Article type
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Abstract
Introduction/Objective: The aim of the systematic review was to determine the effectiveness of dynamic exercise therapy to improve joint mobility, muscle strength, aerobic capacity and daily functioning in RA patients. In addition, possible side effects on pain, disease activity and radiological progression were studied.
Methods: Datasources: The MEDLINE, Embase and SCISEARCH databases (1966 to October 1996) were searched by the terms: 'explode /rheumatoid arthritis' or 'arthritis in ti,abs' and 'explode/exercise therapy in MeSH, 'exercis* or training' combined with a search for controlled trials. Reference lists of the searched articles were scanned. Study selection: Participants: Patients according to the 1958 or 1987 ARA classification of RA. Types of intervention: 1) Randomized trials comparing dynamic exercise therapy with conventional exercise therapy or with a control group 2) Intervention, adequate to improve aerobic capacity, fulfilling the following criteria: exercise frequency at least twice a week, duration of intervention >= 6 weeks and a intensity level such that during at least 20 minutes heart rates exceeded 60% of maximal heart rate. Outcome measures: any validated measure of joint mobility, muscle strength, aerobic capacity, functional ability, disease activity, pain, and radiological progression. Data extraction: Selection criteria, methodological quality, data of outcome measures and trial characteristics were extracted by 2 blinded reviewers. In case of persistent disagreement a third reviewer decided. The methodological quality was rated by 9 criteria.
Results: Six out of 30 identified controlled trials met the selection criteria. Concealment of allocation was unclear in all included trials; 2 studies had a blinded assessor; 4 studies fulfilled >6 criteria. Due to heterogeneity in outcome measures data could not be pooled. Preliminary results indicate that short-term dynamic exercise therapy is effective in increasing aerobic capacity and muscle strength without detrimental effect on disease activity and pain.
Discussion: Outcome measures varied widely, but data suggest a positive effect of dynamic exercise therapy. Future research designs of exercise therapy trials should include adequate allocation concealment, blinding of assessors and standardization of outcome measures.
Methods: Datasources: The MEDLINE, Embase and SCISEARCH databases (1966 to October 1996) were searched by the terms: 'explode /rheumatoid arthritis' or 'arthritis in ti,abs' and 'explode/exercise therapy in MeSH, 'exercis* or training' combined with a search for controlled trials. Reference lists of the searched articles were scanned. Study selection: Participants: Patients according to the 1958 or 1987 ARA classification of RA. Types of intervention: 1) Randomized trials comparing dynamic exercise therapy with conventional exercise therapy or with a control group 2) Intervention, adequate to improve aerobic capacity, fulfilling the following criteria: exercise frequency at least twice a week, duration of intervention >= 6 weeks and a intensity level such that during at least 20 minutes heart rates exceeded 60% of maximal heart rate. Outcome measures: any validated measure of joint mobility, muscle strength, aerobic capacity, functional ability, disease activity, pain, and radiological progression. Data extraction: Selection criteria, methodological quality, data of outcome measures and trial characteristics were extracted by 2 blinded reviewers. In case of persistent disagreement a third reviewer decided. The methodological quality was rated by 9 criteria.
Results: Six out of 30 identified controlled trials met the selection criteria. Concealment of allocation was unclear in all included trials; 2 studies had a blinded assessor; 4 studies fulfilled >6 criteria. Due to heterogeneity in outcome measures data could not be pooled. Preliminary results indicate that short-term dynamic exercise therapy is effective in increasing aerobic capacity and muscle strength without detrimental effect on disease activity and pain.
Discussion: Outcome measures varied widely, but data suggest a positive effect of dynamic exercise therapy. Future research designs of exercise therapy trials should include adequate allocation concealment, blinding of assessors and standardization of outcome measures.