Research Article

Response of Lipid Profile to Laser Acupuncture along with Diet and Pilates Exercise in Obese Women with Systemic Lupus Erythematosus: a Randomized Controlled Trial
1Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
2Department of Medical Biochemistry and Molecular Biology, Kasr Alainy Faculty of Medicine, Cairo University, Giza, Egypt
3Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Badr University in Cairo, Cairo, Egypt
4Department of Internal Medicine and Geriatrics, Faculty of Physical Therapy, Badr University in Cairo, Cairo, Egypt
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
J Acupunct Meridian Stud 2023; 16(4): 152-158
Published August 31, 2023 https://doi.org/10.51507/j.jams.2023.16.4.152
Copyright © Medical Association of Pharmacopuncture Institute.
Abstract
Objectives: This research aimed to assess the effect of adding laser acupuncture therapy (LAT) to a Pilates exercise program (PEP) and low-calorie diet protocol (LCDP) on blood lipids among 60 obese women with SLE.
Methods: Study participants were women aged between 23 and 49 years, randomly assigned to one of two groups, A or B, each comprising 30 women. In addition to adherence to the LCDP, both groups were supervised five times weekly during 50-minute PEP sessions. Group A also received LAT three times weekly, with each session lasting 2 minutes on selected acupoints. After the 12-week intervention, plasma total cholesterol, high-density lipoprotein, triglycerides, and low-density lipoprotein were assessed.
Results: Both groups demonstrated significant improvement in the aforementioned lipids after the 12-week intervention. A comparison between the post-intervention values of the lipids in the groups revealed a significant improvement favoring group A (the group that received LAT).
Conclusion: Adding a 12-week LAT regimen to PEP and LCDP significantly improved lipid profiles among 60 obese women with SLE.
Keywords
INTRODUCTION
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease that has a higher prevalence in women than men. Compared with age-matched healthy peers, obese women with SLE have a 50-fold higher incidence of coronary artery disease (CAD) [1].
Obesity, one of the risk factors for CAD, is highly prevalent among women with SLE. The usual causes of obesity in these individuals include an overabundance of cytokines and pro-inflammatory markers, high energy intake, low energy expenditure, and dietary choices [2].
Dyslipidemia, a primary complication of obesity, is frequently observed in women with SLE. This condition can be triggered by concurrent systemic diseases, such as diabetes mellitus or thyroid gland disorders, substantial metabolic shifts related to menopause and aging, chronic use of steroidal agents, and the number of organs affected by SLE. Optimal lifestyle interventions for dyslipidemia and obesity in SLE patients involve dietary modifications and exercise therapy [1].
Pilates, a contemporary physical activity program involving the concurrent performance of deep breathing exercises and repeated isometric contractions of the skeletal muscles, is recognized for improving weight loss, dyslipidemia, metabolic profile, and overall health. Consequently, it attracts many women engaged in lifestyle modification programs [3].
Conversely, traditional acupuncture intervention (TAI), despite ongoing debate over its safety and efficacy, is frequently utilized by patients with chronic illnesses, including SLE [4-8]. A 2008 report highlighted the potential use of TAI for reducing pain and fatigue associated with SLE, though side effects, such as needling pain, lightheadedness, and localized bruising, have been reported [9].
Laser acupuncture therapy (LAT) offers a non-invasive alternative to mechanical or electrical needling of acupoints and can elicit similar physiological effects to TAI. LAT settings can be adjusted for strength and intensity in a manner akin to controlling the depth and direction of needles in TAI but without invasiveness. Notable benefits of LAT include its non-invasiveness, simplicity of administration, minimal time consumption, and the alleviation of needle phobia [10].
The growing need to adequately treat modifiable risk factors, including dyslipidemia, to alleviate the burden of morbidities and mortalities in SLE patients has prompted calls for examining the impact of complementary treatments within their major care plans [11].
To our knowledge, no studies have examined the lipid profile response to LAT in conjunction with dietary restriction and Pilates exercise (PE) in obese women with SLE. Thus, this study was designed to investigate this response.
MATERIALS AND METHODS
1. Ethics approval
Before recruiting women diagnosed with lupus, local ethical clearance (ref. P.T.REC/012/003660) was obtained from the Faculty of Physical Therapy, Cairo University. In addition to obtaining consent from each participating woman with SLE, every procedure adhered to the recommendations of the Declaration of Helsinki.
2. Study setting and design
This randomized controlled trial recruited women with SLE from the immunology outpatient clinic at Cairo University Hospitals. The majority of eligible patients who visited the clinic between February 28 and July 1, 2022, were women; consequently, no male participants were enrolled. The trial was prospectively registered on www.clinicaltrials.gov (ref. NCT05381545).
