Table 1 Summary of findings
Author, year and country of publication | Characteristic: Sample size (n), Age (M ± SD), Gender (% female) | IG and CG: design and content | Duration & timepoints | Assessment of PA and/or SB | Disease activity outcome measure and results | PA/SB results | Secondary Outcome: measure and results |
|---|---|---|---|---|---|---|---|
Brodin et al., 2008 [47] Sweden | IG: 94 54 ± 14.0 72 CG: 134 56 ± 13.9 75 | IG: Individual coaching program aimed to implement healthy PA. Telephone support given after 1 week, then monthly. 3 monthly function tests to support adherence CG: Ordinary physical therapy | 1 year baseline PI: 1 year FU: NR | SR: 3 questions- intensity of low, moderate and high intensity PA not validated in RA | DAS28 (ESR): IG: ~ , CG: ~  BGD not assessed | IG: n = 26 (34%) ↑, n = 19 (20%) ↓ CG: n = 23 (20%) ↑, n = 31 (23%) ↓ no BGD in number increasing PA | FA (HAQ): IG: ~ , CG: ~ , no BGD QoL (EuroQol VAS): IG: ↑*, CG: ~ , sig. BGD Pain (VAS): IG: ~ , CG: ~ , no BGD |
Feldthusen et al., 2016 [48] Sweden | IG: 36 54.2 ± 8.5 88.9 CG: 34 52.7 ± 10.9 88.2 | IG: Develop self-care plan focussing on tailoring health enhancing PA (reaching adult PA guidelines- i.e., aerobic MPA > 30min, 5d/week; aerobic VPA > 20min, 3d/week; combination of the 2)) and balancing life activities Follow-up support meetings and telephone calls conducted by specialised physical therapists. Frequency of follow-up was individualised. CG: Usual care and activities only | 12 weeks baseline PI: 12 week FU: 6 months | SR: LTPAI not validated in RA | DAS28 (ESR): IG: ↓ (at post-test and follow-up), CG: ~ , no BGD | LTPAI: IG:↑, CG: ~  sig. BGD between at PI and FU | Fatigue (VAS): IG: ↓*, CG: ↓* at PI and FU, no BGD Pain (VAS): IG: ~ , CG: ~ , no BGD Anxiety (HADS): IG: ↓*, CG: ~ , sig. BGD at PI and FU Depression (HADS): IG: ↓*, CG: ~ , no BGD QoL (EuroQol VAS): IG: ↑*, CG: ~ , sig. BGD at FU |
Gilbert et al., 2018 [49] USA | IG: 93 55.0 ± 13.8 82.8 CG: 92 54.7 ± 13.7 84.8 | IG: Minimum 3-monthly motivational interviews with HCP (in person/telephone)-, individual goal setting, tailored strategies for increasing PA and monitoring progress Progress evaluated in subsequent interviews and further goals set CG: Brief PA counselling - physician advice only | 24 months baseline DI: 3 months DI: 6 months DI: 12 months PI: 24 months FU: NR | DB: GT1M ActiGraph SR: Yale physical activity scale |  | Total PA (mins/day): IG: ~ , CG: ~ , no BGD MVPA (mins/day): IG: ~ , CG: ~ , no BGD | FA (HAQ): IG: ~ , CG: ~ , no BGD QoL- Physical (SF-36): IG: ~ , CG: ~ , no BGD QoL- Mental (SF-36): IG: ~ , CG: ~ , sig. BGD at follow-up Pain (HAQ VAS): IG: ~ , CG: ~ , no BGD |
Knittle et al., 2015 [50] Netherlands | IG: 38 60.7 ± 11.9 79* CG: 40 64.7 ± 11.5 55* | IG: Small group patient education sessions delivered by physical therapist- and one to one motivational interviews and self-regulation coaching FU telephone self-regulation coaching sessions CG: Group based patient education session | 5 weeks baseline PI: 6 weeks FU: 32 weeks | SR: SQUASH | RADAI: IG: ~ , CG: ~ , sig. BGD at FU in favour of CG | Leisure time PA (mins/week): IG: ↑, CG: ~ , sig. BGD at FU Number active days (days/week): IG: ↑, CG: ~ , sig. BGD at PI and FU | FA (HAQ): IG: ~ , CG: ~ , no BGD Depression (BSI): IG: ~ , CG: ~ , no BGD Fatigue (CIS-20): IG: ~ , CG: ~ , no BGD |
