Abstract
BackgroundDepression is a major public health problem among adults with arthritis and other rheumatic disease. The purpose of this study was to conduct a systematic review of previous meta-analyses addressing the effects of exercise (aerobic, strength or both) on depressive symptoms in adults with osteoarthritis, rheumatoid arthritis, fibromyalgia and systemic lupus erythematous.MethodsPrevious meta-analyses of randomized controlled trials were included by searching nine electronic databases and cross-referencing. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) Instrument. Random-effects models that included the standardized mean difference (SMD) and 95% confidence intervals (CIs) were reported. The alpha value for statistical significance was set at p ≤ 0.05. The U3 index, number needed to treat (NNT) and number of US people who could benefit were also calculated.ResultsOf the 95 citations initially identified, two aggregate data meta-analyses representing 6 and 19 effect sizes in as many as 870 fibromyalgia participants were included. Methodological quality was 91% and 82%, respectively. Exercise minus control group reductions in depressive symptoms were found for both meta-analyses (SMD, -0.61, 95% CI, -0.99 to -0.23, p = 0.002; SMD, -0.32, 95% CI, -0.53 to -0.12, p = 0.002). Percentile improvements (U3) were equivalent to 22.9 and 12.6. The number needed to treat was 6 and 9 with an estimated 0.83 and 0.56 million US people with fibromyalgia potentially benefitting.ConclusionsExercise improves depressive symptoms in adults with fibromyalgia. However, a need exists for additional meta-analytic work on this topic.
Highlights
Depression is a major public health problem among adults with arthritis and other rheumatic disease
Given the proliferation of systematic reviews, with or without meta-analysis on the same topic, a need exists to systematically review these previous reviews in order to provide decision-makers and practitioners with the information they need to make evidence-based decisions regarding the efficacy and effectiveness of various interventions on selected outcomes as well as provide researchers with direction for future research [11]. Given the former, the purpose of the current study was to conduct a systematic review of previous meta-analyses addressing the effects of exercise on depressive symptoms in adults with osteoarthritis, rheumatoid arthritis, fibromyalgia or systemic lupus erythematous
For the two included meta-analyses [30,37], one included studies on aerobic or strength training exercise [30] while the second was limited to aerobic exercise studies and included studies in which participants performed strength training as long as the number of minutes of strength training did not exceed the number of minutes spent performing aerobic exercise [37]
Summary
Depression is a major public health problem among adults with arthritis and other rheumatic disease. The purpose of this study was to conduct a systematic review of previous meta-analyses addressing the effects of exercise (aerobic, strength or both) on depressive symptoms in adults with osteoarthritis, rheumatoid arthritis, fibromyalgia and systemic lupus erythematous. Arthritis is a broad term used to describe more than 100 rheumatic diseases and conditions that affect joints as well as the surrounding tissues around joints [1]. Four common types of arthritis and other rheumatic diseases are osteoarthritis, rheumatoid arthritis, fibro-. The prevalence of osteoarthritis, rheumatoid arthritis, fibromyalgia and systemic lupus erythematous have been estimated to be 27 million [4], 1.5 million [5], 5 million [4], and 161,000 [4], respectively. A common problem among adults with arthritis is depression. A recent study that included 1,793 US adults 45 years of age and older with arthritis found that 18% had depression while only slightly more than half (51.3%) sought help for their depression [6]
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