Background Physical activity (PA) is a major public health issue in the developed world and people who have rheumatoid arthritis (RA) are no exception. It has been found that the total amount of time spent on PA is lower in people who have RA. Health care practitioners are encouraged to promote PA in people who have RA however, little is known with regards to the effectiveness of these efforts. It is important therefore to see what the effect PA interventions have on people who have RA using the International Classification of Functioning, Disability and Health outcome measures, as it also allows the impact of the environment on a person's functioning to be recorded
Objectives To systematically review the literature of the effects of PA interventions using the World Health Organisation's (WHO) International Classification of Functioning, Disability and Health (ICF): Study Outcome Measures, in people who have RA.
Methods The review comprised three phases (i) search of databases (Academic Search Complete, PUBMED, AMED, CINAHL, MEDLINE and SPORTDiscus) using combinations of key terms and phrases. Grey literature and the reference lists of the studies were also manually checked; (ii) potentially suitable papers were screened for eligibility and (iii) validity and internal reliability was assessed. Inclusion criteria specified that studies had to be quantitative in design and relevant ICF outcome measures were used. PEDro was used to appraise RCT's while the Newcastle-Ottawa Quality Assessment Scale was applied to non RCT's. The strength of the studies was assessed according to four criteria of systematic errors namely selection, detection, performance and attrition bias.
Results Six studies fulfilled the eligibility criteria: four RCT's; one quasi-experimental trial and one evaluation trial. A total of 1,208 arthritis subjects are included in this review. Only two of those studies had 100% RA subjects, while the other four had RA as a percentage of their overall type of arthritis, when describing their subject characteristics. Different PA outcome measures were used, both subjective and objective, meeting the Outcome measures in Rheumatology (OMERACT) criteria for validity, feasibility and discrimination of differences however, efforts to compare what is measured by each were hampered due to conversion issues. Five studies had a high risk of bias with one having a moderate risk. The review found positive results in PA behaviour, reduction in symptoms and improvement in function however, no evidence on outcomes to conclusively say that PA interventions are positive for people who have RA.
Conclusions Due to the small number of studies and a high risk of bias, this review did not find any consistent or conclusive evidence regarding the effectiveness of PA interventions on outcomes in people who have RA therefore, no firm conclusions can be made. However, they do show some positive results with regards to PA behaviour, reduction in symptoms and improvement in function. From this review the outcomes of PA interventions, specifically among people who have RA have only been studied in two RCTs. Neither of these RCT's included strength training, which is now part of the American College of Sports Medicine (ACSM) guidelines. There is a necessity for further research to look at the effects of interventions in improving PA for people who have RA.
Disclosure of Interest None declared