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Effectiveness of physical exercise on foot pain and function in adults with rheumatoid arthritis: systematic review
Alejandro Cruz-López1, Ana María Rayo-Pérez1, Natalia Tovaruela-Carrión2
1Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, C/Avicena s/n., 41009, Seville, Spain.
Background:
Foot involvement is highly prevalent in rheumatoid arthritis (RA), affecting over 90% of patients during the disease course. However, the specific impact of structured exercise on foot pain and functional limitations remains insufficiently understood. This systematic review and meta-analysis aimed to evaluate the effectiveness of supervised exercise programs on foot-specific outcomes in adults with RA.
Methods:
We conducted a systematic review and meta-analysis following PRISMA guidelines, searching five databases for randomized and controlled quasi-experimental trials evaluating supervised exercise interventions in adults with RA and foot involvement. Primary outcomes included foot pain and physical function measures. Data were pooled using random-effects models, and risk of bias was assessed using Cochrane tools. Analysis was performed with RevMan 5.4 and STATA 17.
Results:
Thirteen studies (n = 548) were included; ten entered the meta-analysis. Exercise significantly reduced foot pain (SMD - 0.68, 95% CI - 0.89 to - 0.46; p < 0.001) and improved function (Health Assessment Questionnaire SMD - 0.73, 95% CI - 0.96 to - 0.49; 6MWT MD + 47.6 m, 95% CI 31.4 to 63.8; Time Up-and-Go SMD - 0.40, 95% CI - 0.59 to - 0.21). Aquatic exercise and Tai Chi showed larger pain reductions, while high-intensity interval training improved functional outcomes. Programs ≥ 12 weeks yielded greater effects. Risk of bias ranged from low to some concerns; non-randomized studies showed moderate-serious confounding risk.
Conclusions:
Supervised, structured exercise reduces foot pain and improves function in RA, with aquatic and combined modalities particularly beneficial. Findings support implementation within multidisciplinary care.
