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Representation of adults with rheumatoid arthritis in US-based randomized controlled exercise trials: a systematic review with meta-analysis

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Abstract 

The purpose of this study was to conduct a systematic review with meta-analysis to determine the representation of adults with rheumatoid arthritis (RA) according to sex, race, and ethnicity in exercise randomized controlled trials (RCTs) conducted in the USA. Exercise RCTs ≥ 4 weeks conducted in the USA in adults ≥ 18 years with RA were eligible. Studies were retrieved by searching six electronic databases, cross-referencing and searching a clinical trials registry. Dual, independent, study selection and data abstraction were conducted. The primary outcomes were the proportion of participants in each study according to sex as well as race/ethnicity. Results were pooled meta-analytically using the inverse-variance heterogeneity (IVhet) model after applying the double-arcsine transformation. Of the 1030 unique articles screened, five RCTs representing 353 participants with RA were included. The pooled participant prevalence was 83% (95% CI = 73 to 92%) for women and 17% (95% CI = 8 to 27%) for men, suggesting an over-representation of women and an under-representation of men by approximately 7.4% based on current prevalence US estimates for each. Qualitative examination for race and ethnicity demonstrated an under-representation of racial/ethnic minority groups. There is a lack of representation of men with RA in US-based randomized controlled exercise intervention studies. Additional US-based randomized controlled exercise trials, including greater inclusion and reporting of the racial/ethnic composition of participants, are also needed.

Key Points

• This systematic review with meta-analysis of US studies found an under-representation of men in randomized controlled trials examining the effects of exercise in those with rheumatoid arthritis (RA).

• Qualitative examination according to race/ethnicity found both a lack of reporting as well as under-representation of selected racial/ethnic minorities in US-based randomized controlled exercise studies among adults with RA.

• This study highlights the need for additional US-based randomized controlled trials of exercise in adults with RA that better represent the RA population in the USA.

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Data availability

All data are avilable from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. School of Public Health, Department of Epidemiology and Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9190, Morgantown, WV, 26506-9190, USA

    George A. Kelley & Kristi S. Kelley

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Both authors were involved in drafting the article or revising it critically for important intellectual content, and both authors approved the final version to be submitted for publication. Dr. G. A. Kelley had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study conception and design: G. A. Kelley, K. S. Kelley.

Acquisition of data: G. A. Kelley, K. S. Kelley.

Analysis and interpretation of data: G. A. Kelley, K. S. Kelley.

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Correspondence to George A. Kelley.

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Kelley, G.A., Kelley, K.S. Representation of adults with rheumatoid arthritis in US-based randomized controlled exercise trials: a systematic review with meta-analysis. Clin Rheumatol 42, 29–38 (2023). https://doi.org/10.1007/s10067-022-06360-3

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