Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis

Emalie Hurkmans; Florus J van der Giesen; Thea PM Vliet Vlieland; Jan Schoones; Els CHM Van den Ende

doi:10.1002/14651858.CD006853.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Podcasts
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Analysis 1.1

Comparison 1 Short‐term land‐based aerobic capacity training, Outcome 1 Functional ability.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Short‐term land‐based aerobic capacity training, Outcome 2 Aerobic capacity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Short‐term land‐based aerobic capacity training, Outcome 3 Muscle strength.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Short‐term land‐based aerobic capacity training, Outcome 4 Self‐reported pain.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 Short‐term land‐based aerobic capacity and muscle strength training, Outcome 1 Functional ability.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 Short‐term land‐based aerobic capacity and muscle strength training, Outcome 2 Muscle strength.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 Short‐term land‐based aerobic capacity and muscle strength training, Outcome 3 Self‐reported pain.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 Short‐term water‐based aerobic capacity training, Outcome 1 Aerobic capacity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 Short‐term water‐based aerobic capacity training, Outcome 2 Muscle strenght.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3 Short‐term water‐based aerobic capacity training, Outcome 3 Self‐reported pain.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4 Long‐term land‐based aerobic capacity and muscle strength training, Outcome 1 Aerobic capacity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

Comparison 4 Long‐term land‐based aerobic capacity and muscle strength training, Outcome 2 Muscle strength.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.3

Comparison 4 Long‐term land‐based aerobic capacity and muscle strength training, Outcome 3 Self‐reported pain.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.4

Comparison 4 Long‐term land‐based aerobic capacity and muscle strength training, Outcome 4 Disease activity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.5

Comparison 4 Long‐term land‐based aerobic capacity and muscle strength training, Outcome 5 Radiological damage.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. Short‐term land‐based aerobic capacity and muscle strength training for patients with Rheumatoid Arthritis

short‐term land‐based aerobic capacity and muscle strength training for patients with Rheumatoid Arthritis
Patient or population: patients with Rheumatoid Arthritis Settings: hospital, outpatient (rheumatology) clinics Intervention: short‐term land‐based aerobic capacity and muscle strength training
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	short‐term land‐based aerobic capacity and muscle strength training
Functional ability HAQ . Scale from: 0 to 3. Follow‐up: mean 12 weeks	The mean functional ability in the control groups was 0.16 points	The mean Functional ability in the intervention groups was 0.54 standard deviations lower (1.11 lower to 0.02 higher)		50 (1 study)	⊕⊕⊕⊝ moderate¹	Absolute % change: HAQ ‐6%, relative % change: HAQ ‐25%, NNT: n.a., SMD: ‐0.4 (‐0.86 to 0.06)
Muscle strength Isometric extension Follow‐up: mean 12 weeks	The mean muscle strength in the control groups was ‐2.7 Nm	The mean Muscle strength in the intervention groups was 0.47 standard deviations higher (0.01 to 0.93 higher)		74 (2 studies)	⊕⊕⊕⊝ moderate¹	Absolute % change: isometric extension 17%, relative % change: isometric extension 19%, NNT: 45, SMD: 0.47 (0.01 to 0.93)
Self‐reported pain VAS. Scale from: 0 to 10. Follow‐up: mean 12 weeks	The mean self‐reported pain in the control groups was 0.9 cm	The mean Self‐reported pain in the intervention groups was 0.53 standard deviations lower (1.09 lower to 0.04 higher)		50 (1 study)	⊕⊕⊕⊝ moderate¹	Absolute % change: VAS 6%, relative % change: VAS ‐21%, NNT: n.a., SMD: ‐0.53 (‐1.09 to 0.04)
Disease activity	See comment	See comment	Not estimable	74 (2 studies)	⊕⊕⊕⊝ moderate¹	Absolute % change:ESR ‐33%/swollen joints ‐33%, absolute % change:ESR ‐51%/swollen joints ‐36%,NNT:n.a., SMD:statistical heterogeneity,pooling data not possible
Radiological damage ‐ not measured	See comment	See comment	Not estimable	‐	See comment	Was not measured in included studies
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Small patient number

