Table 3.

Population, intervention, comparison, outcomes, and study (PICOS) design of each study included in the systematic review.

Studies	Interventions by Group	Frequency	Session Duration	Intervention Duration	Outcomes	Main Results
Noreu et al. [21]	I: Warm-up (10 min), Exercise (15–30 min): aerobic exercise in the format of aerobic dancing, without jumps or sudden movements. 3 weeks: 50% of HRR max. 9 weeks: 70% of HRR max. Cool-down (10 min) Counseling C: usual care	Twice per wk Once per wk	35–50 min	12 wk	Peak VO2 QoL (AIMS, POMS)	Peak VO2 -↑ in peak VO2 in the I group (from 22.2 ± 7.5 to 25.0 ± 7.2 mL/kg/min, p ≤ 0.01). In the C group, there was not a significant difference (from 22.7 ± 6.5 to 23.8 ± 5.7 mL/kg/min, p > 0.05). QoL AIMS -Significant ↓ in pain, mobility, household activities, depression, and anxiety within the I group (p < 0.05), but no difference in any of these variables within the C group (p > 0.05). POMS -Significant ↓ in tension, fatigue, depression, and total score, and significant ↑ in vigor within the I group (p < 0.01), but only in depression within the C group (p < 0.05).
Rintala et al. [22]	I: Water exercise program in a pool. Warm-up (12 min) Exercise: arm, trunk, and leg movements, such as rotation of the upper body, abduction and adduction of arm and legs, and flexion and extension of arms; some included the use of fins and balls (35 min). Cool-down included stretching, floating, and breathing exercises. C: usual care	2 times/wk	45–60 min Increased gradually	12 wk	Peak VO2	Peak VO2 -In the I group, increase from 27.9 + 7.1 to 29.5 ± 7.0 mL/kg/min, and in the C group, from 25.7 + 5.1 to 27.1 ± 5.8 mL/kg/min). -No statistically significant difference between groups (p > 0.05).
Bilberg et al. [23]	I: exercises for aerobic capacity, of moderate aerobic intensity, dynamic (eccentric and concentric), static muscle strength, and muscle endurance in the upper and lower extremities, flexibility, coordination, and relaxation. C: usual care	2 times/wk	45 min	12 wk	Peak VO2 QoL (SF-36, AIMS2)	Peak VO2 -No significant difference within the I group (from 34.0 ± 10.9 to 33.8 ± 10.0 mL/kg/min, p > 0.05) and the C group (from 34.2 ± 6.7 to 32.4 ± 7.3 mL/kg/min, p > 0.05). -No statistically significant difference between groups (p > 0.05). QoL SF-36 -Significant improvement in physical functioning, bodily pain, vitality, and physical component within I group (p < 0.01). -Significant improvement in bodily pain within C group (p < 0.05). -Significant improvement only in vitality in the I group compared to the C group (p = 0.021). AIMS2 -Significant improvement in physical and HAQ score within the I group (p < 0.05). -No difference within the C group (p > 0.05). -Significant improvement in HAQ score in the I group compared to the C group (p = 0.045).
Neuberger et al. [24]	I 1: Gym-based warm-up, low-impact aerobic exercise, strengthening exercises, and cool-down, 60% and 80% MHR. Weeks 1–3: 20, 10, 20, and 10 min; weeks 2–3: 15, 20, 15, and 10 min; weeks 4–6: 10, 25, 20, and 5 min; and weeks 7–12: 10, 30, 15, and 5 min. I 2: The same program, but home- based from a videotape. C: usual care	3 times/wk	60 min	12 wk	Peak VO2 QoL (POMS, MAF, CES-D)	Peak VO2 -Significant difference within the I1 group (from 22.50 to 25.09 mL/kg/min, p < 0.05) and I2 group (from 23.32 to 24.58 mL/kg/min, p < 0.05), but not within the control group (p > 0.05). -No statistically significant difference between the exercise and control groups (p > 0.05). QoL -Overall symptoms (latent variable for pain, fatigue, and depression) decreased significantly (p < 0.04) within the I1 and I2 groups compared to the C group, as well as between the I and C groups.