3. Inclusion and exclusion criteria
Sixty obese Egyptian women aged 23-49 years, diagnosed with SLE based on the American Rheumatology College criteria, were recruited [12]. Exclusion criteria included the following: high plasma creatinine (≥ 150 mmol/l), thyroid and parathyroid disorders, elevated serum transaminases, systemic illness, breastfeeding or pregnancy, daily prednisolone dosage > 20 mg, CAD, heart failure, arrhythmia, neurological conditions, other autoimmune or rheumatic diseases, orthopedic conditions, integrative treatment within the previous 90 days, cancer, and age under 18 years.
4. Randomization
Sixty women were randomly assigned to groups A or B by an unaffiliated physiotherapist using the closed envelope method.
5. Interventions
Group A, comprising 30 women, underwent 12-week LAT, low-calorie diet protocol (LCDP), and PE; group B (30 women) underwent 12-week LCDP and PE only.
6. LCDP
Interviews were conducted every 2 weeks by the last author, a certified nutritionist, to update the LCDP for each participant, capping daily caloric intake at 1000 kilocalories: 15% protein, 55% carbohydrates, and 30% fat [13-15]. Compliance was assessed via bi-weekly interviews.
7. PEP
Both groups underwent 50-minute Pilates sessions five times per week for 12 weeks, supervised by an experienced physiotherapist (Table 1) [16].
-
Table 1 . Components of performed Pilates exercise in both groups
The components of performed Pilates in every exercise session in both groups Repetitions performed in every session Warm-up exercises (10 minutes) Breathing exercise, neck stretching, knee stretching, pectoral muscles stretching, and stretching of wrist flexors (2 minutes for each exercise). Floating exercise of shoulders from supine Floating exercise was repeated for 3 minutes. Single-leg stretching (level 1) For every leg, this action was repeated for 30 seconds. Single-leg stretching (level 2) This exercise was repeated 10 times on each leg (nearly one minute for every leg). Hip twisting (level 1) For every leg, this exercise was repeated for 30 seconds. Hip twisting (level 2) This exercise was done for one minute for every hip. Roll up This exercise was repeated for 3 minutes. Side kicking This exercise was repeated for 1.5 minutes for each leg. Saw exercise This exercise was repeated for 3 minutes. Spine stretch This exercise was repeated for 3 minutes. One leg circle This exercise consumed 3 minutes for both legs. Shoulder bridge This exercise was repeated for 3 minutes. Double-arm stretch This exercise consumed 3 minutes. Cool down exercises (10 minutes) Breathing exercise, neck stretching, knee stretching, pectoral muscles stretching, and stretching of wrist flexors (2 minutes for each exercise).
8. LAT
LAT was administered thrice weekly on selected acupoints according to traditional Chinese medicine principles [17]. Group A was treated at specific acupoints (GB34, GB28, ST25, ST36, ST40, SP6, CV4, CV9, and CV12) with a 2-minute laser at specific settings (a 2-J/cm2 amplitude, 200-ns pulse period, 5000 Hz, and a 940-nm wavelength) [18-22].
9. Measured outcome lipids
Plasma low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and total cholesterol (TC) levels were assessed using a laboratory blood analyzer.
10. Blinding
Laboratory staff and technicians assessing blood lipids were blinded to the interventions.
11. Sample size
Using G*Power (Heinrich Heine University Düsseldorf, Düsseldorf, Germany), with a test power of 80% and an effect size of 0.67 for TG, at least 56 women were required, accounting for a 15% dropout rate; 64 women participated in total.
12. Statistical analysis
Data distribution was validated using the Shapiro test with PASW Statistics for Windows, version 18.0 (SPSS Inc., Chicago, IL, USA). The significance of
RESULTS
Fig. 1 presents a study flow chart. Initially, the study enrolled 32 patients in each group; however, four patients (two in each group) were unable to complete the trial due to scheduling conflicts (Fig. 1).
-
Figure 1.CONSORT flow chart of participating-lupus women during the 12-week intervention trial.
Before the interventions began, no significant difference was noted between the groups in terms of sociodemographic and baseline clinical characteristics (Table 2) or pre-intervention lipid values (Table 3).
-
Table 2 . Women’s demographic characteristics
Data of participating women Group A of SLE women
(mean ± SD)Group B of SLE women
(mean ± SD)p -valueAge (year) 34.96 ± 5.86 35.40 ± 8.43 0.815 Duration of disease (year) 9.23 ± 5.11 9.10 ± 5.90 0.927 Lupus women’s body mass index (kg/m2) 31.85 ± 2.06 32.37 ± 2.12 0.339 Lupus women’s waist circumference (cm) 98 ± 12.09 99.80 ± 13.59 0.589 p -values of this table are non-significant. Group A = laser acupuncture therapy + lowcalorie-diet protocol + Pilates exercise; Group B = low-calorie-diet protocol + Pilates exercise; SLE = systemic lupus erythematosus.
