ABSTRACT: Systemic lupus erythematosus (SLE) patients may show increased insulin resistance (IR) when compared with their healthy peers. Exercise training has been shown to improve insulin sensitivity in other insulin-resistant populations, but it has never been tested in SLE. Therefore, the aim of the present study was to assess the efficacy of a moderate-intensity exercise training program on insulin sensitivity and potential underlying mechanisms in SLE patients with mild/inactive disease. A 12-week, randomized controlled trial was conducted. Nineteen SLE patients were randomly assigned into two groups: trained (SLE-TR, n?=?9) and non-trained (SLE-NT, n?=?10). Before and after 12?weeks of the exercise training program, patients underwent a meal test (MT), from which surrogates of insulin sensitivity and beta-cell function were determined. Muscle biopsies were performed after the MT for the assessment of total and membrane GLUT4 and proteins related to insulin signaling [Akt and AMP-activated protein kinase (AMPK)]. SLE-TR showed, when compared with SLE-NT, significant decreases in fasting insulin [-39 vs. +14%, p?=?0.009, effect size (ES)?=?-1.0] and in the insulin response to MT (-23 vs. +21%, p?=?0.007, ES?=?-1.1), homeostasis model assessment IR (-30 vs. +15%, p?=?0.005, ES?=?-1.1), a tendency toward decreased proinsulin response to MT (-19 vs. +6%, p?=?0.07, ES?=?-0.9) and increased glucagon response to MT (+3 vs. -3%, p?=?0.09, ES?=?0.6), and significant increases in the Matsuda index (+66 vs. -31%, p?=?0.004, ES?=?0.9) and fasting glucagon (+4 vs. -8%, p?=?0.03, ES?=?0.7). No significant differences between SLT-TR and SLT-NT were observed in fasting glucose, glucose response to MT, and insulinogenic index (all p?>?0.05). SLE-TR showed a significant increase in AMPK Thr 172 phosphorylation when compared to SLE-NT (+73 vs. -12%, p?=?0.014, ES?=?1.3), whereas no significant differences between groups were observed in Akt Ser 473 phosphorylation, total and membrane GLUT4 expression, and GLUT4 translocation (all p?>?0.05). In conclusion, a 12-week moderate-intensity aerobic exercise training program improved insulin sensitivity in SLE patients with mild/inactive disease. This effect appears to be partially mediated by the increased insulin-stimulated skeletal muscle AMPK phosphorylation. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT01515163.