Summary of findings for the main comparison. Short‐term land‐based aerobic capacity and muscle strength training for patients with Rheumatoid Arthritis

Ir a la tabla de la revisión

Summary of findings 2. Short‐term land‐based aerobic capacity training for patients with Rheumatoid Arthritis

Short‐term land‐based aerobic capacity training for patients with Rheumatoid Arthritis
Patient or population: patients with Rheumatoid Arthritis Settings: hospital, outpatient (rheumatology) clinics Intervention: Short‐term land‐based aerobic capacity training
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Short‐term land‐based aerobic capacity training
Functional ability AIMS . Scale from: 0 to 10. Follow‐up: mean 12 weeks	The mean functional ability in the control groups was 0.9 points¹	The mean Functional ability in the intervention groups was 0.06 standard deviations lower (1.33 lower to 1.2 higher)		56 (1 study)	⊕⊕⊝⊝ low²	Absolute % change: AIMS ‐22%, relative % change: AIMS ‐43%, NNT: n.a., SMD: 0.03 (‐0.46 to 0.51)
Muscle strength Isometric extension Follow‐up: mean 12 weeks	The mean muscle strength in the control groups was 11 foot points	The mean Muscle strength in the intervention groups was 0.38 standard deviations lower (1.67 lower to 0.9 higher)		10 (1 study)	⊕⊕⊝⊝ low²	Absolute % change: isometric extension 22%, relative % change: isometric extension 18%, NNT: n.a., SMD: ‐0.38 (‐1.67 to 0.9)
Self‐reported pain AIMS. Scale from: 0 to 10. Follow‐up: mean 12 weeks	The mean self‐reported pain in the control groups was ‐0.7 points	The mean Self‐reported pain in the intervention groups was 0.27 standard deviations lower (0.79 lower to 0.26 higher)		56 (1 study)	⊕⊕⊕⊝ moderate²	Absolute % change: AIMS ‐23%, relative % change: AIMS ‐10%, NNT: n.a., SMD: ‐0.27 (‐0.79 to 0.26)
Disease activity	See comment	See comment	Not estimable	0 (3 studies)	⊕⊕⊝⊝ low²	Absolute % change: ERS 5%/tender joints ‐36%, relative % change:ESR 19%/tender joints ‐29%, NNT:n.a., SMD: statistical heterogeneity, pooling data not possible
Radiological damage ‐ not measured	See comment	See comment	Not estimable	‐	See comment	Was not assessed in included studies
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Mean change from baseline in control group ² Small patient numbers

Summary of findings 2. Short‐term land‐based aerobic capacity training for patients with Rheumatoid Arthritis

Ir a la tabla de la revisión

Summary of findings 3. Short‐term water‐based aerobic capacity training for patients with Rheumatoid Arthritis

Short‐term water‐based aerobic capacity training for patients with Rheumatoid Arthritis
Patient or population: patients with Rheumatoid Arthritis Settings: hospital, outpatient (rheumatology) clinics Intervention: Short‐term water‐based aerobic capacity training
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Short‐term water‐based aerobic capacity training
Functional ability outcome was measured on different scales in different studies Follow‐up: mean 11 days	See comment	See comment	Not estimable	88 (2 studies)	⊕⊕⊕⊝ moderate¹	Absolute % change: HAQ ‐12%/AIMS ‐24%, relative % change: HAQ 7%/AIMS ‐43%, NNT: n.a., SMD: statistical heterogeneity, pooling data not possible
Muscle strenght Grip strength Follow‐up: mean 11 weeks	The mean muscle strenght in the control groups was 11.3 Nm	The mean Muscle strenght in the intervention groups was 0.38 standard deviations lower (1.27 lower to 0.51 higher)		20 (1 study)	⊕⊕⊝⊝ low¹	Absolute % change: grip strength 15%, relative % change: grip strength ‐24%, NNT: n.a., SMD: ‐0.38 (‐1.27 to 0.51)
Self‐reported pain AIMS. Scale from: 0 to 10. Follow‐up: mean 12 weeks	The mean self‐reported pain in the control groups was ‐0.7 points	The mean Self‐reported pain in the intervention groups was 0.06 standard deviations higher (0.43 lower to 0.54 higher)		68 (1 study)	⊕⊕⊕⊝ moderate¹	Absolute % change: AIMS ‐12%, relative % change: AIMS 2%, NNT: n.a., SMD: 0.06 (‐0.43 to 0.54)
Disease activity Follow‐up: mean 11 weeks	See comment	See comment	Not estimable	88 (2 studies)	⊕⊕⊕⊝ moderate¹	Absolute % change: active joints ‐44%, relative % change: active joints ‐40%, NNT: n.a., SMD: statistical heterogeneity, pooling of data not possible
Radiological damage ‐ not measured	See comment	See comment	Not estimable	‐	See comment	Was not measured in included studies
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Small patient number

Summary of findings 3. Short‐term water‐based aerobic capacity training for patients with Rheumatoid Arthritis

Ir a la tabla de la revisión

Summary of findings 4. Long‐term land‐based aerobic capacity and muscle strength training for patients with Rheumatoid Arthritis

Long‐term land‐based aerobic capacity and muscle strength training for patients with Rheumatoid Arthritis
Patient or population: patients with patients with Rheumatoid Arthritis Settings: hospital, outpatient (rheumatology) clinics Intervention: Long‐term land‐based aerobic capacity and muscle strength training
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Long‐term land‐based aerobic capacity and muscle strength training
Functional ability outcome was measured on different scales in different studies Follow‐up: mean 24 months	See comment	See comment	Not estimable	305 (2 studies)	⊕⊕⊕⊕ high	Absolute % change: HAQ 74%/ MACTAR 7%, relative % change: HAQ 50%/MACTAR 0%, NNT: n.a., SMD: due to conflicting evidence pooling of data was not possible
Muscle strength Isometric extension Follow‐up: mean 24 months	The mean muscle strength in the control groups was 15.3 Nm	The mean Muscle strength in the intervention groups was 0.49 standard deviations higher (0.06 lower to 1.04 higher)		305 (2 studies)	⊕⊕⊕⊕ high	Absolute % change: isometric extension 16%, relative % change: isometric extension 10%, NNT: n.a., SMD: 0.49 (‐0.06 to 1.04)
Self‐reported pain VAS. Scale from: 0 to 10. Follow‐up: mean 24 months	The mean self‐reported pain in the control groups was 0 cm	The mean Self‐reported pain in the intervention groups was 0.35 standard deviations higher (0.46 lower to 1.16 higher)		24 (1 study)	⊕⊕⊝⊝ low¹	Absolute % change: VAS 11%, relative % change: VAS 11%, NNT: n.a., SMD: 0.35 (‐0.46 to 1.16)
Disease activity DAS Follow‐up: mean 24 months	The mean disease activity in the control groups was ‐0.7 score	The mean Disease activity in the intervention groups was 0.14 standard deviations lower (0.38 lower to 0.09 higher)		281 (1 study)	⊕⊕⊕⊕ high	Absolute % change: ESR ‐15%/DAS ‐17%, relative % change: ESR: ‐40%/DAS ‐6%, NNT: n.a., SMD: ‐0.16 (‐0.39 to 0.06)
Radiological damage Joint score radiographics Follow‐up: mean 12 weeks	The mean radiological damage in the control groups was 4 points	The mean Radiological damage in the intervention groups was 0.15 standard deviations lower (0.37 lower to 0.08 higher)		305 (2 studies)	⊕⊕⊕⊕ high	Absolute % change: joint score 0%, relative % change: joint score: 0%, NNT: n.a., SMD: ‐0.15 (‐0.37 to 0.08)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Small patient number

Summary of findings 4. Long‐term land‐based aerobic capacity and muscle strength training for patients with Rheumatoid Arthritis

Ir a la tabla de la revisión

Table 1. Short‐term land‐based aerobic capacity training

Study	Functional ability	Aerobic capacity	Muscle strength	Self‐reported pain	Disease activity	Radiological damage
Baslund 1993		SUBMAXIMAL BICYCLE TEST Dynamic group: Mean (SD) baseline: 27.2 (1.7) ml/kg/min After 8 weeks: 33.3 Control group: Mean (SD) baseline: 20.9 (2.9) ml/kg/min After 8 weeks: 22.2 SMD: 1.93 (0.68, 3.17) P between groups: <.05	‐	‐	ESR Dynamic group: Mean (SD) baseline: 21 (4) After 8 weeks: 22 Control group: Mean (SD) baseline: 28 (3) After 8 weeks: 25 SMD: 0.95 (‐0.10, 2.0) P between groups: ns	‐
Minor 1989	AIMS (physical activity) Dynamic group: Mean (SD) baseline: 4.6 (2.7) After 12 weeks: 3.6 Control group: Mean (SD) baseline: 4.0 (2.5) After 12 weeks: 4.9 SMD: ‐0.06 (‐1.33, 1.20) P between groups: n.s. P between groups after 3 months: ? P between groups after 9 months: ns	MAXIMAL TREADMILL TEST Dynamic group: Mean (SD) baseline: 18.9 (4.8) After 12 weeks: 22.4 Control group: Mean (SD) baseline: 17.4 (5.9) After 12 weeks: 17.3 SMD: 0.74 (0.20, 1.28) P between groups: <.05 P between groups after 3 months:? P between groups after 9 months: ns		PAIN (AIMS) Dynamic group: Mean (SD) baseline: 5.1 (1.9) After 12 weeks: 3.9 Control group: Mean (SD) baseline: 5.5 (1.6) After 12 weeks: 4.8 SMD: ‐0.27 (‐0.79, 0.26) P between groups: ns P between groups after 3 months:? P between groups after 9 months: ns	CLINICALLY ACTIVE JOINTS Dynamic group: Mean (SD) baseline: 12.4 (12.5) After 12 weeks: 7.9 Control group: Mean (SD) baseline: 12.4 (13.2) After 12 weeks: 12.0 SMD: ‐0.39 (‐0.92, 0.14) P between groups: ns P between groups after 3 months:? P between groups after 9 months: ns	‐
Harkcom 1985	FSI Dynamic group: Mean (SD) baseline: 16.8 (8.3) After 12 weeks: 16.0 Control group: Mean (SD) baseline: 14.8 (10.2) After 12 weeks: 14.8 SMD: 0.04 (‐0.48, 0.56) P between groups: ns	MAXIMAL BICYCLE TEST Dynamic group: Mean (SD) baseline: 21.9 (9.0) ml/kg/min After 12 weeks: 29.1 Control group: Mean (SD) baseline: 18.5 (7.4) ml/kg/min After 12 weeks: 18.6 SMD: 0.63 (‐0.69, 1.94) P between groups: ns	ISOMETRIC EXTENSION Dynamic group Mean (SD) baseline: 60.5 (15.6) foot pounds After 12 weeks: 62.5 Control group: Mean (SD) baseline: 63.6 (15.7) foot pounds After 12 weeks: 74.6 SMD: ‐0.38 (‐1.67, 0.90) P between groups: ns		N OF TENDER JOINTS (PAIN AND SWELLING) Dynamic group: Mean (SD) baseline: 32.5 (19.4) After 12 weeks: 23.0 Control group: Mean (SD) baseline: 27.5 (7.5) After 12 weeks: 23.0 SMD: ‐1.13 (‐2.55, 0.28) P between groups: ns	‐
Qualitative analysis	Moderate evidence	Moderate evidence	Limited evidence	Limited evidence	Moderate evidence	No evidence
Quantitative analysis	0.03 (‐0.46, 0.51)*	0.99 (0.29, 1.68)*	‐0.38 (‐1.67, 0.90)	‐0.27 (‐0.79, 0.26)	na (statistical heterogeneity, I²=70.3%)	na
* = pooled effect size

Table 1. Short‐term land‐based aerobic capacity training

Ir a la tabla de la revisión

Table 2. Short‐term land‐based aerobic capacity and muscle strength training

Study	Functional ability	Aerobic capacity	Muscle strength	Self‐reported pain	Disease activity	Radiological damage
Van den Ende 1996	HAQ Dynamic group: Mean (SD) baseline: 0.83 (0.61) After 12 weeks: 0.78 After 12 weeks follow up: 0.88 Control group: Mean (SD) baseline: 0.70 (0.61) After 12 weeks: 0.86 After 12 weeks follow up: 0.80 SMD: ‐0.54 (‐1.11, 0.02) P between groups: After 12 weeks: ns After 12 weeks follow up: ns	SUBMAXIMAL BICYCLE TEST Dynamic group: Mean (SD) baseline: 27.6 (7.1) ml/kg/min After 12 weeks: 32.3 After 12 weeks follow up: 28.7 Control group: mean (SD) baseline: 25.8 (6.1) After 12 weeks: 26.1 After 12 weeks follow up: 26.3 SMD: 1.55 (0.91, 2.19) P between groups: After 12 weeks: P<.001 After 12 weeks follow up: ns	ISOKINETIC EXT. 120 DEGREES/sec Dynamic group: Mean (SD) baseline: 81 (35) Nm After 12 weeks: 94.6 After 12 weeks follow up: 87 Control group: Mean (SD) baseline: 78 (48) Nm After 12 weeks: 77.3 After 12 weeks follow up: 75 SMD: 0.74 (0.16, 1.31) P between groups: After 12 weeks: P<.05 After 12 weeks follow up: ns	PAIN ON VAS Dynamic group: Mean (SD) baseline: 3.4 (2.0) cm After 12 weeks: 3.6 After 12 weeks follow up: 4.8 Control group: Mean (SD) baseline: 2.1 (1.6) cm After 12 weeks: 3.0 After 12 weeks follow up: 3.3 SMD: ‐0.53 (‐1.09, 0.04) P between groups: After 12 weeks: ns After 12 weeks follow up: ns	N OF SWOLLEN JOINTS (range 0‐26) Dynamic group: Mean (SD) baseline: 5.2 (3.2) After 12 weeks: 3.5 After 12 weeks follow up: 4.3 Control group: Mean (SD) baseline: 3.6 (3.3) After 12 weeks: 3.8 After 12 weeks follow up: 3.8 SMD: ‐0.76 (‐1.34, ‐0.18) P between groups: After 12 weeks: P<.05 After 12 weeks follow up: ns
Lyngberg 1994	FRIES INDEX Dynamic group: Mean (SD) baseline: 18 (6‐30) After 12 weeks: 16 Control group: Mean (SD) baseline: 15 (0‐37) After 12 weeks: 15 SMD: ‐0.11 (‐0.91, 0.69) P between groups: ns	SUBMAXIMAL BICYCLE TEST Dynamic group: Median (range) baseline: 2.6 (1.5‐4.2) l/min Increase after 12 weeks: 2.7 Control group: Median (range) baseline: 2.8 (1.8‐3.9) l/min Increase after 12 weeks: 2.7 SMD: 0.15 (‐0.65, 0.95) P between groups: ns	ISOKINETIC EXT. 30 degrees/sec Dynamic group: Median (range) baseline: 79 (35‐181) Nm After 12 weeks: 77 Control group: Median (range) baseline: 76 (37‐178) Nm After 12 weeks: 55 SMD: 0.26 (‐0.55, 1.06) P between groups: ns		ERS Dynamic group: Median (range) baseline: 33 (2‐97) After 12 weeks: 22 Control group: Median (range) baseline: 17 (6‐48) After 12 weeks: 23 SMD: ‐0.04 (‐0.84, 0.76) P between groups: ns	‐
Qualitative analysis	Moderate evidence	Moderate evidence	Moderate evidence	Moderate evidence	Moderate evidence	No evidence
Quantitative analysis (effect size)	‐0.40 (‐0.86, 0.06)*	na (statistical heterogeneity, I²=86.2%)	0.47 (0.01 to 0.93)*	‐0.53 (‐1.09, 0.04)	na (statistical heterogeneity, I²=51.5%)	na
* = pooled effect size