-
Table 3 . Outcomes of both SLE groups
Parameters Group A of SLE women
(mean ± SD)Group B of SLE women
(mean ± SD)p -value (between lupus groups)Cholesterol (mg/dl) Pre-serum level 212.53 ± 38.91 216.80 ± 42.17 0.685 Post-serum level 175.90 ± 38.28 200.13 ± 39.20 0.018* p -value (within lupus groups)* * Triglyceride (mg/dl) Pre-serum level 185.60 ± 35.11 189.36 ± 32.91 0.670 Post-serum level 136.83 ± 29.16 157.36 ± 28.46 0.007* p -value (within lupus groups)< 0.001* < 0.001* Low density lipoprotein (mg/dl) Pre-serum level 165.46 ± 59.56 167.63 ± 55.78 0.884 Post-serum level 130.46 ± 55.69 159.76 ± 56.54 0.047* p -value (within lupus groups)0.001* < 0.001* High density lipoprotein (mg/dl) Pre-serum level 41.20 ± 8.52 38.84 ± 9.77 0.322 Post-serum level 45.92 ± 11.66 39.78 ± 9.38 0.028* p -value (within lupus groups)0.001* 0.006* Data of this lupus study are presented with mean ± SD unless stated otherwise. *
p -value is significant. Group A = laser acupuncture therapy + low-calorie-diet protocol + Pilates exercise; Group B = low-calorie-diet protocol + Pilates exercise; SD = standard deviation; SLE = systemic lupus erythematosus.
A detailed comparison of TC, TG, LDL, and HDL levels was conducted between group A and group B (Table 3). Both groups displayed elevated lipid levels prior to the intervention. After the intervention, significant improvements (
DISCUSSION
To our knowledge, this study was the first to demonstrate a PE-mediated lipid-lowering effect in obese women with SLE. The findings reveal that sustained, active, and slow muscle contraction, coupled with the use of respiratory muscles during exercise, boosts energy consumption from fat sources. It is hypothesized that training-induced breathing synchronization with active limb contraction will decrease both body fat mass and percentage [23].
Our research corroborated the previous finding of significant improvement in lipid profiles in obese women after a 12-week PE regimen, whether applied alone or in conjunction with LCDPs [24]. Additional studies have further affirmed the efficacy of PE in enhancing lipid profiles in various populations [16,25-27]. However, contrary findings by other researchers have emerged [3,28-30], illustrating the unclear effects of PE on lipids.
A few studies have explored low-level laser therapy (LLLT) or LAT as anti-lipidemic treatment. LLLT operates on cellular photo-signaling phenomena to regulate cellular bio-functions and activities. The process involves the absorption of photon energy by specific intracellular or extracellular photoreceptors, accelerating electron transfer processes and resulting in increased energy (adenosine triphosphate, ATP) production, including in association with cyclooxygenase pathways [31,32].
The increase in ATP further stimulates the breakdown of TG into free fatty acids (FFAs) and glycerol, enabling FFAs to enter the bloodstream as an energy source. The application of LAT to specific abdominal acupoints (e.g., CV4, CV9, and CV12) enhances the likelihood of FFA utilization for muscular energy [33].
LLLT also induces changes in the intracellular redox state (increased production of reactive oxygen species, ROS), mitochondrial membrane potential, and a resulting increase in ADP (adenosine diphosphate)–ATP exchange rates, which may inhibit or modulate transcription factors and crucial genes involved in the biosynthetic cholesterogenesis process [34].
Given that ROS combines with the lipids in the adipocytes’ cell membranes, LLL-induced elevation of ROS concentrations increases lipid peroxidation. This breaks down the adipocytes’ cell membranes and causes the release of fatty contents, which are removed as waste by the lymphatic system [32]. Furthermore, specific acupoint stimulation amplifies the lipid-lowering effects by modifying inflammatory markers (tumor necrosis factor-alpha and interleukin 6) and regulating lipid synthesis and conversion processes (inhibiting the conversion of FFA to TG and enhancing the conversion of proHDL to HDL). Several studies have corroborated these findings, highlighting the beneficial effects of acupoint stimulation on blood lipids [7,18,21,35].
