Effect of Exercise Interventions for Rheumatoid Arthritis: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials.

Objective: To compare the efficacy of various exercise modalities for Rheumatoid arthritis (RA) employing a network meta-analysis. Methods: A systematic search was conducted across eight databases-PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed-up to December 4, 2024, for randomized controlled trials on exercise for RA. The Cochrane Risk of Bias Assessment Tool (RoB 2) assessed study quality. A network meta-analysis was performed utilizing Stata 17.0. Our study measured outcomes through mean differences (MD) accompanied by 95% credible intervals (CIs) to quantify effect sizes, while interventions were ranked using surface under the cumulative ranking curve (SUCRA) probability scores, and the Confidence in Network Meta-Analysis (CINeMA) software to evaluate evidence certainty. Results: A total of 34 trials included 2,435 RA patients and 10 exercise interventions: walking or jogging, relaxation training, resistance exercise, Pilates, aerobic exercise, aerobic exercise + resistance exercise, yoga, traditional Chinese exercise, cycling, and Pilates + walking or jogging. The NMA results indicated that Pilates was the most effective for pain relief (VAS: MD = -2.17 cm, 95% CI: -3.77 to -2.57, SUCRA = 91.8%); aerobic exercise + resistance exercise was most effective for reducing morning stiffness duration (MD = -8.23 min, 95% CI: -9.06 to -7.39, SUCRA = 100.0%); and traditional Chinese exercise was most effective for improving disease activity (DAS28-ESR: MD = -0.68 scores, 95% CI: -1.04 to -0.32, SUCRA = 95.5%). Risk assessment showed 4 studies "low", 4 "high", and 26 "some concern" regarding bias. The CINeMA assessment indicated that most comparisons provided low or very low-quality evidence. Conclusion: Exercise interventions are effective supplements for RA treatment, with specific exercises offering distinct benefits: Pilates for pain, aerobic exercise + resistance exercise for morning stiffness, traditional Chinese exercise for disease activity. Further high-quality studies are needed for validation.