Effects of exercise on depression in adults with arthritis: a systematic review with meta-analysis of randomized controlled trials
Research article
1 Department of Biostatistics, Robert C. Byrd Health Sciences Center, School of Public Health, West Virginia University, Morgantown 26506-9190, WV, USA
2 Division of Population Health MS F-78, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, Atlanta 30341, GA, USA
Arthritis Research Therapy 2015, 17:21Â
doi:10.1186/s13075-015-0533-5
Published: 3 February 2015
Abstract (provisional)
IntroductionPrevious randomized controlled trials have led to conflicting findings
regarding the effects of exercise on depressive symptoms in adults with arthritis
and other rheumatic conditions (AORC). The purpose of this study was to use the meta-analytic
approach to resolve these discrepancies.MethodsThe inclusion criteria were: (1) randomized
controlled trials, (2) exercise (aerobic, strength training, or both) ?4?weeks, (3)
comparative control group, (4) adults with osteoarthritis, rheumatoid arthritis, fibromyalgia
or systemic lupus erythematosus, (5) published and unpublished studies in any language
since January 1, 1981 and (6) depressive symptoms assessed. Studies were located by
searching 10 electronic databases, cross-referencing, hand searching and expert review.
Dual-selection of studies and data abstraction was performed. Hedge?s standardized
mean difference effect size (g) was calculated for each result and pooled using random-effects
models, an approach that accounts for heterogeneity. Non-overlapping 95% confidence
intervals (CI) were considered statistically significant. Heterogeneity based on fixed-effect
models was estimated using Q and I 2 with alpha values ?0.10 for Q considered statistically
significant.ResultsOf the 500 citations reviewed, 2,449 participants (1,470 exercise,
979 control) nested within 29 studies were included. Length of training, reported
as mean???standard deviation (?SD) was 19???16?weeks, frequency 4???2 times per week
and duration 34???17?minutes per session. Overall, statistically significant exercise
minus control group reductions were found for depressive symptoms (g?=??0.42, 95%
CI, ?0.58, ?0.26, Q?=?126.9, P 0.0001, I 2 ?=?73.2%). The number needed-to-treat
was 7 (95% CI, 6 to 11) with an estimated 3.1 million (95% CI, 2.0 to 3.7) United
States adults not currently meeting physical activity guidelines improving their depressive
symptoms if they began and maintained a regular exercise program. Using Cohen?s U3
Index, the percentile reduction was 16.4% (95% CI, 10.4% to 21.9%). All studies were
considered to be at high risk of bias with respect to blinding of participants and
personnel to group assignment.ConclusionsExercise is associated with reductions in
depressive symptoms among selected adults with AORC. A need exists for additional,
well-designed and reported studies on this topic.