A Cochrane review [Abstract] 1 included 8 studies with a total of 575 subjects. In all trials participants with low to medium disease activity were included and patients with serious co-morbidities were excluded. Exercise programmes had to fulfil the following criteria: frequency at least twice weekly for > 20 minutes; duration> 6 weeks; aerobic exercise intensity > 55% of the maximum heart rate and/or muscle strengthening exercises starting at 30% to 50% of one repetition maximum; and performed under supervision. Short-term, land-based aerobic capacity training showed a positive effect on aerobic capacity (SMD 0.99, 95% CI 0.29 to 1.68; 3 studies, n=82) immediately after the intervention. Short-term, land-based aerobic capacity and muscle strength training showed a positive effect on aerobic capacity and muscle strength (SMD 0.47, 95% CI 0.01 to 0.93; 2 studies, n=74) immediately after the intervention. Short-term, water-based aerobic capacity training: one of the two included trials reported statistically significant positive effects of the intervention on functional ability (P < 0.05) and aerobic capacity (P < 0.05) immediately after the intervention. Data could only be pooled for aerobic capacity resulting in a non-significant trend toward a positive effect (SMD 0.47, 95% CI -0.04 to 0.98; 2 studies, n=88). Long-term, land-based aerobic capacity and muscle strength training (2 years) showed a positive effect on aerobic capacity (SMD 0.46, 95% CI 0.22 to 0.70; 1 study, n=281) and a non-significant trend toward a positive effect on muscle strength (SMD 0.49, 95% CI -0.06 to 1.04; 2 studies, n=305). In the one study including a 18-month follow-up, the improvement of muscle strength was maintained in those participants from the intervention group who continued exercising at similar intensity levels as in the original intervention (although on average at a lower frequency) but not in those who did not remain physically active. With respect to safety, no deleterious effects were found in any of the included studies.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and inadequate intention-to-treat adherence).
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