Exercise for depression in adults with rheumatic diseases


In a previous blog we looked at the burden of musculoskeletal conditions.

Four common forms of rheumatic diseases have been described: i. Osteoarthritis (estimated prevalence of 27 million), ii. Rheumatoid arthritis (estimated prevalence of 1.5 million), iii. Fibromyalgia (estimated prevalence of 5 million), iv. Systemic lupus erythematous (estimated prevalence of 161,000).

We know that rheumatic diseases affect approximately 20% of the adult US population, with an estimated cost of 128 billion dollars per annum.

The burden of these diseases also includes depression with an estimated 18% of individuals suffering with depressive symptoms. Depression is commonly managed with medication, but despite the positive results there is a risk of side effects and a substantial financial burden.

Exercise therapy is a low cost intervention and may be an alternative to medication to manage depressive symptoms. Interestingly a recent review of systematic reviews looked at the effects of exercise on depressive symptoms in adults with arthritis and other rheumatic diseases (Kelley et al, 2014). Let’s see what they found.

Depression often

Depression often goes hand in hand with rheumatic diseases.


The authors searched nine electronic databases to July 2013 for systematic reviews with meta-analysis of randomized controlled trials.

They looked for studies of adults 18 years and older with a doctor’s diagnosis of arthritis (osteoarthritis, rheumatoid arthritis, fibromyalgia and systemic lupus erythematous) and an aerobic and strength training intervention that lasted a minimum of 4 weeks.

Methodological quality of the included studies was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR).


  • No studies in patients with osteoarthritis, rheumatoid arthritis and systemic lupus erythematous were found
  • Two meta-analyses in patients with fibromyalgia involving 1,164 individuals (610 exercise and 551 control) were included.
    • Reductions in depressive symptoms within the exercise group were found in both meta-analysis:
      • Standard Mean Difference (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)
  • The AMSTAR methodological quality of the two reviews was high at 91% and 82%
  • The number needed to treat in each meta-analysis was 6 and 9 with an estimated 0.83 and 0.56 million US people with fibromyalgia potentially benefitting


The authors concluded:

Exercise improves depressive symptoms in adults with fibromyalgia.


The two meta-analyses included in this review of reviews found that exercise improves depressive symptoms in adults with fibromyalgia.

The Musculoskeletal Elf’s view

The Musculoskeletal ElfSo it appears that exercise is a viable option for managing depressive symptoms in people with fibromyalgia. However, there were no reviews evaluating the effectiveness of exercise for osteoarthritis, rheumatoid arthritis and systemic lupus erythematous.

This review used the AMSTAR checklist that was developed to help users differentiate between systematic reviews, focusing on their methodological quality and expert consensus and to facilitate the development of high-quality reviews. There are 11 questions with the following responses; yes, no, can’t answer and not applicable. The website calculates the methodological quality (percentage). The AMSTAR has been found to have good inter-rater reliability (k=0.70) and good intra class correlation coefficient (0.84).

What do you think?

  1. Do you encourage patients with fibromyalgia to use exercise to manage their depressive symptoms?
  2. What method of exercise (i.e. aerobic or strength training) do you find most effective?
  3. What prescriptions (i.e. intensity, duration and exercise modality) do you find the most effective when working with fibromyalgia patients?

Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community. Post your comment below, or get in touch via social media (FacebookTwitterLinkedInGoogle+).


Kelley GA, Kelley KS. Effects of exercise on depressive symptoms in adults with arthritis and other rheumatic disease: a systematic review of meta-analyses. BMC Musculoskelet Disord. 2014 Apr 7;15:121. doi: 10.1186/1471-2474-15-121.

Assessment of Multiple Systematic Reviews (AMSTAR)

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Pamela Andrews

I am currently a student researcher at Glasgow Caledonian University. My research area is examining ways to improve the management of patients suffering with fibromyalgia. Prior to this I completed my BSc and MSc at Teesside University in Sports Therapy and Advanced Sports Therapy and Rehabilitation Science respectively. When not in the university I am a full time Sports Therapist I currently own and practice out of Sports Injury Scotland, based within Run4It in Glasgow. Other research interests include running injuries, biomechanical imbalances and strength and conditioning.

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Tracey Howe

Hi I am Tracey Howe. I am a Professor of Rehabilitation Sciences at Glasgow Caledonian University, UK and Deputy Chair of Glasgow City of Science. I am also an editor for the Cochrane Musculoskeletal Review Group and a convenor for the Cochrane Health Care of Older People Field. I am a Trustee of the Picker Institute Europe. I started my career as a physiotherapist in the National Health Service in England. I have extensive experience of assessing the quality of research in Universities in the UK and internationally. I enjoy strategic visioning, creative problem-solving, and creating vibrant, multi-disciplinary environments, through collaboration, partnerships, and relationships, that empower others to succeed.

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