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Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis
  1. Silje Halvorsen Sveaas1,2,
  2. Geir Smedslund1,3,
  3. Kåre Birger Hagen1,2,
  4. Hanne Dagfinrud1,2
  1. 1 Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
  2. 2 Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
  3. 3 The Norwegian Knowledge Center for the Health Services, The Norwegian Institute of Public Health, Oslo, Norway
  1. Correspondence to Silje Halvorsen Sveaas, Department of Rheumatology, 1National Advisory Unit on Rehabilitation in Rheumatology, P.O. box 23 Vinderen, Oslo 0319, Norway; s.h.sveaas{at}


Objective To investigate the effects of cardiorespiratory and strength exercises on disease activity for patients with inflammatory rheumatic diseases (IRDs).

Design A systematic review with meta-analysis registered at PROSPERO (CRD42015020004).

Participants Patients with IRDs.

Data sources The databases MEDLINE, AMED, Embase and CINAHL were searched from inception up to April 2016.

Eligibility criteria for selecting studies Trials were included if they were randomised controlled trials of adults with IRDs, comparing the effect of cardiorespiratory and strength exercises with usual care on disease activity and followed the American College of Sports Medicine’s exercise recommendations. The primary outcome was disease activity in terms of inflammation, joint damage and symptoms.

Data synthesis Data were pooled in a random-effect model for all outcomes, and standardised mean differences (SMDs) were calculated. The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation approach.

Results Twenty-six trials with a total of 1286 participants were included. There was high to moderate quality evidence, for a small beneficial effect on disease activity scores (0.19 (95% CI 0.05 to 0.33), p<0.01) and joint damage (SMD 0.27 (95% CI 0.07 to 0.46), p<0.01). Furthermore, moderate quality evidence for a small beneficial effect on erythrocyte sedimentation rate (SMD 0.20 (95% CI 0.0 to 0.39), p=0.04) and for no effect on C reactive protein (SMD −0.14 (95% CI −0.37 to 0.08), p=0.21). Beneficial effects were also seen for symptoms.

Conclusions The results of this review suggest beneficial effects of exercises on inflammation, joint damage and symptoms in patients with IRDs.

  • Exercises

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  • Acknowledgements We thank librarian Kari Engen Matre, Diakonhjemmet Hospital, for technical support in developing and running the literature searches. We thank Suzanne Capell for English editing of the manuscript.

  • Contributors SHS, KBH and HD designed the study. All authors acquired the data. SHS and GS coded and analysed the data. All authors drafted the manuscript and approved the final version to be published.

  • Funding This work was supported by The Norwegian Fund for Post-Graduate Training in Physiotherapy.

  • Competing interests None declared.

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

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