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Lupus

Erythematosis (characterized by a skin rash only), systemic lupus erythematosis, and drug-induced systemic lupus erythematosis.

 

More people have lupus than cerebral palsy, sickle-cell anemia, multiple sclerosis, AIDS, and cystic fibrosis combined (Colorado Health Net, 1999). Systemic lupus erythematosis (SLE or lupus) can be categorized into three groups: discoid lupuschronic, inflammatory, multi-system disorder of the immune system (NIH/NIAMS, 1999).

 

The course of the disease is unpredictable and individualized, varying greatly in severity. There can be nervous system involvement, arthritis, and/or muscle damage. Thus, the teacher-student ratio depends on the unique needs of the individual with lupus and whether their disease is in remission or exacerbation.

 

 

A warm water learning environment is extremely beneficial for an individual with lupus because it is extremely beneficial for an individual with lupus because it:

  • Promotes muscle relaxation and increased ease of movement about a joint. Individuals with lupus arthritis can experience early morning and late afternoon stiffness in distal joints (LFA,1995).

  • Reduces pain sensitivity (a very common symptom of lupus and a side effect of some of its treatments -LFA, 1995) through the effects of buoyancy, the reduction of the compression force on joints, and the disruption of the pain cycle because pain perception is gated. 90% of the people with lupus experience muscle and/or joint pain at some point during their illness (LFA, 1995).

  • Increases muscular strength and endurance. Muscle weakness and fatigue are common symptoms of SLE and treatment with corticosteroids.

  • Increases cardio-respiratory fitness in a carefully designed program. This is important to prevent unwanted effects of SLE and its treatments, such as obesity, muscle weakness, low energy or fatigue and to improve desirable effects such as stamina, stress management and ideal body composition.

  • Increases peripheral circulation that promotes skin healing. Non-contagious sores on the skin are the second most common characteristic of SLE and the only symptom of discoid lupus (LFA, 1995).

 

Recommended aquatic activities depend on the symptoms of the type of lupus and the side effects of its medications. They include:

  • Walking and running in the pool and lap swimming to increase cardiovascular respiratory endurance and to relieve stress.

  • Deep-water exercise using weights, weight belts, and floats to improve range of motion and muscular strength and endurance. Characteristically, the muscles of the trunk are affected by muscle weakness (LFA, 1995).

  • Swimming strokes in the supine position, such as the elementary backstroke, if muscle weakness makes it difficult for head alignment.

 

Special considerations for individuals with lupus include

  • Providing water tables, chairs, and pool wall benches for resting platforms, wide and gradually ascending stairs, lifts and handrails, and self-monitored rest periods as needed during activity.

  • Using equipment such as fins and hand paddles if there is upper body weakness.

  • Scheduling out-door aquatic activity before 10am and after 3pm to avoid sun exposure when it is at its brightest.

  • Recommending the use of sunscreen that has a sun block factor of at least 15 and contains titanium oxide to block ultraviolet light of long wavelengths (NIAMS, 1999). One third of individuals with lupus are photosensitive and 40-70% note that their systemic disease is aggravated by sun exposure (LFA, 1995).

  • Providing repetition and simple short instructions if the individual experiences cognitive dysfunction from CNS lupus and/or side effects from lupus medications (according to the LFA, 50% do).

  • Encouraging showers before and after swimming to decrease the chemical reactions of chlorine with their skin lesions and medications. Chlorine may cause a burning sensation when in contact with the skin lesions. Applying a petroleum jelly, such as Vaseline, to the lesion and covering with a waterproof bandage and/or plastic covering before swimming may help to reduce the burning and associated pain. However, aquatics may be contraindicated if the pain is too great to tolerate (LFA, 1999).

  • Avoiding activities that compress bones and joints, excessively flex the spine (i.e. jumping, diving), and prone strokes with face out of the water.

Caution should be taken to keep the individual with lupus from becoming over-fatigued. A balance between sufficient rest and excessive rest needs to be achieved. In addition, the patient’s tolerance for physical activity and need to control what s/he can do should be respected. They should not be instructed to work through pain.

 

This content was created Cathy Simbeck,

Doctoral Student in Adapted Physical Education at Texas Woman's University,

as part of requirements for

"Aquatics for Special Populations", Huettig, Summer, 1999.