title: Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Several lines of evidence have emphasized an improvement in aerobic capacity and muscle strength after physical exercise programs in rheumatoid arthritis (RA) patients. Our objective was to evaluate the efficacy of aerobic exercises in RA on quality of life, function, and clinical and radiologic outcomes by a systematic literature review and a meta-analysis.
  
  
  METHODS
  A systematic literature search was performed in the Medline, EMBase, and Cochrane databases up to July 2009 and in the abstracts presented at rheumatology scientific meetings during the last 5 years. Randomized controlled trials (RCTs) comparing aerobic exercises with non-aerobic interventions in RA patients were included. Outcomes studied were postintervention quality of life, function assessed by the Health Assessment Questionnaire (HAQ), a pain visual analog scale (VAS), joint count, the Disease Activity Score in 28 joints (DAS28), and radiologic damage. Efficacy was assessed by standardized mean differences (SMDs; difference between groups of mean outcome variation from baseline/SD at baseline) of aerobic exercises versus non-aerobic rehabilitation. Heterogeneity was tested. SMDs were pooled by a meta-analysis using the inverse of variance model.
  
  
  RESULTS
  Fourteen RCTs, including 1,040 patients, met the inclusion criteria. Exercise improved the postintervention quality of life (SMD 0.39, P < 0.0001), HAQ score (SMD 0.24, P = 0.0009), and pain VAS (SMD 0.31, P = 0.02). Exercise in this RA population appeared safe, since global compliance, DAS28, and joint count were similar in both groups.
  
  
  CONCLUSIONS
  Cardiorespiratory aerobic conditioning in stable RA appears to be safe and improves some of the most important outcome measures. However, the degree of the effect of aerobic exercise on the abovementioned parameters is small.
authors.affiliation: University of Grenoble Medical School, Centre Hospitalier Universitaire, Hôpital Sud, and GREPI CNRS UMR 5525, Grenoble, France. abaillet@chu-grenoble.fr
authors.forename: Athan
authors.initials: A
authors.lastname: Baillet
authors.forename: Nadine
authors.initials: N
authors.lastname: Zeboulon
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.forename: Louis-Antoine
authors.initials: LA
authors.lastname: Bodin
authors.forename: Robert
authors.initials: R
authors.lastname: Juvin
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
mesh_terms: D001172:Arthritis, Rheumatoid / Q000628:therapy*; D015444:Exercise; D005081:Exercise Therapy; D006801:Humans; D010147:Pain Measurement; D010809:Physical Fitness / Q000502:physiology; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index