BMC Musculoskeletal Disorders, 04/08/2014  Evidence Based Medicine  Clinical Article

Kelley GA, et al. – Depression is a major public health problem among adults with arthritis and other rheumatic disease. The purpose of this study was to conduct a systematic review of previous meta–analyses addressing the effects of exercise (aerobic, strength or both) on depressive symptoms in adults with osteoarthritis, rheumatoid arthritis, fibromyalgia and systemic lupus erythematous. Exercise improves depressive symptoms in adults with fibromyalgia. However, a need exists for additional meta–analytic work on this topic.

Methods

• Previous meta–analyses of randomized controlled trials were included by searching nine electronic databases and cross–referencing.
• Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) Instrument.
• Random–effects models that included the standardized mean difference (SMD) and 95% confidence intervals (CIs) were reported.
• The alpha value for statistical significance was set at p <= 0.05.
• The U3 index, number needed to treat (NNT) and number of US people who could benefit were also calculated.

Results

• Of the 95 citations initially identified, two aggregate data meta–analyses representing 6 and 19 effect sizes in as many as 870 fibromyalgia participants were included.
• Methodological quality was 91% and 82%, respectively.
• Exercise minus control group reductions in depressive symptoms were found for both meta–analyses (SMD, –0.61, 95% CI, –0.99 to –0.23, p = 0.002; SMD, –0.32, 95% CI, –0.53 to –0.12, p = 0.002).
• Percentile improvements (U3) were equivalent to 22.9 and 12.6.
• The number needed to treat was 6 and 9 with an estimated 0.83 and 0.56 million US people with fibromyalgia potentially benefitting.