Session Type: Abstract Submissions (ACR)
Background/Purpose: Previous randomized controlled trials have led to conflicting findings regarding the effects of exercise on depressive symptoms in adults with arthritis and other rheumatic diseases (AORD). The purpose of this study was to use the meta-analytic approach to try and reach some general conclusions regarding 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(4) adults with osteoarthritis, rheumatoid arthritis, fibromyalgia or systemic lupus erythematosus, (5) published and unpublished studies in any language since January 1, 1981, (6) depressive symptoms assessed. Studies were located by searching 10 electronic databases, cross-referencing, hand searching 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 random-effects models, an approach that accounts for heterogeneity. Non-overlapping 95% confidence intervals (CI) were considered statistically significant. Heterogeneity based on fixed-effect models 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, with adjustment for statistically significant results (non-overlapping one-tailed 95% confidence intervals). In addition, the number-needed-to-treat (NNT), percentile improvement, and 95% prediction intervals (PI) were calculated. 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 500 studies screened, 2,449 participants (1,470 exercise, 979 control) from 29 studies met the criteria for inclusion. Length of training averaged 19.1 +/- 16.0 weeks, frequency 3.6 +/- 2.0 times per week and duration 33.6 +/- 16.9 minutes per session. Overall, statistically significant exercise minus control group improvements were found for depressive symptoms (g = -0.41, 95% CI, -0.58, -0.24, Q = 196.2, p<0.0001, I2 = 82.7%). The NNT was 8 with percentile improvements of 16.0%. Overlapping 95% PI (-1.33, 0.50) were observed. When adjusted for statistically significant small-study effects, improvements were reduced by 54.7% but remained statistically significant (g= -0.19, 95% CI, -0.37, -0.003). The NNT increased to 15 while percentile improvements were reduced to 7.4%. All studies were considered to be at high risk of bias with respect to blinding of participants and personnel to group assignment. Given the lack of information provided, greater than 50% of the studies were at an unclear risk of bias with respect to (1) incomplete outcome reporting (86%), (2) allocation concealment (72%), (3) blinding of outcome assessors (62%) and (4) subjects not exercising regularly prior to enrollment (52%).
Conclusion: Exercise may improve depressive symptoms in selected adults with AORD. However, a need exists for additional, well-designed, randomized controlled trials on this topic.
G. A. Kelley,
K. S. Kelley,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-exercise-on-depressive-symptoms-in-adults-with-arthritis-a-systematic-review-with-meta-analysis/