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Meta-Analysis
. 2008 Apr 16;2008(2):CD005954.
doi: 10.1002/14651858.CD005954.pub2.

Exercise therapy in juvenile idiopathic arthritis

T Takken  1 , M van Brussel, R H H Engelbert, J Van der Net, W Kuis, P J M Helders
Affiliations
Meta-Analysis

Exercise therapy in juvenile idiopathic arthritis

T Takken et al. Cochrane Database Syst Rev. .

Abstract

Background: Exercise therapy is considered an important component of the treatment of arthritis. The efficacy of exercise therapy has been reviewed in adults with rheumatoid arthritis but not in children with juvenile idiopathic arthritis (JIA).

Objectives: To assess the effects of exercise therapy on functional ability, quality of life and aerobic capacity in children with JIA.

Search strategy: The Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE (January 1966 to April 2007), CINAHL (January 1982 to April 2007), EMBASE (January 1966 to October 2007), PEDro (January 1966 to October 2007), SportDiscus (January 1966 to October 2007), Google Scholar (to October 2007), AMED (Allied and Alternative Medicine) (January 1985 to October 2007), Health Technologies Assessment database (January 1988 to October 2007), ISI Web Science Index to Scientific and Technical Proceedings (January 1966 to October 2007) and the Chartered Society of Physiotherapy website (http://www.cps.uk.org) were searched and references tracked.

Selection criteria: Randomised controlled trials (RCTs) of exercise treatment in JIA.

Data collection and analysis: Potentially relevant references were evaluated and all data were extracted by two review authors working independently.

Main results: Three out of 16 identified studies met the inclusion criteria, with a total of 212 participants. All the included studies fulfilled at least seven of 10 methodological criteria. The outcome data of the following measures were homogenous and were pooled in a meta-analysis: functional ability (n = 198; WMD -0.07, 95% CI -0.22 to 0.08), quality of life (CHQ-PhS: n = 115; WMD -3.96, 95% CI -8.91 to 1.00) and aerobic capacity (n = 124; WMD 0.04, 95% CI -0.11 to 0.19). The results suggest that the outcome measures all favoured the exercise therapy but none were statistically significant. None of the studies reported negative effects of the exercise therapy.

Authors' conclusions: Overall, based on 'silver-level' evidence (www.cochranemsk.org) there was no clinically important or statistically significant evidence that exercise therapy can improve functional ability, quality of life, aerobic capacity or pain. The low number of available RCTs limits the generalisability. The included and excluded studies were all consistent about the adverse effects of exercise therapy; no short-term detrimental effects of exercise therapy were found in any study. Both included and excluded studies showed that exercise does not exacerbate arthritis. The large heterogeneity in outcome measures, as seen in this review, emphasises the need for a standardised assessment or a core set of functional and physical outcome measurements suited for health research to generate evidence about the possible benefits of exercise therapy for patients with JIA. Although the short-term effects look promising, the long-term effect of exercise therapy remains unclear.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Functional ability, Outcome 1 CHAQ.
2.1
2.1. Analysis
Comparison 2 Quality of life, Outcome 1 CHQ‐PhS.
3.1
3.1. Analysis
Comparison 3 Quality of life, Outcome 1 CHQ‐PsS.
4.1
4.1. Analysis
Comparison 4 Quality of life, Outcome 1 JAQQ and QoL (vAS).
5.1
5.1. Analysis
Comparison 5 Aerobic capacity, Outcome 1 VO2peak.
6.1
6.1. Analysis
Comparison 6 Mean baseline functional ability calculated using generic inverse method, Outcome 1 Mean baseline functional ability.
7.1
7.1. Analysis
Comparison 7 Mean baseline quality of life (CHQ‐PhS) calcualted using generic inverse method, Outcome 1 CHQ‐PhS.
8.1
8.1. Analysis
Comparison 8 Mean baseline quality of life (CHQ‐PsS) calculated using generic inverse method, Outcome 1 quality of life (CHQ‐PsS).
9.1
9.1. Analysis
Comparison 9 mean baseline aerobic capacity calculated using generic inverse method, Outcome 1 aerobic capacity.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Epps 2005 {published data only}
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Takken 2003 {published data only}
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