Supporting our findings, daily LLL has been shown to reduce diabetes and obesity incidence in rats through improved hepatic lipid metabolism and serum lipid profiling, particularly when rats are fed a high-fat diet [34,36]. Similarly, LAT on specific acupoints (LU7 and LV5) in rats has demonstrated a reduction in hyperlipidemia by boosting lipid metabolism [37]. In comparative studies, LAT has favored reductions in TC and LDL in diabetic rat models, though not in HDL and TG [38]. LAT has also been effective in modulating lipid profiles of cardiovascular disease [39].
In the realm of human studies concerning LAT-controlled dyslipidemia, the literature is limited. However, those that have combined LAT with lifestyle modifications have endorsed its efficacy in improving lipid profiles in women with metabolic syndrome or obesity [20,40]. Some research even underscores the substantial enhancing effects of LAT on TC and LDL, with no significant adverse effects, aligning with our findings [22,41].
Contradictory to our findings, a study by Hassan et al. [41] on obese women did not show the anticipated significant improvement in HDL and TG lipid profile components after adding LLL to a diet-restriction program, likely differing from our findings due to the frequency of LLL sessions.
Despite the attrition of four participants, our study’s robustness lies in the completion of the interventions by 60 women with SLE. A strength of this study was the meticulous follow-up concerning the interventions. The consistent face-to-face interviews by the last author to monitor women’s adherence to a low-calorie diet, coupled with excellent adherence to Pilates sessions, contributed to the study’s strength. Factors such as location, affordability, and flexibility in scheduling may explain the successful adherence to both Pilates and laser acupuncture sessions in the trial.
1. Trial limitations and future research directions
The presented randomized controlled trial of women with SLE had its limitations, and further investigation is needed to corroborate the reported blood lipid outcomes. Future studies may extend to exploring similar lipid outcomes in males, presenting an intriguing avenue for continued research.
CONCLUSIONS
Adding a 12-week regimen of LAT to PE and LCDP can significantly improve the lipid profiles of women with SLE.
ACKNOWLEDGEMENTS
We would like to thank all the participating women with lupus.
FUNDING
No funding.
AUTHORS' CONTRIBUTIONS
A.M.A.I, A.E.S, N.A.F.A, and A.M.A.E equally contributed to conceptualization, methodology, lupus patients’ data curation, investigation, collecting lupus patients’ data, editing, supervision, validation, writing the original draft of this lupus paper. All authors read and approved the final version of this in-women lupus research manuscript, and agreed with the order of authors’ presentation, agree with all aspects of the lupus research for integrity, accuracy, and publication.
DATA AVAILABILITY
The data of this lupus manuscript are available on mailed request.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
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Related articles in JAMS

Article
Research Article
J Acupunct Meridian Stud 2023; 16(4): 152-158
Published online August 31, 2023 https://doi.org/10.51507/j.jams.2023.16.4.152
Copyright © Medical Association of Pharmacopuncture Institute.
Response of Lipid Profile to Laser Acupuncture along with Diet and Pilates Exercise in Obese Women with Systemic Lupus Erythematosus: a Randomized Controlled Trial
Ali Mohamed Ali Ismail1,* , Ahmad Elsayed Saad2
, Noha Ahmed Fouad Abd-Elrahman3
, Ahmed Mohamed Abdelhalim Elfahl4
1Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
2Department of Medical Biochemistry and Molecular Biology, Kasr Alainy Faculty of Medicine, Cairo University, Giza, Egypt
3Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Badr University in Cairo, Cairo, Egypt
4Department of Internal Medicine and Geriatrics, Faculty of Physical Therapy, Badr University in Cairo, Cairo, Egypt
Correspondence to:Ali Mohamed Ali Ismail
Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
E-mail ali.mohamed@pt.cu.edu.eg, ali-mohamed@cu.edu.eg
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Obesity-induced dyslipidemia is one of the main factors contributing to morbidity and mortality associated with metabolic syndrome, atherosclerosis, and coronary artery disease among patients with systemic lupus erythematosus (SLE).
Objectives: This research aimed to assess the effect of adding laser acupuncture therapy (LAT) to a Pilates exercise program (PEP) and low-calorie diet protocol (LCDP) on blood lipids among 60 obese women with SLE.
Methods: Study participants were women aged between 23 and 49 years, randomly assigned to one of two groups, A or B, each comprising 30 women. In addition to adherence to the LCDP, both groups were supervised five times weekly during 50-minute PEP sessions. Group A also received LAT three times weekly, with each session lasting 2 minutes on selected acupoints. After the 12-week intervention, plasma total cholesterol, high-density lipoprotein, triglycerides, and low-density lipoprotein were assessed.
Results: Both groups demonstrated significant improvement in the aforementioned lipids after the 12-week intervention. A comparison between the post-intervention values of the lipids in the groups revealed a significant improvement favoring group A (the group that received LAT).
