Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Feb 17;8(2):e019138.
doi: 10.1136/bmjopen-2017-019138.

Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: a systematic review with meta-analysis of randomised controlled trials

George A Kelley  1 , Kristi S Kelley  2 , Leigh F Callahan  3
Affiliations
Review

Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: a systematic review with meta-analysis of randomised controlled trials

George A Kelley et al. BMJ Open. .

Erratum in

Abstract

Background/purpose: Given conflicting findings, the purpose of this study was to use the meta-analytic approach to examine the effects of exercise (aerobic, strength training or both) on anxiety in adults with arthritis and other rheumatic diseases (AORD).

Methods: Randomised controlled exercise intervention trials ≥4weeks in adults ≥18 years of age with osteoarthritis, rheumatoid arthritis or fibromyalgia were included. Studies were located by searching eight electronic databases, cross-referencing and expert review. Dual selection and data abstraction of studies were performed. Hedge's standardised effect size (ES) was calculated for each result and pooled using the recently developed inverse heterogeneity model. Two-tailed z-alpha values ≤0.05 and non-overlapping 95% CI were considered statistically significant. Heterogeneity 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. In addition, the number needed to treat (NNT), percentile improvement and meta-regression were conducted.

Results: Of the 639 citations screened, 14 studies representing 926 initially enrolled participants (539 exercise, 387 control) met the criteria for inclusion. Length of training (mean±SD) averaged 15.8±6.7 weeks, frequency 3.3±1.3 times per week and duration 28.8±14.3 min per session. Overall, statistically significant reductions in anxiety were found (exercise minus control changes ES=-0.40, 95% CI -0.65 to -0.15, tau2=0.14; Q=40.3, P=0.0004; I2 =62.8%). The NNT was 6 with a percentile improvement of 15.5% and an estimated 5.3 million inactive US adults with AORD improving their anxiety if they started exercising regularly. Statistically significant small-study effects were observed (P<0.0001).

Conclusions: Exercise is associated with reductions in anxiety among adults with selected types of AORD. However, a need exists for additional, well-designed, randomised controlled trials on this topic.

Prospero registration number: CRD42016048728.

Keywords: anxiety; arthritis; exercise; meta-analysis; systematic review.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram depicting the search process.
Figure 2
Figure 2
Risk of bias results using the Cochrane Risk of Bias Assessment Instrument.
Figure 3
Figure 3
Forest plot for changes in anxiety. ES, effect size.
Figure 4
Figure 4
Funnel plot for changes in anxiety. ES, effect size.
Figure 5
Figure 5
Cumulative meta-analysis for changes in anxiety. ES, effect size.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Barbour KE, Helmick CG, Boring M, et al. . Vital signs: prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation - United States, 2013-2015. MMWR Morb Mortal Wkly Rep 2017;66:246–53. 10.15585/mmwr.mm6609e1 - DOI - PMC - PubMed
    1. Hootman JM, Helmick CG, Barbour KE, et al. . Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis Rheumatol 2016;68:1582–7. 10.1002/art.39692 - DOI - PMC - PubMed
    1. Yelin E, Murphy L, Cisternas MG, et al. . Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997. Arthritis Rheum 2007;56:1397–407. 10.1002/art.22565 - DOI - PMC - PubMed
    1. Player MS, Peterson LE. Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med 2011;41:365–77. 10.2190/PM.41.4.f - DOI - PubMed
    1. Roest AM, Martens EJ, de Jonge P, et al. . Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol 2010;56:38–46. 10.1016/j.jacc.2010.03.034 - DOI - PubMed

MeSH terms