title: Does exercise impact on sleep for people who have rheumatoid arthritis? A systematic review.
abstract: To systematically search for the availability of evidence for exercise impacting on sleep for people who have rheumatoid arthritis. Two reviewers independently searched seven electronic databases, identified and extracted relevant studies by applying eligibility criteria. Sources of bias were assessed independently by two reviewers using the Cochrane bias assessment tool for randomized controlled trials (RCTs) and Newcastle-Ottawa Quality Assessment Scale for non-RCTs. Data were synthesized using a level of evidence approach. Meta-analyses were deemed to be inappropriate due to the heterogeneity of study designs, measurement tools and interventions. Five studies were included: one RCT; two pilot RCTs and two samples of convenience. A total of 262 people with RA were included. Interventions used were difficult to assess due to the heterogeneity of study designs and the inclusion of two using different types of yoga as an intervention. Different sleep outcome measures were used thus, it was not feasible to pool results. Studies had a high risk of bias. This review could find no consistent or conclusive evidence on whether exercise impacts on sleep in people who have rheumatoid arthritis, therefore no firm conclusions can be made. However, there is some indication that exercise may have positive benefits on sleep in people who have rheumatoid arthritis. Further studies with improved study designs, using subjective and objective measures, are needed.
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland. sean.g.mckenna@ul.ie.
authors.forename: Sean
authors.identifier: http://orcid.org/0000-0003-4707-6654
authors.initials: S
authors.lastname: McKenna
authors.affiliation: Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland.
authors.forename: Alan
authors.initials: A
authors.lastname: Donnelly
authors.affiliation: Department of Rheumatology, University Hospital Limerick, Limerick, Ireland.|Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fraser
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors.forename: Laura
authors.initials: L
authors.lastname: Comber
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors.forename: Norelee
authors.initials: N
authors.lastname: Kennedy
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D006304:Health Status; D006801:Humans; D011788:Quality of Life; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Inflammatory arthritis; Physical activity; Review; Rheumatology; Sleep disturbance; Sleep quality