The evidence suggests that exercise does not increase quality of life (g = 0.26; IC95%, 0.57 to 0.05). Controlled home-based exercise may be as beneficial as center-based exercise for all outcomes.
There are no major adverse effects reported during exercise interventions.
The quality of evidence is downgraded by two levels due to risk of bias of included studies (indirectness, imprecision and inconsistency).
| Reference | Study type | Population n Country |
Intervention (I) and comparison (C) | Outcomes | Risk of bias «Additional comments for included studies...»2 |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis; PSQI = Pittsburgh Sleep Quality Index; RA = rheumatoid arthritis; HAQ = Health Assessment Questionnaire; HAQ DI = Health Assessment Questionnaire disability index; DAS28 = Disease Activity Score in 28 joints; VAS = visual analogue scale; SF-36 = Short-Form Health Survey 36; RAQoL = Rheumatoid Arthritis Quality of Life Questionnaire; AIMS2 = Arthritis Impact Measurement Scales 2; TJS = Tender joint count; SES = Stanford Arthritis Self-Efficacy Scale; ESR = erythrocyte sedimentation rate; DAS28-CRP = Disease Activity Score in 28 joints calculated with C-reactive protein | |||||
| Sieczkowska et al. 2021 «Sieczkowska SM, Smaira FI, Mazzolani BC, et al. Ef...»1 |
SR+MA | Autoimmune rheumatic diseases (rheumatoid arthritis, spondylo-arthritis, Sjögren's
syndrome etc.) 15 RCT studies (5 with RA) Countries not reported |
I: Home-based exercise C: Center-based exercise or non-active control group |
Function (HAQ) Quality of life (RAQol) Disease activity (DAS28) Pain (VAS) Adherence |
High |
| Lange et al. 2019 «Lange E, Kucharski D, Svedlund S, et al. Effects o...»2 | RCT |
Older adults with rheumatoid arthritis, 74 participants Sweden |
I: Supervised gym exercise (high intensity aerobic + strength) C: Home-based exercise (no gym, same protocol) |
Function (HAQ DI) |
Moderate |
| Häkkinen et al. 2004 «Häkkinen A, Sokka T, Kautiainen H, et al. Sustaine...»3 | RCT | Recent onset rheumatoid arthritis 70 participants Finland |
I: Strength exercise C: Mobility exercise |
Function (HAQ) Disease activity (ESR, DAS28) Adherence |
Moderate |
| Durcan et al. 2014 «Durcan L, Wilson F, Cunnane G. The effect of exerc...»4 | RCT | Rheumatoid arthritis 40 participants Ireland |
I: Combination exercise (strength, aerobic & mobility) C: Advice on exercise benefits |
Function (HAQ) Pain (VAS) |
Low |
| Seneca et al. 2015 «Lineker SC, Bell MJ, Wilkins AL, et al. Improvemen...»5 |
RCT | Recent onset rheumatoid arthritis 51 participants Denmark |
I: Partly supervised combination exercise (aerobic + strength) C: Self-administered exercise, same dose as intervention group |
Function (HAQ-DI) Disease activity (DAS28-CRP) Pain (NRS) Quality of life (SF-36) |
High |
| Reference | Comments |
|---|---|
| Sieczkowska et al. 2021 «Sieczkowska SM, Smaira FI, Mazzolani BC, et al. Ef...»1 |
Inclusion criteria: adults (≥ 18 years) with a clinical diagnosis of one of the following
conditions: SLE, RA, spondyloarthritis (SpA), Sjögren's syndrome, SSc, AS, IIM or
systemic vasculitis. Intervention: a home based PA intervention, which was considered any PA intervention occurring predominantly at home (i.e., > 90% of the sessions being undertaken at home); Interventions included mainly strength and flexibility exercises ≥3/week, 10-60 minutes/session, non-supervised or partially supervised. One to three face-to-face sessions with a physiotherapist to receive exercise instructions were conducted before home-based practice. Comparison group included both non-PA interventions and centre-based exercise. Five of 15 studies on rheumatoid arthritis (two RCTs). Evidence downgraded due to indirectness. |
| Lange et al. 2019 «Lange E, Kucharski D, Svedlund S, et al. Effects o...»2 | Inclusion criteria: ages ≥65 years, disease duration >2 years, and low-to-Moderate
Disease Activity Score in 28 joints (DAS28 <5.1). The exclusion criteria were comorbidities
such as unstable ischemic heart disease or arrhythmia that might preclude moderate
intensity exercise, joint surgery within 6 months prior to inclusion, ongoing exercise
of moderate-to- high intensity ≥2 times/week, inability to understand or speak Swedish,
and inability to participate in physical testing that involved walking or bicycling. Intervention group received individually tailored gym-exercise program accompanied by home exercises. The intervention was delivered by a person-centered approach. Physiotherapists supervised 2-3 of the gym session. The control group received one individual meeting after they performed the home-exercises, but no gym training. Risk of bias due to lack of blinding and use of patient-reported outcome measures, all of which are inevitable in exercise studies. Evidence downgraded due to unclear allocation concealment and small sample size (n=74). |