Giraudet-Le Quintrec et al., 2007 [25] France | IG: 104 55.3 ± 11.8 86.4 CG: 104 54.3 ± 14.4 85.4 | IG: multidisciplinary educational intervention- home based exercise prescription and recommendations for leisure PA 8 group weekly face to face, 5-h education program sessions on RA management and physical program, OT, physical therapist, aquatic or relaxation training CG: Usual medical care and information booklets with PA recommendations and exercises | 12 months baseline DI: 6 months PI: 12 months FU: NR | SR: Baeke questionnaire (assessed leisure time PA (sports + hobbies)) not validated in RA | DAS28: IG: ~ , CG: ~ , no BGD | Leisure PA score: IG: ↓, CG: ↓, no BGD | FA (HAQ): IG: ~ , CG: ~ , no BGD Anxiety (HADS): IG: ~ , CG: ~ , no BGD Depression (HADS): IG: ~ , CG: ~ , no BGD QoL (AIMS2): IG: ~ , CG: ~ , no BGD Fatigue (FACIT-F): IG: ~ , CG: ~ , no BGD |
Thomsen et al., 2017 [21] Denmark | IG: 75 59.7 ± 10.7 81 CG: 75 59.5 ± 12.7 80 | IG: 1: 3 × individual motivational counselling sessions - individual goal setting and self-efficacy, set behavioural goals to reduce sitting, motivation and confidence to encourage behaviour change. Booklets given containing key messages 2: SMS reminders- based on goals (frequency is individualised) CG: Current lifestyle | 16 weeks baseline PI: 16 weeks- FU: 6 months FU: 22 months | DB: activPAL™ SR: PAS 2.1 | DAS28 (CRP): IG: ↓, CG: ↓, no BGD (assessed at FU only) | DB sitting time (hr/day): IG: ↓, CG: ↑, sig. BGD at PI and FU DB standing time (hr/day): IG: ↑, CG: ↓, sig. BGD at PI and FU DB stepping time (hr/day): IG: ↑, CG: ↓, sig. BGD at PI and FU SR sitting at work (hr/day): IG: ↓, CG: ~ , sig. BGD at PI and FU SR sitting in leisure (hr/day): IG: ↓, CG: ↑, sig. BGD at PI and FU | FA (HAQ): IG: ↓*, CG: ↑*, sig. BGD at post-test and follow-up QoL (SF-36): IG: ↑*, CG: ↓*, sig. BGD at post-test and follow-up Pain (VAS): IG: ↓*, CG: ↑*, sig. BGD at post-test and follow-up Fatigue (VAS): IG: ↓*, CG: ↑*, sig. BGD at post-test and follow-up |
Van den Berg et al., 2006 [45] Netherlands | IG: 82 49.5 (12.9) median (IQR) 76 CG: 78 49.8 (13.9) median (IQR) 77 | IG: Internet based PA programme (performed 5x/week)- Individual PA guidance, bicycle ergometer. Participants advised to do other forms of PA as well. Weekly email supervision with physical therapist 3-monthly group meetings – demonstrated new exercises, exchange of experiences. Tailored self-management strategies addressed during meeting CG: Internet based general PA training advice | 12 months baseline DI: 3 months DI: 6 months DI: 9 months PI: 12 months FU: NR | SR: Questionnaire (number meeting MPA and VPA recommendations) DB: Actilog 3 | DAS28 (ESR): IG: ↓, CG: ↓, no BGD | MPA: IG: ↑, CG: ↑, sig. BGD at 6 and 9 months VPA: IG: ↑, CG: ↑, sig. BGD at 6, 9 and 12 months DB PA score: IG: ↓, CG: ↓ (at 6 months), no BGD DB Peak amplitude: IG: ~ , CG: ~ , no BGD DB No. peaks: IG: ~ , CG: ~ , no BGD | FA (HAQ): IG: ↓*, CG: ~ , sig. BGD at 12 months only QoL (RAQoL): IG: ↑*, CG: ↑*, sig. BGD at 9 and 12 months |
Veldhuijzen et al., 2021 [51] England | IG: 43 55.4 ± 12.1 63 CG: 45 54.5 ± 13.0 69 | IG: 3-month exercise program and SDT-based psychological intervention One to one consultations with BC counsellor: to support autonomous motivation for PA RA tailored exercise program: 3 × 30min/wk independent exercise sessions at gym (×2) and home (×1), semi-supervised CG: RA tailored exercise program | 3 months baseline PI: 3 months FU: 6 months FU: 12 months | SR: IPAQ | DAS28: IG: ~ , CG: ~ , no BGD | MVPA (mins/week): IG: ~ , CG: ↓, sig. BGD at 3, 6 and 12 months | FA (HAQ): IG: ↓*, CG: ↑*, sig. BGD at 6 and 12 months QoL (EQ-5D): IG: ~ , CG: ~ , no BGD Depression (HADS): IG: ~ , CG: ~ , no BGD Anxiety (HADS): IG: ~ , CG: ~ , no BGD Fatigue (MAF): IG: ~ , CG: ~ , no BGD |
Li et al., 2020 [43] Canada | IG: 43 54.8 ± 15.4 88.4 CG: 43 55.3 ± 11.5 93 | IG: 1. in person group education session and individual counselling 2. Wear Fitbit Flex 2 and given PA goals 3. biweekly phone calls from physical therapist trained in motivational interviewing- reviewed PA goals CG: Routine activities weeks 1–9, did intervention weeks 10–18 (delay group) | 8 weeks baseline PI: Week 9 (post-test IG) PI: Week 18 (post-test CG) FU: Week 27 | DB: Sensewear accelerometer |  | MVPA (mins/day): IG: ↑, CG: ~ , no BGD Purposeful activity (mins): IG: ~ , CG: ~ , no BGD Steps (no./day): IG: ~ , CG: ~ , no BGD Sedentary time (mins): IG: ~ , CG: ~ , no BGD | Depression (PHQ): IG: ~ , CG: ~ , no BGD Pain (MPQ): IG: ↓* (9 weeks), CG: ~ , sig. BGD at 9 weeks Fatigue (FSS): IG: ~ , CG: ~ , no BGD |
Katz et al., 2018 [42] USA | PED+: 34 50.2 ± 14.1 88.2 PED: 34 55.9 ± 12.4 88.2 CG: 28 59.1 ± 12.5* 85.7 | IG: 1. PED+: individualized step-count goals + pedometer + step-monitoring diary: booklet and discussion, pedometer, step diary and individualised daily step targets. Follow-up- target review phone call every 2 weeks 2. PED: pedometer + diary, NO targets: booklet and discussion, pedometer and diary to record daily pedometer steps. Follow-up- step count recorded via phone call every 2 weeks CG: education booklet and discussion on PA benefits | 21 weeks baseline DI: 10 weeks PI: 21 weeks FU: NR | DB: Jawbone pedometer DB: Fitbit | RADAI (1–10): PED+: ↓, PED: ↓, CG: ↑ (at week 21), sig. BGD (lower in PED and PED+ than CG) | Steps (no./day): PED+: ↑, PED: ↑, CG: ~ , sig. BGD (changes within PED and PED+ differed from CG) % sedentary participants: PED+: ↓, PED: ↓, CG: ↑, sig. BGD % achieving healthy PA: PED+: ↑, PED: ↑, CG: ~ , no BGD | FA (HAQ): PED+: ↓*, PED: ↓*, CG: ~ , sig. BGD in PED+ vs CG at 21 weeks Pain (PROMIS): PED+: ↓*, PED: ↓*, CG: ~ , no BGD Fatigue (PROMIS): PED+: ↓*, PED: ↓*. CG: ~ , no BGD Depression (PHQ): PED+: ↓*, PED: ↓*, CG: ~ , no BGD |
Nordgren et al., 2015 [8] Sweden | IG: 220 59 ± 8.8 81 | IG: Health enhancing PA (HEPA) programme 1. 30+ mins MPA on most days- given pedometer and access to webpage for step registration to encourage daily PA 2. 2 × circuit training sessions/week in gym 3. biweekly support group meetings by PTs Alternative types of HEPA were encouraged- competitions, monitor aerobic capacity, weekly texts Expert lectures CG: No control, single-arm trial | 2 years baseline DI: 12 months FU: NR | SR: IPAQ-SF SR: modified ESAI |  | % meeting current HEPA: IG: ↑ (at 1 year), ↓ from year 1 to year 2 (82% to 75%) % maintained (> 6 months) HEPA: IG: ↑ 0 to 37% (at 1 year), ↓ from year 1 to year 2 (841% to 27%) | FA (HAQ): IG: ↓* QoL (EQ-5D): IG: ↑* Pain (VAS): IG: ↓* Fatigue (VAS): IG: ~  |
Lange et al., 2020 [52] Sweden | IG: 24 73.5 ± 2.7 75.0 CG: 23 74.0 ± 2.1 78.3 | IG: Moderate-high intensity, aerobic and resistance exercise with person-centred guidance 3 sessions/week tailored gym based exercise: semi-supervised. Home based exercise: LPA 5 days/week and home exercises 2x/week Telephone support 7 months post intervention CG: Encouraged to perform home-based light intensity exercise | 20 weeks baseline FU: 4 years | SR: LTPAI SR: ESAI | DAS28 (ESR): IG: ~ , CG: ↑, sig. BGD | LTPAI: IG: ↑, CG: ~ , no BGD ESAI- current HEPA: IG: 33%, CG: 26%, no BGD ESAI- maintained HEPA: IG: 25%, CG: 17%, no BGD | FA (HAQ)I: IG: ~ , CG: ~ , no BGD QoL (VAS): IG: ~ , CG: ↓*, sig. BGD Pain (VAS): IG: ~ , CG: ↑*, no BGD Fatigue (VAS): IG: ~ , CG: ↑*, no BGD |
John et al., 2013 [44] England | IG: 52 62.2 ± 10.6 71 CG: 58 60.8 ± 10.7 74 | IG: Cognitive behavioural education intervention 3 × interactive small group meetings by HCPs The important role of lifestyle modifications discussed, and individuals challenged to (using probing behavioural techniques), and commit to, a specific behaviour change Weekly progress reviews encouraged to self-monitor CG: Information leaflet | 8 weeks baseline PI: 8 weeks FU: 6 months | SR: IPAQ |  | MET PA (mins/week): no BGD (WGD not assessed) |  |
Garner et al., 2018 [46] Canada | IG: 14 45 ± 10 93 CG: 14 49 ± 14 71 | IG: Individualised counselling intervention on PA and dietary intake 3 × individualized visits to review strategies on: 1. Nutrition: with dietician, food questionnaire, reviewed diet recommendations, asked questions about diet. 2. PA: with rheumatology PT. Reviewed current PA and fitness tests results, instructions on PA guidelines, exercises to improve fitness. CG: Standard care | 6 months baseline PI: 6 months FU: NR | DB: Pedometer | DAS28: IG: ↓, CG: ↓, no BGD | Steps (no./week): IG: ↑ +9,583 steps, CG: ↑ +6,696 steps, no BGD | FA (HAQ): no within group data reported, no BGD |
Cramp et al., 2020 [39] England | IG: 12 58 (range: 23–79) 75 | IG: 4 × group sessions: set goals, autonomy support, facilitate relatedness, group discussion, action plans tailored, individualised, to promote intrinsic motivation, peer support, self-monitoring (daily diaries and pedometers to take home) incorporated to promote self-efficacy and BC. One to one session: individual support to meet specific needs- discussion of individual PA barriers, strategies to overcome these CG: No control, single-arm trial | 12 weeks baseline PI: 12 weeks FU: NR | SR: IPAQ-SF |  | IPAQ PA: IG: ~ (1 = ↑, 1 = ↓) | FA (modified HAQ): IG: 3 = ↑ QoL (EQ-5D): IG: ~  Pain (VAS): IG: 4 = ↑ Fatigue (BRAF-NRS): IG: 6 = ↑ (better), 3 = ↓ (worse), 2 =  ~  didn’t test for significance |
McKenna et al., 2021 [53] Ireland | IG: 10 58 ± 7.4 100 CG: 10 56 ± 7.9 100 | IG: Walking based exercise intervention based on ACSM, WHO and EULAR guidelines Sessions increased in length, intensity and duration each week from 2 to 5 sessions by week 8. Incrementally longer walks and more challenging targets. Progress self-monitored. Unsupervised sessions performed at time and location of choice CG: verbal and written instructions about benefits of exercise in RA | 8 weeks baseline PI: Week 9 FU: NR | DB: activPAL™ | CDAI: IG: ↓ (-0.7), CG: ↑ (+0.7) (didn’t test for significance, BGD not assessed) | MVPA (mins/day): IG: ↑, CG: ~  (BGD not assessed) | FA (HAQ): IG:↓ (-0.6), CG: ↑ (+0.14) QoL (VAS): IG: ↑ (+10.4), CG: ↑ (+0.3) Pain (VAS): IG: ↓, CG: ~  Fatigue (BRAF-NRS): IG: ↓ (-11), CG: ↑ (+1) (didn’t test for significance, BGD not assessed) |