Seminars in Arthritis and Rheumatism · Sep 26, 2026

Evidence-informed exercise dose targets for rheumatoid arthritis: A systematic review and bayesian dose-response network meta-analysis

By Huo R, Luo H, Li W et al.

BACKGROUND: Exercise is strongly recommended as part of integrative management for rheumatoid arthritis (RA). However, most trials and conventional network meta-analyses compare broad exercise categories without explicitly modelling dose, which may obscure non-linear dose-response patterns and limit outcome-specific interpretation. OBJECTIVE: To estimate statistically supported dose ranges and the model-estimated doses associated with the most favourable posterior effects of different exercise modalities on disease activity, pain, physical function, and cardiorespiratory fitness in adults with RA. METHODS: Eight databases were searched from inception to 16 June 2026 for randomised controlled trials (RCTs) evaluating structured exercise interventions lasting at least 2 weeks in adults with RA. Weekly exercise exposure was standardised as metabolic equivalent minutes per week (MET-min/week) using the 2024 Adult Compendium and treated as a pragmatic proxy of exercise volume across five modalities: aerobic exercise (AE), resistance exercise (RE), combined aerobic and resistance exercise (AE+RE), traditional Chinese exercise (TCE), and yoga. Dose-response relationships for DAS28, VAS pain, HAQ-DI, and VO₂max were estimated using the MBNMAdose package with a quadratic function. Risk of bias was assessed using RoB 2, and confidence in the evidence was evaluated using CINeMA. The protocol was registered in PROSPERO (CRD420261418955). RESULTS: Forty-four RCTs comprising 93 arms and 3132 participants were included. The fitted dose-response relationships were frequently non-linear or plateauing, and statistically supported effects varied by modality and outcome. TCE produced the largest reduction in DAS28 at 500 MET-min/week (MD -0.84, 95% CrI -1.16 to -0.50). RE produced the largest reductions in VAS pain at 820 MET-min/week (MD -14.03 mm, 95% CrI -19.98 to -8.68) and HAQ-DI at 1000 MET-min/week (MD -0.26, 95% CrI -0.47 to -0.06), whereas AE produced the largest improvement in VO₂max at 750 MET-min/week (MD 4.75 mL·kg⁻¹·min⁻¹, 95% CrI 3.39 to 6.11). Sensitivity analyses suggested that VO₂max findings were the most robust, whereas DAS28 estimates were more sensitive to exclusion of studies at high risk of bias. Meta-regression did not identify clear moderation by age or intervention duration. Confidence in the evidence ranged from very low to moderate across outcomes and comparisons. CONCLUSION: Exercise management in RA may benefit from an outcome-specific and dose-informed approach rather than a uniform weekly target. Larger model-estimated exercise doses were not consistently associated with greater benefit. Given the very-low-to-moderate confidence in the evidence and inconsistent reporting of adverse events, the estimated dose values should be interpreted as provisional model-based reference targets rather than definitive prescriptions or safety thresholds.

doi.org/10.1016/j.semarthrit.2026.153084PubMed 42945826Interventions