Effects of Exercise on Anxiety in Adults with Arthritis and Other Rheumatic Disease: A Systematic Review of Meta-analyses

Abstract

Background: Anxiety is a major public health problem among adults with arthritis and other rheumatic disease (AORD). The purpose of this study was to conduct a systematic review of previous meta-analyses addressing the effects of exercise on anxiety in adults with osteoarthritis, rheumatoid arthritis, fibromyalgia or systemic lupus erythematous. Methods: The a priori inclusion criteria for this study were as follows: (1) previous systematic reviews that included a meta-analysis of randomized controlled trials or data reported separately for randomized controlled trials if the meta-analysis included other study designs, (2) adults 18 years of age and older with osteoarthritis, rheumatoid arthritis, fibromyalgia or systemic lupus erythematous, as defined by the inclusion criteria of the authors of the original meta-analyses (3) aerobic and/or strength training intervention(s) lasting an average of at least 4 weeks, (4) studies published in any language and from any source, (5) anxiety as a primary outcome in the original metaanalysis. Potential studies to be included were identified by searching nine electronic databases and crossreferencing. Methodological quality was to be assessed using the AMSTAR Instrument. Random-effects models that included the standardized mean difference and 95% confidence intervals were planned, with non-overlapping 95% confidence intervals considered statistically significant. In addition, 95% prediction intervals, U3 index, number needed to treat and number of US people who could benefit were also planned. Results: Of the 46 articles identified, none met the criteria for inclusion. Major reasons for exclusion included (1) inappropriate study design (32.9%), (2) inappropriate intervention (30.4%), (3) inappropriate population (25.3%), (4) inappropriate outcome (8.9%) and (5) inappropriate comparison (2.5%). Conclusions: Given the prevalence of anxiety in adults with AORD and apparent plethora of randomized controlled trials on this topic, a need exists for a meta-analysis addressing the effects of exercise on anxiety in adults with AORD.