Table 2. Short‐term land‐based aerobic capacity and muscle strength training

Ir a la tabla de la revisión

Table 3. Short‐term water‐based aerobic capacity and muscle strength training

Study	Functional ability	Aerobic capacity	Muscle strength	Self‐reported pain	Disease activity	Radiological damage
Minor 1989	AIMS (physical activity) Dynamic group: Mean (SD) baseline: 4.9 (2.4) After 12 weeks: 3.7 Control group: Mean (SD) baseline: 4.0 (2.5) After 12 weeks: 4.9 SMD: ‐0.89 (‐1.39, ‐0.38) P between groups: <.05	MAXIMAL TREADMILL TEST Dynamic group: Mean (SD) baseline: 19.3 (6.7) After 12 weeks: 23.2 Control group: Mean (SD) baseline: 17.4 (5.9) After 12 weeks: 17.3 SMD: 0.64 (0.14, 1.14) P between groups: <.05		PAIN (AIMS) Dynamic group: Mean (SD) baseline: 5.0 (1.6) After 12 weeks: 4.4 Control group: Mean (SD) baseline: 5.5 (1.6) After 12 weeks: 4.8 SMD: 0.06 (‐0.43, 0.54) P between groups: ns	CLINICALLY ACTIVE JOINTS Dynamic group: Mean (SD) baseline: 10.5 (10.7) After 12 weeks: 5.9 Control group: Mean (SD) baseline: 12.4 (13.2) After 12 weeks: 12.0 SMD: ‐0.37 (‐0.85, 0.12) P between groups: ns
Sanford‐Smit 1998	HAQ Dynamic group: Mean (SD) baseline: 19.2 (16.2) After 10 weeks: 16.8 Control group: Mean (SD) baseline: 12.1 (10.7) After 10 weeks: 8.4 SMD: 0.10 (‐0.78, 0.98) P between groups: ns	DURATION ON TREADMILL Dynamic group: Mean (SD) baseline: 9.6 (6.1) After 10 weeks: 12.1 Control group: Mean (SD) baseline: 12.6 (7.8) After 10 weeks: 14.6 SMD: 0.07 (‐0.82, 0.95) P between groups: ns	GRIP STRENGTH Dynamic group: Mean (SD) baseline: 28.5 (16.3) After 10 weeks: 32.9 Control Group: Mean (SD) baseline: 34.6 (10.0) After 10 weeks: 45.9 SMD: ‐0.38 (‐1.27, 0.51) P between groups: ns		ACTIVE JOINT COUNT Dynamic group: Mean (SD) baseline: 8.3 (6.0) After 10 weeks: 7.5 Control group: Mean (SD) baseline: 10.6 (5.6) After 10 weeks: 7.1 SMD: 0.46 (‐0.44, 1.35) P between groups: ns
Qualitative analysis	Limited evidence	Limited evidence	Moderate evidence	Limited evidence	Moderate evidence	No evidence
Quantitative analysis (effect ize)	na (statistical heterogeneity, I²=72.4%)	0.47 (‐0.04, 0.98)*	‐0.38 (‐1.27, 0.51)	0.06 (‐0.43, 0.54	na (statistical heterogeneity, I²=59.9%)	na
* = pooled effect size

