Study Results Support the Use of Exercise for Improving Depressive Symptoms in SLE Patients

Investigators from the Robert C. Byrd Health Sciences Center at West Virginia University School of Public Health, in collaboration with the CDC, conducted a meta-analysis of previously conducted randomized controlled trials with the goal of determining what effect, if any, prescriptive exercise such as aerobic conditioning and strength training had on depressive symptoms in adults with Arthritis and other rheumatic conditions (AORC): fibromyalgia, osteoarthritis, rheumatoid arthritis and systemic lupus erythematosus (SLE). The results of their study were published this week in the journal Arthritis Research & Therapy.

AORC is the leading cause of disability in the US, affecting 1 in 5 adults. The conditions are characterized as pain and stiffness in and around one or more joints with immune and internal organ system involvement in certain conditions, such as SLE. Patients diagnosed with one of the AORC have higher rates of inactivity, depression and social life limitations than the general US population.

A diagnosis of depression in AORC is of particular importance due to the substantial negative impacts on quality of life associated with afflicted patients.  It is also highly pervasive in this patient population, affecting approximately 18% of those diagnosed, with women disproportionately impacted. A commonly prescribed non-pharmaceutical intervention for depression is exercise. Unfortunately, in this patient population the experience of chronic pain, fatigue, and inflammation leads to high rates of inactivity. A recent study found that only 37% of adults with diagnosed arthritis performed moderate physical activity for at least 30 minutes per day, 3 days per week.  Currently, there is no consensus among researchers as to the exact level of effectiveness, and at what dose, exercise has on alleviating or preventing depressive symptoms in AORC patients.

In this study, the authors used a meta-analytic approach (combining data from multiple studies to develop a single conclusion) to establish measures of both effectiveness and dosing quantity of exercise on depressive symptoms in AORC patients. They reviewed 500 publications that included data on 2,449 patients with 1,470 who were prescribed exercise and 979 controls (did not exercise). The included studies in the analysis had to meet the following criteria:

• Were randomized controlled trials with the unit of assignment at the patient level
• Had an exercise-only intervention group (aerobic, strength training, or both),
• Had community-deliverable exercise interventions ≥ 4 weeks in duration,
• Had a comparative control group (non-intervention, usual care, wait-list control, attention control),
• Participants were adults aged 18 years and older with one of the following; rheumatoid arthritis, osteoarthritis, fibromyalgia, or SLE
• Were studies published in any language between January 1, 1981 and January 1, 2013
• Had depressive symptoms as an outcome

The major study finding was that there is a statistically significant reduction in depressive symptoms when patients followed a prescribed exercise regimen.  Other findings of interest included improvements in physical function, pain, quality-of-life, anxiety, VO2max, and upper and lower body strength.

The study authors stated that these findings provide evidence to support the use of exercise for improving multiple outcomes in AORC patients.