Effectiveness of Resonance Frequency Breathing Exercises in Patients With Systemic Lupus Erythematosus and Central Sensitization

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by systemic inflammation, fatigue, central sensitization, and chronic pain. While physical exercise is strongly recommended to enhance functional capacity and manage fatigue, heightened central sensitivity and pain often limit adherence and clinical gains. Resonance frequency breathing (paced diaphragmatic breathing at 6 breaths per minute, 0.1 Hz) stimulates the baroreflex and facilitates autonomic regulation, which may alleviate central pain processing. This randomized controlled trial aims to evaluate the effects of resonance frequency breathing added to a standard exercise program compared with exercise alone on central sensitization, pain thresholds, fatigue, pain catastrophizing, functional capacity, respiratory muscle strength, disease activity, and quality of life in patients with SLE. Participants will be randomly allocated to either a Standard Exercise Group or a Standard Exercise + Resonance Breathing Group for an 8-week intervention.

Inclusion Criteria: * Clinically diagnosed with Systemic Lupus Erythematosus (SLE) according to the 2019 ACR/EULAR classification criteria * Aged between 18 and 65 years * Central Sensitization Inventory (CSI) score of 40 or higher (CSI \>= 40) * Stable medical therapy with no pharmacological regimen changes within the last 3 months * Willing and cognitively able to provide written informed consent and adhere to the intervention protocol Exclusion Criteria: * Presence of severe cardiovascular or pulmonary contraindications that preclude safe participation in exercise or paced breathing training * Major surgical operation within the preceding 6 months * Current pregnancy * Active severe disease flare-up * Regular and ongoing practice of structured breathing exercises, pranayama, or yoga