Conclusion: Adding a 12-week LAT regimen to PEP and LCDP significantly improved lipid profiles among 60 obese women with SLE.
Keywords: Laser-acupuncture, Pilates, Lipids, Obesity, Lupus
INTRODUCTION
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease that has a higher prevalence in women than men. Compared with age-matched healthy peers, obese women with SLE have a 50-fold higher incidence of coronary artery disease (CAD) [1].
Obesity, one of the risk factors for CAD, is highly prevalent among women with SLE. The usual causes of obesity in these individuals include an overabundance of cytokines and pro-inflammatory markers, high energy intake, low energy expenditure, and dietary choices [2].
Dyslipidemia, a primary complication of obesity, is frequently observed in women with SLE. This condition can be triggered by concurrent systemic diseases, such as diabetes mellitus or thyroid gland disorders, substantial metabolic shifts related to menopause and aging, chronic use of steroidal agents, and the number of organs affected by SLE. Optimal lifestyle interventions for dyslipidemia and obesity in SLE patients involve dietary modifications and exercise therapy [1].
Pilates, a contemporary physical activity program involving the concurrent performance of deep breathing exercises and repeated isometric contractions of the skeletal muscles, is recognized for improving weight loss, dyslipidemia, metabolic profile, and overall health. Consequently, it attracts many women engaged in lifestyle modification programs [3].
Conversely, traditional acupuncture intervention (TAI), despite ongoing debate over its safety and efficacy, is frequently utilized by patients with chronic illnesses, including SLE [4-8]. A 2008 report highlighted the potential use of TAI for reducing pain and fatigue associated with SLE, though side effects, such as needling pain, lightheadedness, and localized bruising, have been reported [9].
Laser acupuncture therapy (LAT) offers a non-invasive alternative to mechanical or electrical needling of acupoints and can elicit similar physiological effects to TAI. LAT settings can be adjusted for strength and intensity in a manner akin to controlling the depth and direction of needles in TAI but without invasiveness. Notable benefits of LAT include its non-invasiveness, simplicity of administration, minimal time consumption, and the alleviation of needle phobia [10].
The growing need to adequately treat modifiable risk factors, including dyslipidemia, to alleviate the burden of morbidities and mortalities in SLE patients has prompted calls for examining the impact of complementary treatments within their major care plans [11].
To our knowledge, no studies have examined the lipid profile response to LAT in conjunction with dietary restriction and Pilates exercise (PE) in obese women with SLE. Thus, this study was designed to investigate this response.
MATERIALS AND METHODS
1. Ethics approval
Before recruiting women diagnosed with lupus, local ethical clearance (ref. P.T.REC/012/003660) was obtained from the Faculty of Physical Therapy, Cairo University. In addition to obtaining consent from each participating woman with SLE, every procedure adhered to the recommendations of the Declaration of Helsinki.
2. Study setting and design
This randomized controlled trial recruited women with SLE from the immunology outpatient clinic at Cairo University Hospitals. The majority of eligible patients who visited the clinic between February 28 and July 1, 2022, were women; consequently, no male participants were enrolled. The trial was prospectively registered on www.clinicaltrials.gov (ref. NCT05381545).
3. Inclusion and exclusion criteria
Sixty obese Egyptian women aged 23-49 years, diagnosed with SLE based on the American Rheumatology College criteria, were recruited [12]. Exclusion criteria included the following: high plasma creatinine (≥ 150 mmol/l), thyroid and parathyroid disorders, elevated serum transaminases, systemic illness, breastfeeding or pregnancy, daily prednisolone dosage > 20 mg, CAD, heart failure, arrhythmia, neurological conditions, other autoimmune or rheumatic diseases, orthopedic conditions, integrative treatment within the previous 90 days, cancer, and age under 18 years.
4. Randomization
Sixty women were randomly assigned to groups A or B by an unaffiliated physiotherapist using the closed envelope method.
5. Interventions
Group A, comprising 30 women, underwent 12-week LAT, low-calorie diet protocol (LCDP), and PE; group B (30 women) underwent 12-week LCDP and PE only.
6. LCDP
Interviews were conducted every 2 weeks by the last author, a certified nutritionist, to update the LCDP for each participant, capping daily caloric intake at 1000 kilocalories: 15% protein, 55% carbohydrates, and 30% fat [13-15]. Compliance was assessed via bi-weekly interviews.
7. PEP
Both groups underwent 50-minute Pilates sessions five times per week for 12 weeks, supervised by an experienced physiotherapist (Table 1) [16].
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Table 1
Components of performed Pilates exercise in both groups.
