Article Text

Download PDFPDF

Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: a systematic review with meta-analysis of randomised controlled trials
  1. George A Kelley1,
  2. Kristi S Kelley2,
  3. Leigh F Callahan3
  1. 1 Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
  2. 2 Department of Biostatistics, School of Public Health, Robert C Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
  3. 3 Departments of Social Medicine and Orthopaedics, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Professor George A Kelley; gkelley{at}hsc.wvu.edu

Abstract

Background/purpose Given conflicting findings, the purpose of this study was to use the meta-analytic approach to examine the effects of exercise (aerobic, strength training or both) on anxiety in adults with arthritis and other rheumatic diseases (AORD).

Methods Randomised controlled exercise intervention trials ≥4weeks in adults ≥18 years of age with osteoarthritis, rheumatoid arthritis or fibromyalgia were included. Studies were located by searching eight electronic databases, cross-referencing and expert review. Dual selection and data abstraction of studies were performed. Hedge’s standardised effect size (ES) was calculated for each result and pooled using the recently developed inverse heterogeneity model. Two-tailed z-alpha values ≤0.05 and non-overlapping 95% CI were considered statistically significant. Heterogeneity was estimated using Q and I2 with alpha values ≤0.10 for Q considered statistically significant. Small-study effects were examined using funnel plots and Egger’s regression test. In addition, the number needed to treat (NNT), percentile improvement and meta-regression were conducted.

Results Of the 639 citations screened, 14 studies representing 926 initially enrolled participants (539 exercise, 387 control) met the criteria for inclusion. Length of training (mean±SD) averaged 15.8±6.7 weeks, frequency 3.3±1.3 times per week and duration 28.8±14.3 min per session. Overall, statistically significant reductions in anxiety were found (exercise minus control changes ES=−0.40, 95% CI −0.65 to −0.15, tau2=0.14; Q=40.3, P=0.0004; I2 =62.8%). The NNT was 6 with a percentile improvement of 15.5% and an estimated 5.3 million inactive US adults with AORD improving their anxiety if they started exercising regularly. Statistically significant small-study effects were observed (P<0.0001).

Conclusions Exercise is associated with reductions in anxiety among adults with selected types of AORD. However, a need exists for additional, well-designed, randomised controlled trials on this topic.

PROSPERO registration number CRD42016048728.

  • exercise
  • anxiety
  • arthritis
  • systematic review
  • meta-analysis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors GAK was responsible for the conception and design, acquisition of data, analysis and interpretation of data, drafting the initial manuscript and revising it critically for important intellectual content. KSK was responsible for the conception and design, acquisition of data, drafting the initial manuscript and revising all drafts critically for important intellectual content. LFC was responsible for the conception and design, acquisition of data, drafting the initial manuscript and revising all drafts critically for important intellectual content. All authors read and approved the final manuscript.

  • Funding This meta-analysis was funded by the National Institutes of Health, National Institute for Arthritis, Musculoskeletal and Skin Diseases, grant number R01AR061346 (GAK, principal investigator).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are available upon request from the corresponding author.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles