A systematic review exploring the evidence reported to underpin exercise dose in clinical trials of rheumatoid arthritis

Abstract

We aimed to evaluate the evidence reported to underpin exercise dose in randomised controlled trials (RCTs) using strengthening exercise in RA. We searched six different databases between 1 January 2000 and 3 April 2019. We included RCTs, where a main component of the intervention and/or control used strengthening exercise. Evidence sources cited to underpin dose were judged for their quality, consistency and applicability. Thirty-two RCTs were reviewed. Four (12.5%) piloted the intervention without using dose-escalation designs to determine optimal dose-response. Twenty (62.5%) reported no evidence underpinning dose. Where reported, quality, consistency and applicability of the underpinning evidence was a cause for methodological concern. The majority of RCTs did not report the evidence underpinning dose. When reported, the evidence was often not applicable to the clinical population. Frequently, the dose used differed to the dose reported/recommended by the underpinning evidence. Our findings illustrate exercise dose may not be optimised for use with clinical populations prior to evaluation by RCT.

Examining Rehabilitation Dose in Adults With Rheumatoid Arthritis: Association With Baseline Factors and Change in Clinical Outcomes

“…A systematic review evaluating the quality of clinical practice guidelines regarding PT for adults with RA found that the guidelines lacked detail about recommended dose (21). Likewise, a more recent systematic review summarized the available evidence to support dosing in clinical trials of exercise in adults with RA and noted that most trials do not provide evidence to support their dosing choices (25). For those who provided evidence, the quality was low.…”

“…Notably, only 2 clinical trials included interventions with fewer than 24 visits; thus, whether similar outcomes would be achieved with fewer visits is unclear. Similar to OA, most clinical trials investigating the efficacy of exercise in adults with RA tested interventions with 24 or more visits over periods of 2–6 months (25). In contrast, only 31% of the participants in our sample reported >8 rehabilitation visits in 6 months.…”

“…Further, a systematic review of the evidence to support exercise dose in clinical trials of RA found that a majority of trials did not report evidence to support the dose used and did not conduct dose‐response studies. Of those who provided evidence to support the dose, the quality of the evidence was low (25).…”

Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy

“…Similar strong evidence is lacking for the other fitness dimensions. A recently published review confirmed that exercise intervention studies in people with inflammatory arthritis are not adequately reported, neither was the exercise dose underpinned with evidence [ 58 ]. Furthermore, better knowledge of adherence patterns, e.g.…”

Effectiveness of web-based and mobile health interventions designed to enhance adherence to physical activity for people with inflammatory arthritis: a systematic review

“…It is crucial that future digital interventions include evidence-based PA prescriptions that are aligned to public health guidance and the EULAR [ 2 ] for people with inflammatory arthritis recommendations (i.e. ≥150 min of moderate PA/week and twice weekly strengthening and flexibility exercises) [ 3 ] Exercise formats and dosages should be described accurately and the options for tailoring, progression and regression of exercises highlighted such that they can be replicated safely [ 3 , 61 ]. Interventions should also optimize an individual’s capacity, motivation and opportunity to adhere to PA. Evidence-informed BCTs, such as goal setting, instruction and demonstration of appropriate PA, strategies to facilitate regular practice and social support should be incorporated.…”