Breedland et al. [25]	I: Muscle exercise circuit at 40–60% of 1 RM for 3 sets × 20 reps with increased load 5%/wk. Bicycle training, 10–20 min, at 60% HRmax. Other activities included badminton, table tennis, bowling, uni-hockey, circuit training, and aqua jogging. C: usual care	2 times/wk	90 min	8 wk	Peak VO2 DAS28 QoL (Dutch-AIMS2, ASES)	Peak VO2 -↑ in the I group (from 31.52 ± 10.17 to 35.34 ± 11.33 mL/kg/min, p < 0.01), while no significant change in the C group (from 25.99 ± 6.07 to 25.55 ± 6.36 mL/kg/min, p = 0.24). -There was a statistically significant increase in the I group compared to the C group (+12.1% versus −1.7%, p = 0.002). DAS28 No significant differences in DAS28 scores between groups. QoL Dutch-AIMS2 -Significant improvement in physical health within the I group (p = 0.05); no significant changes were found within the C group (p > 0.05). -No statistically significant differences between groups (p > 0.05). ASES -No statistically significant differences within and between groups (p > 0.05).
Stavropoulos- Kalinoglou et al. [26]	I: First 3 months aerobic exercise. Three circuits of 3–4 exercises (walk on treadmill, cycle, row, or hand ergometer) at 70% VO2max for 3–4 min, with 1 min resting interval. After 3 months, resistance training was added to the schedule above. Three sets of 4 resistance exercises (leg press, chest press, shoulder press, pull-ups) for 12–15 reps. C: usual care	3 times/wk	50–60 min	6 months	Peak VO2 DAS28 QoL (HAQ) At 3 and at 6 months	Peak VO2 -Peak VO2 significantly improved within the I group from 24.8 ± 7.6 mL/min/kg by >10% and 17% within 3 and 6 months (p < 0.001), while there was not an improvement within the C group (p > 0.05). -There was a significant increase in the I group compared to the C group (3 months: p = 0.023; 6 months: p = 0.002). DAS28 -↓ DAS28 within the I group (from 3.5 ± 1.2 to 2.9 ± 0.8 at 3 months and 2.7 ± 0.7 at 6 months; p < 0.05), but no significant reduction within the C group (from 3.1 ± 1.2 to 3.1 ± 0.6 at 3 months and 3.2 ± 0.9 at 6 months; p > 0.05). -Statistically significant improvement in the I group compared to the controls (p = 0.008). QoL (HAQ) -Significant improvement in the I group (from 1.4 ± 0.8 to 1.0 ± 0.6 at 3 months and 0.9 ± 0.6 at 6 months; p < 0.001), but not in the C group (from 1.3 ± 0.7 to 1.6 ± 0.5 at 3 months and 1.5 ± 0.6 at 6 months; p > 0.05). -Significant improvement in the I group compared to the C group (p = 0.003).
Azeez et al. [27]	I: Personalized exercise program. Cardiovascular exercises, such as walking, cycling, or swimming, depended on the patient’s preferences. Strength exercises for the upper body (biceps curls, triceps extensions, and shoulder press). Exercises for the lower body (leg squat). Resistance bands and balls were used for grip strength. C: usual care	NA	NA	3 months	Peak VO2 DAS28 QoL (HAQ, GFI)	Peak VO2 -Significant increase within the I group (from 23.2 (16–88) to 27.6 (14–75) mL/kg/min, p = 0.002), but no difference in the C group (from 26.1 (14–83) to 27.6 (18–65) mL/kg/min, p = 0.313). DAS28 No difference in DAS28 within and between groups (p > 0.05). QoL HAQ -Significant improvement in HAQ within the I group (from 0.5 (0.0–2.4) to 0.25 (0.0–2.5), p = 0.05) and within the C group (from 1.1 (0–3.0) to 0.8 (0.0–2.9), p = 0.026). -No difference between groups (p > 0.05). GFI (global fatigue index) -Significant improvement within the I group (from 13.2 (6.4–34.1) to 10.9 (6.5–37.5), p = 0.047), but no difference within the C group (p = 0.96). -Significant improvement in the I group compared to the C group (p = 0.047).

HRR max, maximal heart rate reserve; MHR, maximum heart rate; QoL, quality of life; wk, weeks; min, minutes; 1 RM, one-repetition maximum; AIMS, Abnormal Involuntary Movement Scale (questionnaire); AIMS2, Arthritis Impact Measurement Scales 2 (questionnaire); Dutch-AIMS2, Arthritis Impact Measurement Scales Dutch version (questionnaire); POMS, Profile of Mood States (questionnaire); SF-36, 36-Item Short-Form Survey (questionnaire); HAQ, The Health Assessment Questionnaire; GFI, Global Fatigue Index (questionnaire). ↑ means increase and ↓ means decrease.