title: Evidence for aerobic insufficiency in women with systemic Lupus erythematosus.
abstract: OBJECTIVE
  To determine if fatigue is associated with diminished aerobic capacity in women with systemic lupus erythematosus (SLE).
  
  
  METHODS
  Eighteen women (age 35 +/- 9 years) with mild SLE (Systemic Lupus Activity Measure = 3.1 +/- 2.1) and 16 healthy but sedentary controls (age 38 +/- 8 years) completed peak treadmill exercise tests to determine aerobic capacity and Fatigue Severity Scales to quantify the severity of fatigue. Measures of oxygen consumption (VO(2)) were recorded during the treadmill tests.
  
  
  RESULTS
  Peak VO(2) was lower in patients with SLE (19.2 +/- 4.4 ml/kg/minute) as compared with controls (27.4 +/- 4.7 ml/kg/minute) and expected values (30.7 +/- 3.1 ml/kg/minute; P < 0.0006 versus controls and P < 0.0001 versus expected). Functional aerobic impairment was observed in 14 of the 18 patients with SLE. In patients with SLE, ventilatory threshold, a marker for the onset of lactic acidemia, was observed at the lowest energy requirement for instrumental activities of daily living. Peak VO(2) in the patients with SLE was similar to the highest energy requirements for instrumental activities of daily living, leaving little or no reserve for more intense occupational and recreational activities. Peak VO(2) was significantly higher (P < 0.0001) than the activity of daily living requirements in controls, providing a substantial energy reserve. Fatigue severity score (FSS) was 5.0 +/- 1.4 in patients with SLE, with 14 of the 18 patients having scores above 4.0, a score indicating that fatigue severity limited physical activity. Of the 14, 12 had functional aerobic impairment. An FSS of greater than 4.0 was not observed in controls (mean = 2.5 +/- 0.7).
  
  
  CONCLUSIONS
  In women with SLE, aerobic capacity was diminished to levels that were insufficient for engaging in activities of daily living and below those expected to result from physiologic deconditioning. This functional aerobic impairment was strongly correlated with the perception of severe, activity-limiting fatigue.
authors.affiliation: Department of Physical Therapy, University of Maryland School of Medicine, Baltimore, Maryland 21201-1082, USA. rkeyser@som.umaryland.edu
authors.forename: Randall E
authors.initials: RE
authors.lastname: Keyser
authors.forename: Violeta
authors.initials: V
authors.lastname: Rus
authors.forename: William Todd
authors.initials: WT
authors.lastname: Cade
authors.forename: Neeta
authors.initials: N
authors.lastname: Kalappa
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Flores
authors.forename: Barry S
authors.initials: BS
authors.lastname: Handwerger
mesh_terms: D000328:Adult; D015308:Anaerobic Threshold; D015444:Exercise; D005080:Exercise Test; D005221:Fatigue / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology*; D008875:Middle Aged