| Häkkinen et al. 2004 «Häkkinen A, Sokka T, Kautiainen H, et al. Sustaine...»3 | Interventions: strength-training included personal instructions to perform a homebased
strength training for 24 months. The training program included exercises for all muscle
groups of the arms, legs, and trunk using. Subjects were instructed to exercise twice
a week with moderate loads. The intensity and technique of exercises were checked
at 6-, 12-, 18-, and 24-month follow-up visits. Control group were instructed to perform
range-of-motion and stretching exercises twice a week. In addition, all patients were
encouraged to perform recreational physical activities 2–3 times per week. Risk of bias due to lack of blinding and use of patient-reported outcome measures, all of which are inevitable in exercise studies. Evidence downgraded due to unclear allocation concealment and small sample size (n=62). |
| Durcan et al. 2014 «Durcan L, Wilson F, Cunnane G. The effect of exerc...»4 | The exercise program consisted of a 12-week home exercise program including specific
exercises to target individual deficiencies identified using the Health Assessment
Questionnaire (HAQ) including cardiovascular exercise, resistance training and flexibility
and neuromotor conditioning. The control group received advice only on the benefits
of exercise in RA. Risk of bias due to lack of blinding and use of patient-reported outcome measures, all of which are inevitable in exercise studies. Evidence downgraded due to unclear allocation concealment and small sample size (n=80). |
| Seneca et al. 2015 «Lineker SC, Bell MJ, Wilkins AL, et al. Improvemen...»5 |
Eligible patients met the criteria for RA according to the American College of Rheumatology
(ACR) criteria or the ACR/The European League Against Rheumatism (EULAR) criteria,
were diagnosed between 2008 and 2012, ≥ 18 years, were able to participate in sessions
twice a week during a six-week period, were able to use a bicycle, resided within
a 20 km radius from the hospital and were able to understand and read Danish. The
exclusion criteria were a high disease activity according to the Disease Activity
Score in 28 joints Calculated with C-reactive protein (DAS28-CRP): > 5.1, myocardial
infarction within the past six months, angina pectoris, hypertension at ≥ 180/≥ 110
mmHg or treated hypertension at 160-179/100-109 mmHg, treatment with beta-blockers
or presence of symptoms of severe or very severe chronic obstructive pulmonary disease.
Interventions: partly supervised exercises included 12 weeks of supervised training of physical fitness on an exercise bike and strength training, twice a week in groups of 2-4 patients. Self-administered exercises included 12 week of self-administered exercises in their local community. The dropout was 40% in the supervised group versus 20% in the self-administered group. Risk of bias due to lack of participant blinding and use of patient-reported outcome measures, all of which are inevitable in exercise studies. Evidence downgraded due to baseline difference in disease activity, missing data and small sample size (n=51). |
| Clinically meaningful means HAQ DI change >0.22, which is the frequently used Minimal
clinically important differences (MCID) for HAQ-DI in people with rheumatoid arthritis
(Behrens et al. 2019). However, MCID may be as low as 0.07 in people with arthralgia
(Claasen et al. 2025), whereas discrimination from random long-term variations in
patients on stable therapy may require a MCID as high as 0.68 (Claasen et al. 2025). The Minimal Important Difference for the PSC1 NRS (on a scale from 0 to 10) ranged from 1.3 (small change) to 2.3 (medium change) to 2.7 (large change) in people with musculoskeletal disorders (Abbott 2014). |
Results
| Reference | Number of studies and number of participants (intervention / control) | Follow-up time | Results after intervention (95% CI) | Results after follow-up (95% CI) | ||
|---|---|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to (study limitations, inconsistency, indirectness, imprecision). I= intervention; C=comparison; CI=confidence interval; HAQ DI=Health Assessment Questionnaire disability index; SES = Stanford Arthritis Self-Efficacy Scale; MD = Mean Difference; SMD = Standardized Mean Difference; RA = Rheumatoid arthritis |
||||||
| Sieczkowska et al. 2021 «Sieczkowska SM, Smaira FI, Mazzolani BC, et al. Ef...»1 |
5 RCT with RA 345 participants with RA |