The components of performed Pilates in every exercise session in both groups Repetitions performed in every session Warm-up exercises (10 minutes) Breathing exercise, neck stretching, knee stretching, pectoral muscles stretching, and stretching of wrist flexors (2 minutes for each exercise). Floating exercise of shoulders from supine Floating exercise was repeated for 3 minutes. Single-leg stretching (level 1) For every leg, this action was repeated for 30 seconds. Single-leg stretching (level 2) This exercise was repeated 10 times on each leg (nearly one minute for every leg). Hip twisting (level 1) For every leg, this exercise was repeated for 30 seconds. Hip twisting (level 2) This exercise was done for one minute for every hip. Roll up This exercise was repeated for 3 minutes. Side kicking This exercise was repeated for 1.5 minutes for each leg. Saw exercise This exercise was repeated for 3 minutes. Spine stretch This exercise was repeated for 3 minutes. One leg circle This exercise consumed 3 minutes for both legs. Shoulder bridge This exercise was repeated for 3 minutes. Double-arm stretch This exercise consumed 3 minutes. Cool down exercises (10 minutes) Breathing exercise, neck stretching, knee stretching, pectoral muscles stretching, and stretching of wrist flexors (2 minutes for each exercise).
8. LAT
LAT was administered thrice weekly on selected acupoints according to traditional Chinese medicine principles [17]. Group A was treated at specific acupoints (GB34, GB28, ST25, ST36, ST40, SP6, CV4, CV9, and CV12) with a 2-minute laser at specific settings (a 2-J/cm2 amplitude, 200-ns pulse period, 5000 Hz, and a 940-nm wavelength) [18-22].
9. Measured outcome lipids
Plasma low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and total cholesterol (TC) levels were assessed using a laboratory blood analyzer.
10. Blinding
Laboratory staff and technicians assessing blood lipids were blinded to the interventions.
11. Sample size
Using G*Power (Heinrich Heine University Düsseldorf, Düsseldorf, Germany), with a test power of 80% and an effect size of 0.67 for TG, at least 56 women were required, accounting for a 15% dropout rate; 64 women participated in total.
12. Statistical analysis
Data distribution was validated using the Shapiro test with PASW Statistics for Windows, version 18.0 (SPSS Inc., Chicago, IL, USA). The significance of
RESULTS
Fig. 1 presents a study flow chart. Initially, the study enrolled 32 patients in each group; however, four patients (two in each group) were unable to complete the trial due to scheduling conflicts (Fig. 1).
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Figure 1. CONSORT flow chart of participating-lupus women during the 12-week intervention trial.
Before the interventions began, no significant difference was noted between the groups in terms of sociodemographic and baseline clinical characteristics (Table 2) or pre-intervention lipid values (Table 3).
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&md=tbl&idx=2' data-target="#file-modal"">Table 2
Women’s demographic characteristics.
Data of participating women Group A of SLE women
(mean ± SD)Group B of SLE women
(mean ± SD)p -valueAge (year) 34.96 ± 5.86 35.40 ± 8.43 0.815 Duration of disease (year) 9.23 ± 5.11 9.10 ± 5.90 0.927 Lupus women’s body mass index (kg/m2) 31.85 ± 2.06 32.37 ± 2.12 0.339 Lupus women’s waist circumference (cm) 98 ± 12.09 99.80 ± 13.59 0.589 p -values of this table are non-significant. Group A = laser acupuncture therapy + lowcalorie-diet protocol + Pilates exercise; Group B = low-calorie-diet protocol + Pilates exercise; SLE = systemic lupus erythematosus..
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&md=tbl&idx=3' data-target="#file-modal"">Table 3
Outcomes of both SLE groups.
Parameters Group A of SLE women
(mean ± SD)Group B of SLE women
(mean ± SD)p -value (between lupus groups)Cholesterol (mg/dl) Pre-serum level 212.53 ± 38.91 216.80 ± 42.17 0.685 Post-serum level 175.90 ± 38.28 200.13 ± 39.20 0.018* p -value (within lupus groups)* * Triglyceride (mg/dl) Pre-serum level 185.60 ± 35.11 189.36 ± 32.91 0.670 Post-serum level 136.83 ± 29.16 157.36 ± 28.46 0.007* p -value (within lupus groups)< 0.001* < 0.001* Low density lipoprotein (mg/dl) Pre-serum level 165.46 ± 59.56 167.63 ± 55.78 0.884 Post-serum level 130.46 ± 55.69 159.76 ± 56.54 0.047* p -value (within lupus groups)0.001* < 0.001* High density lipoprotein (mg/dl) Pre-serum level 41.20 ± 8.52 38.84 ± 9.77 0.322 Post-serum level 45.92 ± 11.66 39.78 ± 9.38 0.028* p -value (within lupus groups)0.001* 0.006* Data of this lupus study are presented with mean ± SD unless stated otherwise. *
p -value is significant. Group A = laser acupuncture therapy + low-calorie-diet protocol + Pilates exercise; Group B = low-calorie-diet protocol + Pilates exercise; SD = standard deviation; SLE = systemic lupus erythematosus..
