Background/Purpose: Chronic peripheral joint pain is extremely prevalent and a major cause of physical and psychosocial problems. Exercise improves pain and physical function, but the effect of exercise on psychosocial function (health beliefs, depression, anxiety and quality of life) is unknown. To improve our understanding of the inter-relationship between pain, physical and psychosocial function and exercise we conducted a Cochrane Review with meta-analysis of clinical trials that reported the effect of exercise interventions on psychosocial variables.

Methods: Twenty three clinical, public health, psychology, social care databases and 25 other relevant resources were searched. References of included studies were checked for relevant studies. Key experts were asked about unpublished studies. Quantitative synthesis of randomised controlled clinical trials of exercise-based rehabilitation programmes for chronic peripheral joint pain was conducted. Four of the authors independently assessed studies against inclusion/exclusion criteria and methodological quality, and entered extracted data into a database.

Results: Twenty four trials (with 2640 participants) met criteria for inclusion in the quantitative synthesis. There were large variations in the exercise programme’s content, mode of delivery, frequency and duration, participant’s symptoms, duration of symptoms, outcomes measured, methodological quality and reporting. Design and reporting of the trials was moderate/good, though some were ambiguous, complex and difficult to understand. Many of the trials small (less than 50 participants per group) with low power to detect medium effect size. Outcome measures were heterogeneous, often self-reported, subject to recall and socially desirable biases. Most of the trials reported changes immediately after completing an exercise programme, or had short (less than 6 months) follow-up.

Exercise reduced pain (SMD, 95% CI: -0.22, -0.36 to -0.08), improved physical function (-0.20, -0.31 to -0.09), self-efficacy (0.41, 0.24 to 0.57) and depression (-0.16, -0.28 to -0.03) but not anxiety (-0.38, -1.13 to 0.36). The effect of exercise on health-related quality of life measured in few studies using the SF-36 with significant benefit on social function (6.58, 2.78 to 10.38), borderline significance in mental health (2.90, 0.15 to 5.65), non-significant effect on role emotional (1.20, -4.12 to 6.53) and vitality (3.90, 0.55 to 7.25).

Conclusion: Exercise not only improves pain and physical function, but also has moderate benefits on psychosocial functioning and quality of life. Heterogeneity in the programmes and lack of well-designed trials with psychosocial variables as the primary outcome impedes our understanding. In addition, whether and how to enhance moderate treatment effects, and sustain improvements needs to be determined.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-physical-and-psychosocial-effects-of-exercise-on-chronic-hip-and-knee-pain-a-cochrane-review-with-meta-analysis/