to focus on physical inactivity rather than activity because research has shown that people tend to exaggerate how much exercise they do.

For depression, the researchers relied on a well-validated test called the Patient Health Questionnaire, depression scale. People who showed signs of depression at the beginning of the two-year study were excluded, but those with a history of depression (26 percent of participants) were able to participate in the study.

The 225 participants in the study were drawn from the California Lupus Epidemiology Study, which has tracked individuals with SLE in San Francisco County since 2015. To ensure ethnic diversity, interviews were conducted in English, Spanish, Mandarin and Cantonese, resulting in a mix of participants that was 35 percent Asian, 30 percent white, 22 percent Hispanic, 10 percent African American, and 2 percent other or unspecified.

The vast majority of the study subjects (88 percent) were women. The mean age of participants was 45, and they had been diagnosed with lupus, on average, about 17 years earlier.

About 16 percent of the participants experienced one or more episodes of depression during the 26-month study period. While patients who were male or white had a statistically significant higher risk of becoming depressed, by far the strongest predictor of depression was being sedentary.

Some patients did not exercise anywhere near the conventionally recommended amounts but did engage in some amount of “regular light activity,” such as, perhaps, walking their dogs around a short block twice a day. Even these people had a significantly lower risk of depression compared to the sedentary individuals in the study.

If you’re interested in logging more active time, walking is often the simplest way to start. “It is easy to scale both in intensity and time/distance,” says Dr. Katz. She also advises trying to sit less throughout the day. For example, you could walk around your home while talking on the phone or set a reminder on your phone to get up move briefly every hour or two — say, walk to the kitchen to get a glass of water.

What about getting physical activity during a lupus disease flare? Lupus, like many autoimmune conditions, tends to ebb and flow, with certain periods where the disease is very active and causing a lot of symptoms and other times when it is not as active or debilitating.

“In these situations, it may be better to take it easy,” says Dr. Katz. “It’s important, though, not to fall into the trap of not exercising because of fatigue.  Regular physical activity can actually help reduce fatigue.”

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Interview with Patricia Katz, PhD, professor of Medicine and Health Policy at the University of California San Francisco

Patterson SL, et al. Physical Inactivity Independently Predicts Incident Depression in a Multi-Racial/Ethnic Systemic Lupus Cohort. Arthritis Care & Research. January 9, 2021. doi: https://onlinelibrary.wiley.com/doi/10.1002/acr.24555.