Background/Purpose: Previous randomized controlled trials have led to conflicting findings regarding the effects of exercise on anxiety in adults with arthritis and other rheumatic diseases (AORD). The purpose of this study was to use the meta-analytic approach to try and resolve these discrepancies.

Methods: The a priori inclusion criteria were: (1) randomized controlled trials, (2) exercise (aerobic, strength training, or both) >/= 4 weeks, (3) comparative control group, (4) adults >/= 18 years of age with osteoarthritis, rheumatoid arthritis or fibromyalgia, (5) published and unpublished studies in any language since January 1, 1981, (6) anxiety as an outcome assessed. Studies were located by searching 8 electronic databases, cross-referencing and expert review. Dual selection of studies and data abstraction were performed. Hedge’s standardized effect size (g) was calculated for each result and pooled using the recently developed inverse-heterogeneity (IVhet) model. Non-overlapping 95% confidence intervals were considered statistically significant. Heterogeneity was estimated using Q and I² with alpha values < 0.10 for Q considered statistically significant. Small-study effects were examined using funnel plots and Egger’s regression test. In addition, the number-needed-to-treat (NNT), percentile improvement, and subgroup analyses were conducted. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Training program characteristics were reported as mean +/- standard deviation.

Results: Of the 639 citations screened, 14 studies representing 926 initially enrolled participants (539 exercise, 387 control) met the criteria for inclusion. Length of training averaged 15.8 +/- 6.7 weeks, frequency 3.3 +/- 1.3 times per week and duration 28.8 +/- 14.3 minutes per session. Overall, statistically significant exercise minus control reductions in anxiety were found (g = -0.40, 95% CI, -0.65, -0.15, tau² = 0.14; Q = 40.3, p = 0.0004; I² = 62.8%). The NNT was 6 with a percentile improvement of 15.5% and an estimated 5.3 million inactive US adults with AORD improving their anxiety if they started exercising regularly. Statistically significant small-study effects were observed (p < 0.0001). No between-group differences in anxiety were observed between type of arthritis and type of exercise. All studies were considered to be at high risk of bias with respect to blinding of participants to group assignment. Given the lack of information provided, greater than 50% of studies were at an unclear or high risk of bias with respect to (1) incomplete outcome reporting (78.6%), (2) allocation concealment (78.6%), and (3) blinding of outcome assessors (57.1%).

Conclusion: Exercise is associated with reductions in anxiety among adults with AORD. However, a need exists for additional, well-designed, randomized controlled trials on this topic.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-exercise-on-anxiety-in-adults-with-arthritis-a-systematic-review-with-meta-analysis/