Table 3. Short‐term water‐based aerobic capacity and muscle strength training

Ir a la tabla de la revisión

Table 4. Long‐term land‐based aerobic capacity and muscle strength training

Study	Functional ability	Aerobic capacity	Muscle strength	Self‐reported pain	Disease activity	Radiological damage
Hansen 1993	HAQ Dynamic group: Median (25%‐75%) baseline: 0.50 (0.50‐0.75) After 24 months: 0.87 Control group: Median (25%‐75%) baseline: 0.50 (0.13‐0.88) After 24 months: 0.62 SMD after 24 months: 0.71 (‐0.12, 1.54) P between groups: ns	‐	ISOMETRIC EXTENSION Dynamic group: Median (25%‐75%) baseline: 31 (26‐38) kp After 24 months: 57 Control group: Median (25%‐75%) baseline: 29 (19‐35) kp After 24 months: 45 SMD: 0.93 (0.08, 1.79) P between groups: <.05	PAIN ON VAS Dynamic group: Median (25%‐75%) baseline: 1.9 (1.2‐2.6) After 24 months: 2.1 Control group: Median (25%‐75%) baseline: 1.9 (1.5‐2.3) After 24 months: 1.9 SMD: 0.35 (‐0.46, 1.16) P between groups: ns	ESR Dynamic group: Median (25%‐75%) baseline: 20 (6‐42) mm/hr Increase after 24 months: 17 Control group: Median (25%‐75%) baseline: 23 (12‐32) Increase after 24 months: 28 SMD: ‐0.42 (‐1.23, 0.40) P between groups: ns	X‐RAY SCORE Dynamic group: Median (25%‐75%) baseline: 37 (17‐76) After 24 months: 46 (32‐89) Control group: Median (25%‐75%) baseline: 68 (58‐89) After 24 months: 74 (65‐97) SMD: 0.13 (‐0.68, 0.93) P between groups: ns
De Jong 2003	MACTAR Dynamic group: Mean (SD) baseline: 54.0 (4.8) After 24 months: 57.6 Control group: Mean (SD) baseline: 53.0 (5.0) After 24 months: 54.7 SMD after 24 months: 0.40 (0.16, 0.64) P between groups: at 12, 18 and 24 months: p<.05	ERGOMETER TEST Dynamic group: Mean (range) baseline: 162 (126‐200) After 24 months: 170.2 Control group: Mean (range) baseline: 162 (162‐200) After 24 months: 155.3 SMD after 24 months: 0.46 (0.22, 0.70) P between groups: <.001	ISOKINETIC TEST 60 DEGREES/sec Dynamic group: Mean (range) baseline: 165 (128‐206) After 24 months: 191.1 Control group: Mean (range) baseline: 166 (115‐227) Nw After 24 months: 175.6 SMD after 24 months: 0.32 (0.08, 0.55) P between groups: p <.001		DAS4 Dynamic group: Mean (SD) baseline: 3.3 (1.4) After 24 months: 2.4 Control group: Mean (SD) baseline: 3.4 (1.9) After 24 months: 2.7 SMD after 24 months: ‐0.14 (‐0.38, 0.09) P between groups: ns	LARSEN JOINT SCORE Dynamic group: Mean (SD) baseline: 1.5 (4.5) Increase after 12 months: 1.5 Increase after 24 months: 1.5 Control group: Mean (SD) baseline: 2.0 (5.0) Increase after 12 months: 2.0 Increase after 24 months: 2.0 SMD after 24 months: ‐0.17 (‐0.41, 0.06) P between groups: ns
Qualitative analysis	Conflicting evidence	Moderate evidence	Moderate evidence	Limited evidence	Moderate evidence	Moderate evidence
Quantitative analysis (effect size)	na	0.46 (0.22, 0.70)	0.49 (‐0.06, 1.04)*	0.35 (‐0.46, 1.16)	‐0.16 (‐0.39, 0.06)*	‐0.15 (‐0.37, 0.08)*
* = pooled effect size