A detailed comparison of TC, TG, LDL, and HDL levels was conducted between group A and group B (Table 3). Both groups displayed elevated lipid levels prior to the intervention. After the intervention, significant improvements (
DISCUSSION
To our knowledge, this study was the first to demonstrate a PE-mediated lipid-lowering effect in obese women with SLE. The findings reveal that sustained, active, and slow muscle contraction, coupled with the use of respiratory muscles during exercise, boosts energy consumption from fat sources. It is hypothesized that training-induced breathing synchronization with active limb contraction will decrease both body fat mass and percentage [23].
Our research corroborated the previous finding of significant improvement in lipid profiles in obese women after a 12-week PE regimen, whether applied alone or in conjunction with LCDPs [24]. Additional studies have further affirmed the efficacy of PE in enhancing lipid profiles in various populations [16,25-27]. However, contrary findings by other researchers have emerged [3,28-30], illustrating the unclear effects of PE on lipids.
A few studies have explored low-level laser therapy (LLLT) or LAT as anti-lipidemic treatment. LLLT operates on cellular photo-signaling phenomena to regulate cellular bio-functions and activities. The process involves the absorption of photon energy by specific intracellular or extracellular photoreceptors, accelerating electron transfer processes and resulting in increased energy (adenosine triphosphate, ATP) production, including in association with cyclooxygenase pathways [31,32].
The increase in ATP further stimulates the breakdown of TG into free fatty acids (FFAs) and glycerol, enabling FFAs to enter the bloodstream as an energy source. The application of LAT to specific abdominal acupoints (e.g., CV4, CV9, and CV12) enhances the likelihood of FFA utilization for muscular energy [33].
LLLT also induces changes in the intracellular redox state (increased production of reactive oxygen species, ROS), mitochondrial membrane potential, and a resulting increase in ADP (adenosine diphosphate)–ATP exchange rates, which may inhibit or modulate transcription factors and crucial genes involved in the biosynthetic cholesterogenesis process [34].
Given that ROS combines with the lipids in the adipocytes’ cell membranes, LLL-induced elevation of ROS concentrations increases lipid peroxidation. This breaks down the adipocytes’ cell membranes and causes the release of fatty contents, which are removed as waste by the lymphatic system [32]. Furthermore, specific acupoint stimulation amplifies the lipid-lowering effects by modifying inflammatory markers (tumor necrosis factor-alpha and interleukin 6) and regulating lipid synthesis and conversion processes (inhibiting the conversion of FFA to TG and enhancing the conversion of proHDL to HDL). Several studies have corroborated these findings, highlighting the beneficial effects of acupoint stimulation on blood lipids [7,18,21,35].
Supporting our findings, daily LLL has been shown to reduce diabetes and obesity incidence in rats through improved hepatic lipid metabolism and serum lipid profiling, particularly when rats are fed a high-fat diet [34,36]. Similarly, LAT on specific acupoints (LU7 and LV5) in rats has demonstrated a reduction in hyperlipidemia by boosting lipid metabolism [37]. In comparative studies, LAT has favored reductions in TC and LDL in diabetic rat models, though not in HDL and TG [38]. LAT has also been effective in modulating lipid profiles of cardiovascular disease [39].
In the realm of human studies concerning LAT-controlled dyslipidemia, the literature is limited. However, those that have combined LAT with lifestyle modifications have endorsed its efficacy in improving lipid profiles in women with metabolic syndrome or obesity [20,40]. Some research even underscores the substantial enhancing effects of LAT on TC and LDL, with no significant adverse effects, aligning with our findings [22,41].
Contradictory to our findings, a study by Hassan et al. [41] on obese women did not show the anticipated significant improvement in HDL and TG lipid profile components after adding LLL to a diet-restriction program, likely differing from our findings due to the frequency of LLL sessions.
Despite the attrition of four participants, our study’s robustness lies in the completion of the interventions by 60 women with SLE. A strength of this study was the meticulous follow-up concerning the interventions. The consistent face-to-face interviews by the last author to monitor women’s adherence to a low-calorie diet, coupled with excellent adherence to Pilates sessions, contributed to the study’s strength. Factors such as location, affordability, and flexibility in scheduling may explain the successful adherence to both Pilates and laser acupuncture sessions in the trial.
