The Effects of Exercise and Physical Activity in Inflammatory Rheumatic Diseases - a Narrative Review

Purpose The 2018 European Alliance of Associations for Rheumatology provided recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. It confirmed its safety and feasibility in this patient population, alongside describing possible health benefits. The aim of this narrative review is to synthesise the literature investigating the effects of physical activity and exercise interventions on patient-centred outcomes in a range of inflammatory rheumatic diseases since 2018 to help guide clinical practice. Methods Databases (Cochrane Database of Systematic Reviews, Cochrane central register of controlled trials database, MEDLINE via Pubmed, Embase and CINAHL) were searched for studies from 01/01/2018 to 31/08/2021 for systematic reviews, meta-analyses and randomised controlled trials exploring physical activity interventions in a population of adults with rheumatological diseases. Data on study population, interventions, outcomes and quality was collected before synthesis of the findings and categorisation into three disease groups: rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA), and connective tissue disease (CTD). Results Eighty-six reports were included. Interventions included swimming, aquatic exercises, global posture retraining and land based aerobic exercises with significant heterogeneity also seen in dosing and frequency. Improved quality of life, cardiovascular fitness and physical function, alongside reductions in disease activity and fatigue, were reported as having either a positive or possible positive effect in all disease groups. Outcomes such as pain and mood-related outcomes (such as anxiety and depression) showed the most variation across the disease groups. Conclusion Physical activity interventions have numerous benefits on patient reported outcomes in patients with rheumatological disease from positive impacts on disease activity, physical function and cardiovascular fitness to improvements in multifactorial outcomes like fatigue and quality of life. It should be an integral part of a holistic management approach.