Table 2.

Non-pharmacologic Interventions in Systemic Lupus Erythematosus (SLE)

Author Yr, Country	N	Intervention	Control	Outcomes Measure	Duration (Weeks)	Results
Exercise Intervention (N=8)
Robb-Nicholson 1989, USA (1)	23	Home Aerobic exercise, 30 mins × 3 times/wk × 8 wks	Non-aerobic stretching exercise, 30 mins × 3 times/wk × 8 wks	Fatigue (VAS, POMS) Depression (NIMH) Disease activity (SLE-AI)	8	Significant improvement in Fatigue measured by VAS but not by POMS No significant differences in depression and disease activity
Ramsey-Goldman 2000, USA (2)	10	Aerobic exercise Phase1 - Group exercise, 50 mins × 3 times/wk × 2 months Phase2 - Home exercise × 6 months	Range of motion/muscle strengthening exercise Phase1 - Group exercise, 50 mins × 3 times/wk × 2 months -Phase2 - Home exercise × 6 months	Fatigue (FSS) Quality of life: Physical function (SF-36-PF) Disease activity (SLAM)	32	No significant differences in fatigue, Physical function of quality of life and disease activity
Tench 2003, UK (3)	93	Home exercise (walking, cycling, swimming), 30–50 mins × 3 times/wk × 12 wks	Relaxation audiotape, 30 mins × 3 times/wk + supervised relaxation session, q 2 wk × 12 wks Usual medical care	Fatigue (FSS, Chalder Fatigue scale, VAS) Depression, anxiety (HADS) Quality of Life (SF-36) Disease activity (SLAM)	12	Significant improvement in fatigue measured by the Chalder Fatigue Scale but not by FSS or VAS in exercise group, Mix results No significant differences in depression and anxiety, quality of life and disease activity
Miossi 2012, Brazil (4)	28	Supervised aerobic exercise + resistance training, 80 mins × 2 times/wk × 12 wks	Usual medical care Healthy control: Supervised exercise training program	Disease Activity (SLEDAI)	12	No significant differences in disease activity
Prado 2013, Brazil (5)	19	Supervised aerobic exercise, 30–60 mins × 2 times/wk × 12 wks	Usual medical care	Disease activity (SLEDAI-2K)	12	No significant differences in disease activity
Bogdanovic 2015, Serbia (6)	60	Aerobic exercise, 15 mins × 3 times/wk × 6 wks	Isotonic exercises, 30 mins × 3 times/wk × 6 wks	Fatigue (FSS) Depression (BDI) Quality of Life (SF-36)	6	No significant differences in fatigue and depression Significant improvement in Quality of Life
Abrahão 2016, Brazil (7)	63	Cardiovascular exercise (CT), 50 mins × 3 times/wk × 12 wks	Resistance exercise (RT), 50 mins × 3 times/wk × 12 wks Usual medical care	Depression (BDI) Quality of Life (SF-36) Disease Activity (SLEDAI)	12	No significant differences in depression Significant improvement in Quality of Life in CT and RT groups No significant differences in disease activity
Bostrom 2016, Sweden (8)	35	0–3 months: Supervised aerobic Exercise, 60 mins × 2 times/wk + education + individual coaching of physical activity + heart rate monitor + physical activity diary 4–12 months: Tapering of coaching, self-managed physical activity	Usual medical care	Quality of Life (SF-36) Disease Activity (SLEDAI)	52	Significant improvement in SF-36 mental Health at 6 months No significant differences in other SF-36 subscales No significant differences in disease activity
Psychological & Counselling Intervention (N=6)
Dobkin 2002, Canada (9)	133	Group psychotherapy, 90 mins × 1 time/wk × 3 months + booster session, 1 time/month × 3 months	Usual medical care	Psychological measure (SCL-90-R) Quality of life (SF-36) Disease activity (SLAM-R)	12	No significant differences in psychological measure, quality of life and disease activity
Karlson 2004, USA (10)	122	Psychoeducational intervention, 1 time, followed by a phone call once a month × 5 months	Attention Placebo + Video presentation about lupus, 45 mins once	Fatigue Quality of Life (SF-36) Disease activity (SLAQ)	20	Significant improvement in fatigue Significant improvement in quality of life, global mental health status and self-efficacy No significant differences in disease activity
Greco 2004, USA (11)	92	Biofeedback-assisted/Cognitive-behavioral therapy + relaxation techniques (BF/CBT), 6 sessions × 3 months	Symptom monitoring support intervention (SMS) Usual medical care	Psychological measure (CES-D, STRESS, ASES) Pain (AIMS2-pain, MPI-I) Quality of life: Physical function (SF-36-PF) Disease Activity (SLEDAI, SLAM-R)	12	Significant improvement in long-term psychological function Significant improvement in pain Significant improvement in physical function (SF-36-PF) No significant differences in disease activity
Navarrete-Navarrete 2010, Spain (12)	45	Cognitive-behavioral therapy + relaxation techniques + social skill training, 120 min/wk × 10 wks	Usual medical care	Psychological measure (SVI, BDI, STAI) Quality of Life (SF-36) Disease activity (SLEDAI)	10	Significant improvement in stress, depression and anxiety Significant improvement in SF-36 scales including physical role, pain, social function, mental health and general health No significant differences in disease activity
Brown 2012, USA (13)	53	Cognitive-behavioral therapy (CBT) + home computer modules, 3 sessions × 6 wks	Education only intervention, 3 sessions Usual medical care	Pain (SF-MPQ) Quality of Life (PedsQL)	6	No significant difference in all outcomes
Solati 2017, Iran (14)	46	Mindfulness-based cognitive therapy (MBCT), 45–60 mins × 1 time/wk × 8 wks	Usual medical care	Psychological measure (GHQ-28) Quality of Life (SF-36)	8	Significant improvement in psychological measure Significant improvement in quality of life
Acupuncture Intervention (N=1)
Greco 2008, USA (15)	24	Electrical Acupuncture, 30 mins × 10 sessions × 5 weeks	Minimal needling, 10 sessions × 2 times over 5 weeks Usual medical care	Fatigue (FSS, SF-36 vitality) Pain (AIMS, MPI, SF-36 body pain) Disease activity (SLAM-R, SLEDAI)	5	No significant differences in fatigue, pain and disease activity