n/a | Exercise had a medium effect on function: SMD - 0.51 95% CI [-0.86; -0.16]. No differences in functional capacity between home- and centre-based physical activity: SMD 0.12 95% CI [-0.15, 0.40] |
n/a | ||
| Lange et al. 2019 «Lange E, Kucharski D, Svedlund S, et al. Effects o...»2 | 1 study (RCT) n=74 Intervention (gym + home exercise) 36 participants Control group (home exercise) 38 participants |
20 weeks | No significant difference in HAQ DI between groups. Significant 12 % increase in HAQ
DI score within the intervention group but not within the control group. Evidence
of HAQ floor effect. |
No significant between-or within-group differences of change compared to baseline on HAQ DI score. Evidence of HAQ floor effect. |
||
| Häkkinen et al. 2004 «Häkkinen A, Sokka T, Kautiainen H, et al. Sustaine...»3 | 1 study (RCT) n=70 Intervention (strength training) 35 participants Control group (mobility training) 35 participants |
2 and 5 years | Exercise had a clinically meaningful effect on function: HAQ MD -0.22 95% CI [-0.4, -0.004] |
At the 5 year check up visit the significance between the groups had disappeared: HAQ MD -0.1 95% CI [-0.33, 0.1] |
||
| Durcan et al. 2014 «Durcan L, Wilson F, Cunnane G. The effect of exerc...»4 | 1 study (RCT) n= 78 Intervention (combination training) 42 participants Control group (exercise advice) 38 participants |
n/a | Exercise had a clinically meaningful effect on function: HAQ MD 0.3 95% CI [0.2, 0.3] |
n/a | ||
| Seneca et al. 2015 «Lineker SC, Bell MJ, Wilkins AL, et al. Improvemen...»5 |
1 study (RCT) n=51 Intervention (partly supervised combination exercise) 25 participants Control group (self-administered exercise) 26 participants |
n/a | Exercise had no effect on function HAQ-DI, 0-3 (between group difference 0.0 (–0.63-0.5). (There might be an error in the results) | n/a | ||
| Reference | Number of studies and number of participants (intervention / control) | Follow-up time | Results after intervention | Results after follow-up |
|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to (study limitations, inconsistency, indirectness, imprecision). I= intervention; C=comparison; CI=confidence interval; HAQ DI=Health Assessment Questionnaire disability index; SES = Stanford Arthritis Self-Efficacy Scale; MD = Mean Difference; SMD = Standardized Mean Difference; RA = Rheumatoid arthritis; TJC = Tender joint count; AS - ankylosing spondylitis; DAS28-CRP = Disease Activity Score in 28 joints calculated with C-reactive protein |
||||
| Sieczkowska et al. 2021 «Sieczkowska SM, Smaira FI, Mazzolani BC, et al. Ef...»1 |
1 RCT with RA 8 RCT with AS 150 participants with RA 1 145 participants with AS |
n/a | Exercise decreased disease activity compared to control group: SMD -0.60 95 % CI [-1.16, -0.04] (RCT with RA had a non-significant difference between groups) |
n/a |
| Häkkinen et al. 2004 «Häkkinen A, Sokka T, Kautiainen H, et al. Sustaine...»3 | 1 study (RCT) n=70 Intervention (strength training) 35 participants Control group (mobility training) 35 participants |
2 and 5 years | Exercise did not increase the disease activity based on ESR (-4.5 (-10.0, 0.9) & DAS28 (-0.5 (-1.2, 0.04). | Exercise did not increase the disease activity based on ESR (-3.9 (-10.2, 2.4) & DAS28 -0.6 (-1.3, -0.2). |
| Seneca et al. 2015 «Lineker SC, Bell MJ, Wilkins AL, et al. Improvemen...»5 |
1 study (RCT) n=51 Intervention (partly supervised combination exercise) 25 participants Control group (self-administered exercise) 26 participants |
n/a | Exercise did not increase the disease activity based on DAS28-CRP. (Significant baseline difference, between-group difference not relevant) | n/a |
| Reference | Number of studies and number of participants (intervention / control) | Follow-up time | Results after intervention | Results after follow-up |
|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to (study limitations, inconsistency, indirectness, imprecision). I= intervention; C=comparison; CI=confidence interval; HAQ DI=Health Assessment Questionnaire disability index; SES = Stanford Arthritis Self-Efficacy Scale; MD = Mean Difference; SMD = Standardized Mean Difference; RA = Rheumatoid arthritis; AS - ankylosing spondylitis; VAS = Visual Analogue Scale 0-100 |
||||
| Sieczkowska et al. 2021 «Sieczkowska SM, Smaira FI, Mazzolani BC, et al. Ef...»1 |
2 RCT with RA 7 RCT with SA 92 participants with RA 1 142 participants with SA |
n/a | Exercise had a large beneficial effect on pain (pain decreased): SMD -1.62 95 % CI [-2.94, -0.31] in the two RCT's with RA there were clinically meaningless decrease in pain (Häkkinen et al.) or no effect (Hsieh et al.) |
n/a |
