Table 1_Exercise and physical activity for fatigue, disease activity and immune-inflammatory outcomes in adults with systemic lupus erythematosus: an umbrella review.docx

AMSTAR-2 confidence was high in one review, low in five and critically low in twelve, and overall overlap was very high (CCA 19.6%). For fatigue versus usual care, two Core-eligible reviews reported statistically significant reductions (MD −0.61, 95% CI −1.19 to −0.02; 2 trials, 115 participants; and MD −0.52, 95% CI −0.91 to −0.13; 3 trials, 135 participants), whereas the high-confidence Cochrane review found no significant difference (MD −0.59, 95% CI −1.40 to 0.22; 2 trials, 104 participants); certainty was low, and all three estimates derived from an overlapping pool of four small primary trials.

Disease-activity estimates were not statistically significant. Withdrawal comparisons were statistically inconclusive and of very low certainty; flare evidence was sparse and ungraded.</p>Conclusions<p>Exercise and physical activity may slightly reduce fatigue in adults with SLE, but the evidence is low-certainty and substantially overlapping. Current review-level evidence does not establish a robust immune-inflammatory mechanism or a disease-activity effect, and safety and tolerability remain uncertain.

Future trials should prespecify fatigue, disease activity, flares and immunological endpoints.</p>Systematic Review Registration<p>crd.york.ac.uk/PROSPERO/view/CRD420261392698, identifier CRD420261392698.</p>