VAS = Visual Analog Scale; POMS = the Profile of Mood States; NIMH = the National Institutes of Mental Health Depression Scale; SLE-AI = SLE lupus activity index; FSS = Fatigue Severity Score; SF-36-PF = Short-Form Health Survey Physical Function subscale; SLAM = Systemic Lupus Activity Measure; CFS = Chalder Fatigue Scale; HADS = Hospital Anxiety and Depression Scale; SF-36 = Short-Form Health Survey; SLEDAI = The Systemic Lupus Erythematosus Disease Activity Index; SLEDAI-2K = Systemic Lupus Erythematosus Disease Activity Index 2000; BDI = Beck Depression Inventory; SCL-90-R = The Symptom Checklist 90-Revised; SLAM-R = The Systemic Lupus Activity Measure-Revised; SLAQ = Systemic lupus activity questionnaire for population studies; CES-D = The Center for Epidemiological Studies Depression scale; STRESS = Cohen’s Perceived Stress Scale; ASES = Arthritis Self-Efficacy Scale; AIMS2-pain = The Revised Arthritis Impact Measurement Scales; MPI = Multidimensional Pain Inventory; SVI = Stress Vulnerability Inventory; STAI = Spielberger’s State-Trait Anxiety Inventory; SF-MPQ = The McGill Pain Questionnaire - Short Form; PedsQL = Pediatric Health-related Quality of Life; GHQ-28 = The self-reported General Health Questionnaire