1. Trial limitations and future research directions
The presented randomized controlled trial of women with SLE had its limitations, and further investigation is needed to corroborate the reported blood lipid outcomes. Future studies may extend to exploring similar lipid outcomes in males, presenting an intriguing avenue for continued research.
CONCLUSIONS
Adding a 12-week regimen of LAT to PE and LCDP can significantly improve the lipid profiles of women with SLE.
ACKNOWLEDGEMENTS
We would like to thank all the participating women with lupus.
FUNDING
No funding.
AUTHORS' CONTRIBUTIONS
A.M.A.I, A.E.S, N.A.F.A, and A.M.A.E equally contributed to conceptualization, methodology, lupus patients’ data curation, investigation, collecting lupus patients’ data, editing, supervision, validation, writing the original draft of this lupus paper. All authors read and approved the final version of this in-women lupus research manuscript, and agreed with the order of authors’ presentation, agree with all aspects of the lupus research for integrity, accuracy, and publication.
DATA AVAILABILITY
The data of this lupus manuscript are available on mailed request.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
Fig 1.

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Table 1 . Components of performed Pilates exercise in both groups.
The components of performed Pilates in every exercise session in both groups Repetitions performed in every session Warm-up exercises (10 minutes) Breathing exercise, neck stretching, knee stretching, pectoral muscles stretching, and stretching of wrist flexors (2 minutes for each exercise). Floating exercise of shoulders from supine Floating exercise was repeated for 3 minutes. Single-leg stretching (level 1) For every leg, this action was repeated for 30 seconds. Single-leg stretching (level 2) This exercise was repeated 10 times on each leg (nearly one minute for every leg). Hip twisting (level 1) For every leg, this exercise was repeated for 30 seconds. Hip twisting (level 2) This exercise was done for one minute for every hip. Roll up This exercise was repeated for 3 minutes. Side kicking This exercise was repeated for 1.5 minutes for each leg. Saw exercise This exercise was repeated for 3 minutes. Spine stretch This exercise was repeated for 3 minutes. One leg circle This exercise consumed 3 minutes for both legs. Shoulder bridge This exercise was repeated for 3 minutes. Double-arm stretch This exercise consumed 3 minutes. Cool down exercises (10 minutes) Breathing exercise, neck stretching, knee stretching, pectoral muscles stretching, and stretching of wrist flexors (2 minutes for each exercise).
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Table 2 . Women’s demographic characteristics.
Data of participating women Group A of SLE women
(mean ± SD)Group B of SLE women
(mean ± SD)p -valueAge (year) 34.96 ± 5.86 35.40 ± 8.43 0.815 Duration of disease (year) 9.23 ± 5.11 9.10 ± 5.90 0.927 Lupus women’s body mass index (kg/m2) 31.85 ± 2.06 32.37 ± 2.12 0.339 Lupus women’s waist circumference (cm) 98 ± 12.09 99.80 ± 13.59 0.589 p -values of this table are non-significant. Group A = laser acupuncture therapy + lowcalorie-diet protocol + Pilates exercise; Group B = low-calorie-diet protocol + Pilates exercise; SLE = systemic lupus erythematosus..
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Table 3 . Outcomes of both SLE groups.
Parameters Group A of SLE women
(mean ± SD)Group B of SLE women
(mean ± SD)p -value (between lupus groups)Cholesterol (mg/dl) Pre-serum level 212.53 ± 38.91 216.80 ± 42.17 0.685 Post-serum level 175.90 ± 38.28 200.13 ± 39.20 0.018* p -value (within lupus groups)* * Triglyceride (mg/dl) Pre-serum level 185.60 ± 35.11 189.36 ± 32.91 0.670 Post-serum level 136.83 ± 29.16 157.36 ± 28.46 0.007* p -value (within lupus groups)< 0.001* < 0.001* Low density lipoprotein (mg/dl) Pre-serum level 165.46 ± 59.56 167.63 ± 55.78 0.884 Post-serum level 130.46 ± 55.69 159.76 ± 56.54 0.047* p -value (within lupus groups)0.001* < 0.001* High density lipoprotein (mg/dl) Pre-serum level 41.20 ± 8.52 38.84 ± 9.77 0.322 Post-serum level 45.92 ± 11.66 39.78 ± 9.38 0.028* p -value (within lupus groups)0.001* 0.006* Data of this lupus study are presented with mean ± SD unless stated otherwise. *
p -value is significant. Group A = laser acupuncture therapy + low-calorie-diet protocol + Pilates exercise; Group B = low-calorie-diet protocol + Pilates exercise; SD = standard deviation; SLE = systemic lupus erythematosus..
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