| Häkkinen et al. 2004 «Häkkinen A, Sokka T, Kautiainen H, et al. Sustaine...»3 | 1 study (RCT) n=70 Intervention (strength training) 35 participants Control group (mobility training) 35 participants |
2 and 5 years | Exercise did not increase pain. Clinically meaningless decrease in pain in the exercise
group compared to control group in the two-year follow-up: MD (VAS) -11.2 95 % CI [-21.4; -0.96] |
Exercise did not increase pain. No difference between groups in the five-year follow-up:
MD (VAS) -3.9 95 % CI [-15.5; 2.2] |
| Durcan et al. 2014 «Durcan L, Wilson F, Cunnane G. The effect of exerc...»4 | 1 study (RCT) n= 78 Intervention (combination training) 42 participants Control group (exercise advice) 38 participants |
n/a | Exercise did not increase pain. Clinically meaningless decrease in pain in the exercise group compared to control group. | n/a |
| Seneca et al. 2015 «Lineker SC, Bell MJ, Wilkins AL, et al. Improvemen...»5 |
1 study (RCT) n=51 Intervention (partly supervised combination exercise) 25 participants Control group (self-administered exercise) 26 participants |
n/a | Exercise did not increase pain. | n/a |
| Reference | Number of studies and number of participants (intervention / control) | Follow-up time | Results after intervention | Results after follow-up |
|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to (study limitations, inconsistency, indirectness, imprecision). I= intervention; C=comparison; CI=confidence interval; HAQ DI=Health Assessment Questionnaire disability index; SES = Stanford Arthritis Self-Efficacy Scale; MD = Mean Difference; SMD = Standardized Mean Difference; RA = Rheumatoid arthritis |
||||
| Sieczkowska et al. 2021 «Sieczkowska SM, Smaira FI, Mazzolani BC, et al. Ef...»1 |
1 RCT with RA 3 RCT with SA 152 participants with RA 977 participants with SA |
n/a | Exercise had no effect on quality of life: SMD -0.26 95% CI [-0.57, 0.05] |
n/a |
| Seneca et al. 2015 «Lineker SC, Bell MJ, Wilkins AL, et al. Improvemen...»5 |
1 study (RCT) n=51 Intervention (partly supervised combination exercise) 25 participants Control group (self-administered exercise) 26 participants |
n/a | Exercise had no effect on quality of life. There were no differences between groups. | n/a |
| Reference | Number of studies and number of participants (intervention / control) | Follow-up time | Results after intervention | Results after follow-up |
|---|---|---|---|---|
| Level of evidence: very low The quality of evidence is downgraded due to study limitations, inconsistency, indirectness, imprecision, publication bias. I= intervention; C=comparison; CI=confidence interval; HAQ DI=Health Assessment Questionnaire disability index |
||||
| Lange et al. 2019 «Lange E, Kucharski D, Svedlund S, et al. Effects o...»2 | 1 study (RCT) Intervention (gym + home exercise) 36 participants Control group (home exercise) 38 participants |
20 weeks | Adherence to exercise was 78 % in the intervention group, no difference between groups
in home-exercise frequency. The self-reported hours of moderate-to-vigorous physical activity were increased significantly in the intervention group (2.4-hour increase) when the change was compared to that of the control group (0.3-hour increase) |
Moderate-to- high– intensity activity was increased compared to baseline with 2.2 hours in the intervention group and 0.03 hours in the control group (p=0.005) Group frequence in home-exercise was similar (2 t/w) |
| Häkkinen et al. 2004 «Häkkinen A, Sokka T, Kautiainen H, et al. Sustaine...»3 | 1 study (RCT) Intervention (strength training) 35 participants Control group (mobility training) 35 participants |
2 and 5 years | The strength training compliance averaged 1.4–1.5 times a week in the EG during the 2-year training period. According to the training diaries the mean (SD) times used for various types of physical exercises (including strength training in the EG) throughout the first 2 years for the EG and CG were 245 (115) and 195 (104) minutes a week, respectively. |
During the 5th year the corresponding times were 237 (147) and 223 (131) minutes. Reportedly 20 EG and 12 CG patients at least occasionally practised also intensive aerobic exercises (leading to sweat and getting out of breath). Further, 10 EG but no CG cases continued with their strength training during the 5th follow up year. |
| Seneca et al. 2015 «Lineker SC, Bell MJ, Wilkins AL, et al. Improvemen...»5 |
1 study (RCT) n=51 Intervention (partly supervised combination exercise) 25 participants Control group (self-administered exercise) 26 participants |
n/a | Patients completed an average of 92.2% of the training sessions. | n/a |