Rausch A-K1,2, Juhl C3,4, Knittle K5, Dagfinrud H6, Hurkmans E7, Braun J8, Schoones J9, Vliet Vlieland TPM2, Niedermann K1
1Zurich University of Applied Sciences, Institute for Physiotherapy, Winterthur, Switzerland, 2Leiden University Medical Centre, Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden, Netherlands, 3University of Southern Denmark, Odense, Denmark, 4University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark, 5University of Helsinki, Faculty of Social Sciences, Helsinki, Finland, 6Diakonhjemmet Hospital, National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway, 7Ecorys, Department Social Affaire and Health, Rotterdam, Netherlands, 8Rheumazentrum Ruhrgebiet, Herne, Germany, 9Leiden University Medical Centre, Walaeus Library, Leiden, Netherlands
Background: Public health recommendations for physical activity (PA) exist for apparently healthy adults of all ages. Exercise (encompassing aerobic, muscle strength, flexibility, and neuromotor exercises) is defined as a subcategory of PA. If these recommendations are valid for people with chronic rheumatic conditions needs to be proven.
Purpose: To evaluate the effectiveness of exercise and PA promotion interventions on cardiovascular fitness, muscle strength, flexibility, neuromotor performance (e.g. balance), and daily PA in people with rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip/knee osteoarthritis (HOA/KOA).
Methods: A Systematic review (SR) and meta-analysis (MA) were performed searching the databases Pubmed/Medline, CENTRAL, Embase, Web of Science, Emcare, PsycInfo until 04/2017. We included randomized controlled trials (RCT)s in adults (≥ 18 years) with RA, SpA and HOA/KOA, investigating the effects of exercise or PA promotion interventions according to the public health PA recommendations by the American College of Sports Medicine (ACSM).The time point of interest was the first assessment after the intervention period. If suitable, data were pooled in a MA using a random-effect model presented as standardized mean difference (SMD). Study registration in PROSPERO (CRD42017082131).
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(s): Exercises and PA promotion interventions according to public health recommendations for PA improved cardiovascular fitness, muscle strength, and PA behaviour, with moderate effect sizes in people with RA, SpA and HOA/KOA. There is a knowledge gab concerning the effect of flexibility and neuromotor exercises in people with RA, SpA and HOA/KOA. More studies with a larger number of participants and similar assessments are needed to clearly decide on the long-term effects of exercise, as the overall aim of PA promotion is a change in long-term life style.
Implications: Exercise and PA promotion should be an integral part of standard care throughout the course if the disease in people with RA, SpA, HOA/KOA.
Keywords: rheumatoid arthritis, spondyloarthritis, hip/knee osteoarthritis
Funding acknowledgements: Part of the EULAR project “2018 EULAR recommendations for physical activity in people with inflammatory Arthritis and Osteoarthritis”.
Purpose: To evaluate the effectiveness of exercise and PA promotion interventions on cardiovascular fitness, muscle strength, flexibility, neuromotor performance (e.g. balance), and daily PA in people with rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip/knee osteoarthritis (HOA/KOA).
Methods: A Systematic review (SR) and meta-analysis (MA) were performed searching the databases Pubmed/Medline, CENTRAL, Embase, Web of Science, Emcare, PsycInfo until 04/2017. We included randomized controlled trials (RCT)s in adults (≥ 18 years) with RA, SpA and HOA/KOA, investigating the effects of exercise or PA promotion interventions according to the public health PA recommendations by the American College of Sports Medicine (ACSM).The time point of interest was the first assessment after the intervention period. If suitable, data were pooled in a MA using a random-effect model presented as standardized mean difference (SMD). Study registration in PROSPERO (CRD42017082131).
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(s): Exercises and PA promotion interventions according to public health recommendations for PA improved cardiovascular fitness, muscle strength, and PA behaviour, with moderate effect sizes in people with RA, SpA and HOA/KOA. There is a knowledge gab concerning the effect of flexibility and neuromotor exercises in people with RA, SpA and HOA/KOA. More studies with a larger number of participants and similar assessments are needed to clearly decide on the long-term effects of exercise, as the overall aim of PA promotion is a change in long-term life style.
Implications: Exercise and PA promotion should be an integral part of standard care throughout the course if the disease in people with RA, SpA, HOA/KOA.
Keywords: rheumatoid arthritis, spondyloarthritis, hip/knee osteoarthritis
Funding acknowledgements: Part of the EULAR project “2018 EULAR recommendations for physical activity in people with inflammatory Arthritis and Osteoarthritis”.
Topic: Musculoskeletal
Ethics approval required: No
Institution: Kantonale Ethikkommission Zurich
Ethics committee: Kantonale Ethikkommission Zurich
Reason not required: Meta-analysis, no data collected
All authors, affiliations and abstracts have been published as submitted.
