“Evidence has accumulated on the effectiveness of physical activity to reduce disease-related symptoms such as pain and comorbidity risk in people with rheumatoid arthritis,” investigators stated.
Engaging in physical activity (PA) may increase quality of life (QoL) and function in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA), but future research is necessary, according to a study published in Arthritis Care & Research.1
“During the past several decades, good-quality evidence has accumulated on the effectiveness of aerobic and muscle strengthening PA to reduce disease-related symptoms such as pain and
comorbidity risk in people with RA,” investigators stated. “Nevertheless, more studies are needed to determine whether PA can improve QoL and self-reported function for patients with inflammatory arthritis.”
This systematic review and meta-analysis searched the databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) through September 2020 to identify randomized controlled trails (RCTs). The search included terms such as rheumatoid arthritis, RA, arthritis, rheumatoid, inflammatory joint diseases, psoriatic, psoriatic arthritis, inflammatory arthritis, ankylosing spondylitis, ankylosing, axial spondylarthritis, spondylarthritides, physical activity, physical exercise, exercise training, resistance training, and aerobic fitness.
Searches, risk of bias, and data extraction were performed by 2 investigators with a third investigator adjudicated if agreement was not achieved. Eligible studies fulfilled the PICOS (participants, interventions, comparators, outcomes, study design) criteria. All patients were aged 18 years or older and had a diagnosis of RA, SpA, or PsA. Eligible studies included QoL, an individuals’ perception of their position in life, and self-reported function. QoL was the primary outcome and function was the secondary outcome. Author, year of publication, participant characteristics, comparators, features of interventions, and outcomes were recorded.
Of 11,276 articles identified, 55 RCTs were analyzed in the systematic review and 37 RCTs were available for meta-analysis. Most studies were from Brazil (n =6), Sweden (n = 6), Netherlands (n = 6), UK (n = 5), and USA (n = 5). The median sample size was 60 participants and the mean age ranged from 36.2 to 73.7 years. The majority of patients were female (70%). Of these studies, 76% focused on RA, 20% analyzed SpA, and 4% investigated PsA.
Patient-reported outcome measures (PROMs) were used to measure general health, physical and mental health, emotional and social aspects, wellbeing, and vitality. Instruments utilized included the EuroQol Health, Arthritis Impact Measurement Scale (AIMS) Psychological Health and Components, Life Orientation Test, Short Form Health Survey (SF36), Short Form Health Survey (SF12), and RAND-36 score.
A total of 12 studies determined the effect of PA on QoL in patients with RA. Results indicated a significant post-intervention improvement in QoL when compared with the control group (SMD = 0.50, 95% CI:0.10 to 0.90, P < 0.01, I2 = 66%). However, in the meta-analysis comparing patients with RA and an active control group, there was no longer a significant difference. Overall, 26 studies met inclusion criteria for function regarding PA in patients with RA. Results were based on the Health Assessment Questionnaire (HAQ), the Multidimensional Health Assessment Questionnaire (MHAQ), and the visual analogue scale (VAS). PA intervention significantly improved activity performance, disease activity, fatigue, pain, disease symptoms, and physical function in patients with RA when compared with the control group. However, when compared with an active control group, no significant difference was found.
In total, 5 studies were included for analysis of PA on QoL in patients with SpA. Post intervention improvement was seen in favor of the control group (MD = 3.22, 95% CI:1.99 to 4.45, P < 0.001).
Nine of the studies focused on function of patients with SpA were included in meta-analysis. Improvement was determined by increased scores in sleep, self-efficacy, and physical function. Improvements were found in the cohort that utilized PA interventions when compared with the control group (SMD = −0.60, 95% CI: −1.09 to −0.12, P < 0.02, I2 = 57%) as well as disease activity and symptoms, fatigue (SMD = −1.97, 95% CI: −2.44 to −1.51, P < 0.001), pain (SMD = −1.12, 95% CI: −2.12 to −0.12, P < 0.03, I2=94%), depression, anxiety, and other mental manifestations.
There were no significant results reported for QoL in patients with PsA. Regarding function, only 1 study showed significant improvements in performance for this patient population. Overall, the quality of evidence was low for both QoL and function analysis.
The number of studies, including the sample size, were small, thus limiting the study by not being able to provide sensitivity analyses nor subgroup analyses for SpA and PsA. However, sensitivity analysis was available for patients with RA. Adequately reported data was low, which reduced the number of studies in the meta-analysis. Additionally, long-term effect of PA was not assessed in the study. Lastly, the limited number of studies comparing PA and active controls or follow-ups emphasizes the need for more research into PA intervention.
“The synthesized evidence shows that PA can lead to less pain, fatigue, and improved mental and activity performance in inflammatory arthritis with the most comprehensive information on RA and SpA,” investigators concluded. “This might improve both short-term and long-term compliance to PA interventions with health benefits for the individual. Patient-reported aspects of health are as important as objective measures of disease activity and function in the care of patients with IA. Future research need to focus on effects of PA in PsA, as well on larger, powered studies with standardized protocols to understand the effect of different kind of PA interventions.”
Björk M, Dragioti E, Alexandersson H, et al. Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-reported Function: A Systematic Review and Meta-analysis - The ENHANCE Study [published online ahead of print, 2021 Oct 11]. Arthritis Care Res (Hoboken). 2021;10.1002/acr.24805. doi:10.1002/acr.24805