Table 4. Long‐term land‐based aerobic capacity and muscle strength training

Ir a la tabla de la revisión

Table 5. Sensitivity analyses

Subcategory	Grade of evidence	Effect on/safe for:	Effect size	Grade of evidence	Effect on/safe for	Effect size
	Conclusion 1 (based on all included studies)#			Conclusion 2 (based on the 4 studies with a methodological quality of at least 8)##
Short term aerobic capacity training (land‐based)	Moderate evidence Moderate evidence Limited evidence	Functional ability Aerobic capacity Muscle strength	0.03 (‐0.46, 0.51)* 0.99 (0.29, 1.68)* ‐0.38 (‐1.67, 0.90)	‐	‐	‐
	Limited evidence Moderate evidence No evidence	Self‐reported pain Disease activity Radiological damage	‐0.27 (‐0.79, 0.26) n.a. n.a.	‐	‐	‐
Short term aerobic capacity and muscle strength training (land‐based)	Moderate evidence Moderate evidence Moderate evidence	Functional ability Aerobic capacity Muscle strength	‐0.40 (‐0.86, 0.06)* n.a. 0.58 (0.11, 1.04)*	Moderate evidence Moderate evidence Moderate evidence	Functional ability Aerobic capacity Muscle strength	‐0.40 (‐0.86, 0.06)* n.a. 0.58 (0.11, 1.04)*
	Moderate evidence Moderate evidence No evidence	Self‐reported pain Disease activity Radiological damage	‐0.53 (‐1.09, 0.04) na na
# Conclusion 1 is based on all included studies ## Conclusion 2 is based on the 4 included studies with a high methodological quality

Table 5. Sensitivity analyses

Ir a la tabla de la revisión

Comparison 1. Short‐term land‐based aerobic capacity training

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Functional ability Show forest plot	2	66	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.46, 0.51]

2 Aerobic capacity Show forest plot	3	82	Std. Mean Difference (IV, Random, 95% CI)	0.99 [0.29, 1.68]

3 Muscle strength Show forest plot	1	10	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐1.67, 0.90]

4 Self‐reported pain Show forest plot	1	56	Std. Mean Difference (IV, Random, 95% CI)	‐0.27 [‐0.79, 0.26]

Comparison 1. Short‐term land‐based aerobic capacity training

Ir a la tabla de la revisión

Comparison 2. Short‐term land‐based aerobic capacity and muscle strength training

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Functional ability Show forest plot	2	74	Std. Mean Difference (IV, Random, 95% CI)	‐0.40 [‐0.86, 0.06]

2 Muscle strength Show forest plot	2	74	Std. Mean Difference (IV, Random, 95% CI)	0.47 [0.01, 0.93]

3 Self‐reported pain Show forest plot	1	50	Std. Mean Difference (IV, Random, 95% CI)	‐0.53 [‐1.09, 0.04]

Comparison 2. Short‐term land‐based aerobic capacity and muscle strength training

Ir a la tabla de la revisión

Comparison 3. Short‐term water‐based aerobic capacity training

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Aerobic capacity Show forest plot	2	88	Std. Mean Difference (IV, Random, 95% CI)	0.47 [‐0.04, 0.98]

2 Muscle strenght Show forest plot	1	20	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐1.27, 0.51]

3 Self‐reported pain Show forest plot	1	68	Std. Mean Difference (IV, Random, 95% CI)	0.06 [‐0.43, 0.54]

Comparison 3. Short‐term water‐based aerobic capacity training

Ir a la tabla de la revisión

Comparison 4. Long‐term land‐based aerobic capacity and muscle strength training

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Aerobic capacity Show forest plot	1	281	Std. Mean Difference (IV, Random, 95% CI)	0.46 [0.22, 0.70]

2 Muscle strength Show forest plot	2	305	Std. Mean Difference (IV, Random, 95% CI)	0.49 [‐0.06, 1.04]

3 Self‐reported pain Show forest plot	1	24	Std. Mean Difference (IV, Random, 95% CI)	0.35 [‐0.46, 1.16]

4 Disease activity Show forest plot	2	305	Std. Mean Difference (IV, Random, 95% CI)	‐0.16 [‐0.39, 0.06]

5 Radiological damage Show forest plot	2	305	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.37, 0.08]

Comparison 4. Long‐term land‐based aerobic capacity and muscle strength training

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet