Pactivity interventions for fatigue in rheumatoid arthritis: a systematic review

Background: Fatigue is a major symptom of rheumatoid arthritis (RA) and the need for effective interventions is evident. Programmes based upon physical activity (PA) have been shown to improve patient-reported fatigue in other long-term conditions. Objectives: To investigate the effectiveness of PA interventions for reducing fatigue in adults with RA and to identify key components of effective PA interventions. Methods: Methods were based on a previous Cochrane systematic review for non-pharmacological interventions for fatigue in RA. The following electronic databases were searched up to October 2016: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; AMED; CINAHL; PsycINFO; Social Science Citation Index; Web of Science; Dissertation Abstracts International; Current Controlled Trials Register; The National Research Register Archive; The UKCRN Portfolio Database. Randomised controlled trials evaluating PA interventions in people with RA with self-reported fatigue as an outcome measure were included. Results: Eight studies met the inclusion criteria. Results indicated a small beneficial effect of PA on RA fatigue. The type, frequency, duration, and intensity of PA varied between studies. Delivery methods included supervised group programmes and unsupervised home exercise. Information regarding overall adherence to PA interventions was limited. Conclusions: There is some evidence of the potential for PA to be effective in reducing symptoms of RA fatigue. However, few interventions in the included studies were designed to manage RA fatigue. These findings suggest that further work is needed to identify the optimal PA intervention for fatigue management that meets the needs of people with RA.