title: Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) fatigue is not being well-managed currently, and evidence of effective interventions is limited. Aerobic exercise may provide benefit to treat fatigue in RA. Therefore, the purpose of this meta-analysis is to analyze the effect of aerobic land-based exercise on fatigue in RA.
  
  
  METHODS
  A literature search was conducted using PubMed, Cochrane Library, Embase, and trial registers to identify randomized controlled trials (RCTs) with a supervised land-based aerobic exercise program performed with an intensity between 50% and 90% of maximal heart rate, of at least 15 minutes' duration, performed at least 2 times a week, and lasting for a time period of at least 4 consecutive weeks. Risk of bias was assessed using the Cochrane tool. A meta-analysis of fatigue outcomes was performed by calculating the standardized mean difference (SMD) using a random-effects model.
  
  
  RESULTS
  Five RCTs were included. None of the trials selected patients with RA for having fatigue. Risk of bias was low in 3 RCTs and unclear in 2. Land-based aerobic exercise programs had a positive effect on fatigue in RA compared to no exercise at 12 weeks, SMD -0.31 (95% confidence interval [95% CI] -0.55, -0.06). At 24 weeks, the effect of aerobic land-based exercise was smaller and not statistically significant: SMD -0.15 (95% CI -0.33, 0.02).
  
  
  CONCLUSIONS
  There is evidence with low risk of bias that an aerobic exercise program is effective in reducing fatigue among patients with RA, especially in the short term; however, effects are small. To substantiate the evidence, RCTs should be performed in patients with RA selected for having fatigue.
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: S A A
authors.initials: SA
authors.lastname: Rongen-van Dartel
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Repping-Wuts
authors.affiliation: Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Flendrie
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Bleijenberg
authors.affiliation: University of Wolverhampton, Walsall, UK.
authors.forename: G S
authors.initials: GS
authors.lastname: Metsios
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: W B
authors.initials: WB
authors.lastname: van den Hout
authors.affiliation: Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: C H M
authors.initials: CH
authors.lastname: van den Ende
authors.affiliation: University of Kansas School of Nursing, Kansas City.
authors.forename: G
authors.initials: G
authors.lastname: Neuberger
authors.affiliation: Our Lady's Hospice and Care Services, Dublin, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Reid
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: P L C M
authors.initials: PL
authors.lastname: van Riel
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Fransen
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000534:rehabilitation*; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005221:Fatigue / Q000209:etiology* / Q000534:rehabilitation*; D006801:Humans; D016032:Randomized Controlled Trials as Topic