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Original article
Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis
  1. Anne-Kathrin Rausch Osthoff1,2,
  2. Carsten Bogh Juhl3,4,
  3. Keegan Knittle5,
  4. Hanne Dagfinrud6,
  5. Emalie Hurkmans7,
  6. Juergen Braun8,9,
  7. Jan Schoones10,
  8. Theodora P M Vliet Vlieland2 and
  9. Karin Niedermann1
  1. 1 School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
  2. 2 Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
  3. 3 University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark
  4. 4 University of Southern Denmark, Odense, Denmark
  5. 5 Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
  6. 6 National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  7. 7 Department Social Affaire and Health, Ecorys, Rotterdam, The Netherlands
  8. 8 Rheumazentrum Ruhrgebiet, Herne, Germany
  9. 9 Ruhr University, Bochum, Germany
  10. 10 Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Karin Niedermann; karin.niedermann{at}


Objective To evaluate the effectiveness of exercise and physical activity (PA) promotion on cardiovascular fitness, muscle strength, flexibility, neuromotor performance (eg, balance) and daily PA in people with rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip/knee osteoarthritis (HOA/KOA).

Methods systematic review (SR) and meta-analysis (MA) were performed searching the databases PubMed/Medline, CENTRAL, Embase, Web of Science, Emcare and PsycInfo until April 2017. We included randomised controlled trials (RCTs) in adults (≥18 years) with RA, SpA and HOA/KOA, investigating the effects of exercise or PA promotion according to the public health PA recommendations by the American College of Sports Medicine. The time point of interest was the first assessment after the intervention period. If suitable, data were pooled in a MA using a random-effects model presented as standardised mean difference (SMD).

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 Exercises and PA promotion according to public health recommendations for PA improved cardiovascular fitness, muscle strength and PA behaviour, with moderate effect sizes in people with SpA, RA and HOA/KOA.

Trial registration number CRD42017082131.

  • rehabilitation
  • rheumatoid arthritis
  • spondyloarthritis
  • osteoarthritis
  • knee osteoarthritis

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  • TPMVV and KN contributed equally.

  • Contributors A-KRO performed the SLR and data extraction, supervised by KN and TPMVV. JS developed the search strategy for all databases. CBJ double-checked data and performed the meta-analysis. A-KRO and KN drafted the manuscript. All authors of this manuscript were members of the EULAR Task Force, except JS, who developed the recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. They revised this manuscript and approved the final version for publication.

  • Funding The manuscript is part of the EULAR project ‘2018 EULAR recommendations for physical activity in people with inflammatory Arthritis and Osteoarthritis’.

  • Competing interests None declared.

  • Patient consent Not required.

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

  • Data sharing statement There are no unpublished data from this study.

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