Results from a meta-analysis published in Arthritis Care & Research suggest that physical activity may improve quality of life and functioning in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA).
Although physical activity is often endorsed as a means of managing rheumatic symptoms, its impact on patient-reported and patient-relevant outcomes is unexplored. To inform this gap, investigators searched the databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) for randomized clinical trials describing the effects of physical activity in rheumatic disease. Eligible trials enrolled adults with RA, SpA, or PsA and introduced physical activity or exercise as a stand-alone intervention. Outcomes of interest were patient-reported quality of life and function as defined by the International Classification of Functioning, Disability and Health. Risk for bias was assessed using the Cochrane tool. Meta-analyses were conducted using a random effects model, with separate models for each disease.
The systematic review included 55 studies; the final meta-analysis used 37 studies. Ofthe 55 reviewed studies, 42 enrolled patients with RA; 11 enrolled patients with SpA; and 2 enrolled patients with PsA. Median sample size was 60 participants, with an interquartile range (IQR) of 17 to 490. Mean participant age ranged from 36.2 to 73.7 years; mean disease duration ranged from 0.8 to 24.9 years. The majority (70%) of patients were women. Treatment conditions included cardiorespiratory training only (n=19 studies), mixed cardiorespiratory and strength training (n=24), and strength training only (n=12). Median treatment duration was 3 months but ranged from 15 days to 2 years.
In studies assessing patients with RA, physical activity had a significant positive effect on self-reported quality of life compared with treatment as usual or no treatment. Similarly, compared with the control disorder, physical activity was associated with significant improvements in the following areas of function: activity performance, pain, fatigue, disease activity and symptoms, and physical function. However, physical activity did not outperform other forms of active treatment, such as medication, it was noted. Similar effects were observed in patients with SpA and PsA: compared with an inactive control group, physical activity was associated with significant improvements in patient-reported quality of life and function. However, active control groups tended to experience similar improvements to patients assigned to physical activity. In sensitivity analyses limited to studies with low risk of bias (n=12), physical activity retained a significant effect on activity performance and physical function, although not on quality of life.
Study limitations include the small number of studies for SpA and PsA; the low granularity of outcome data reported across studies; and high variability in intensity and duration of physical activity courses. More research is necessary to adequately characterize the impact of physical activity on patient-reported disease outcomes.
“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 wrote. “Clinical implications support the use of instruments capturing the patient-reported outcomes to assess a larger variety of effects of [physical activity]…in addition to commonly used objective outcome measures.”
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. Arthritis Care Res (Hoboken). Published online October 11, 2021. doi:10.1002/acr.24805