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. 2018 Dec 4;4(2):e000713.
doi: 10.1136/rmdopen-2018-000713. eCollection 2018.

Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis

Anne-Kathrin Rausch Osthoff  1   2 , Carsten Bogh Juhl  3   4 , Keegan Knittle  5 , Hanne Dagfinrud  6 , Emalie Hurkmans  7 , Juergen Braun  8   9 , Jan Schoones  10 , Theodora P M Vliet Vlieland #  2 , Karin Niedermann #  1
Affiliations

Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis

Anne-Kathrin Rausch Osthoff et al. RMD Open. .

Abstract

Objective: To evaluate the effectiveness of exercise and physical activity (PA) promotion on cardiovascular fitness, muscle strength, flexibility, neuromotor performance (eg, balance) and daily PA in people with rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip/knee osteoarthritis (HOA/KOA).

Methods: systematic review (SR) and meta-analysis (MA) were performed searching the databases PubMed/Medline, CENTRAL, Embase, Web of Science, Emcare and PsycInfo until April 2017. We included randomised controlled trials (RCTs) in adults (≥18 years) with RA, SpA and HOA/KOA, investigating the effects of exercise or PA promotion according to the public health PA recommendations by the American College of Sports Medicine. The time point of interest was the first assessment after the intervention period. If suitable, data were pooled in a MA using a random-effects model presented as standardised mean difference (SMD).

Results: The SR included 63 RCTs, of which 49 (3909 people with RA/SpA/HOA/KOA) were included in the MA. Moderate effects were found of aerobic exercises and resistance training on cardiovascular fitness (SMD 0.56 (95% CI 0.38 to 0.75)) and muscle strength (SMD 0.54 (95% CI 0.35 to 0.72)), respectively, but no effect of combined strength/aerobic/flexibility exercises on flexibility (SMD 0.12 (95% CI -0.16 to 0.41)). PA promotion interventions produced a small increase in PA behaviour (SMD 0.21 (95% CI 0.03 to 0.38)).

Conclusion: Exercises and PA promotion according to public health recommendations for PA improved cardiovascular fitness, muscle strength and PA behaviour, with moderate effect sizes in people with SpA, RA and HOA/KOA.

Trial registration number: CRD42017082131.

Keywords: knee osteoarthritis; osteoarthritis; rehabilitation; rheumatoid arthritis; spondyloarthritis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow chart describing the detailed selection process.
Figure 2
Figure 2
Forest plot showing the results of the meta-analysis on the effect of aerobic exercise on measured on VO2max in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis. SMD, standardised mean difference.
Figure 3
Figure 3
Forest plot showing the results of the meta-analysis on the effect of strength exercise on M.quadriceps femoris in people with rheumatoid arthritis and hip/knee osteoarthritis. SMD, standardised mean difference.
Figure 4
Figure 4
Forest plot showing the results of the meta-analysis on the effect of flexibility exercises combined with strength or aerobic exercises on flexibility in people with ankylosing spondylitis and hip/knee osteoarthritis. Flexibility was measured as active or passive range of motion, and using the Bath Ankylosing Spondylitis Mobility Index. SMD, standardised mean difference.
Figure 5
Figure 5
Forest plot showing the results of the meta-analysis on the effect of physical activity promotion strategies including counselling. SMD, standardised mean difference.
See this image and copyright information in PMC

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