4. Aerobic exercise and strength training compared to control for dermatomyositis and polymyositis: GRADE assessments for other quality of life measures (supplementary to 'Summary of findings' table 8).
| Aerobic exercise and strength training compared to control for dermatomyositis and polymyositis | |||||
| Patient or population: people with dermatomyositis and polymyositis Setting: at home and at the department of physical therapy of 3 participating hospitals Intervention: aerobic exercise and strength training Comparison: control without aerobic exercise and strength training | |||||
| Outcomes | Mean (SD) without aerobic exercise and strength training | Mean (SD) with aerobic exercise and strength training | Difference (95% CI) | Certainty of the evidence (GRADE) | What happens |
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Quality of life Assessed with: SF‐36 Physical Function Scale from 0 to 100 (where 100 is optimal) and NHP ‐ Physical Scale from 0 to 100 (where 0 is no perceived problems and 100 is maximum problems) Follow‐up (mean): 18 weeks 40 participants (2 RCTs) |
Quality of life (SF‐36 Physical Function) improved on average 1.5 SDs (0.8 higher to 2.2 higher) in the aerobic exercise and strength training group than in the group without training | SMD 1.5 higher (0.8 higher to 2.2 higher) | ⊕⊝⊝⊝ Very lowa,b | The effect on quality of life‐physical function is uncertain | |
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Quality of life Assessed with SF‐36 Vitality Scale from 0 to 100 (where 100 is optimal) Follow‐up: mean 24 weeks 21 participants (1 RCT) |
The mean change in SF‐36 Vitality score without aerobic exercise and strength training was a decrease of 0.5 (5.1) | The mean change in SF‐36 vitality score with aerobic exercise and strength training was an increase of 11.8 (4.6) | MD 12.3 higher (8.2 higher to 16.5 higher) | ⊕⊝⊝⊝ Very lowa,c | May improve quality of life‐vitality |
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Quality of life Assessed with SF‐36 Physical Function Scale from 0 to 100 (where 100 is optimal) Follow‐up: mean 12 weeks 21 participants (1 RCT) |
The mean change in SF‐36 Physical Function score without aerobic exercise and strength training was −0.2 (6.6) | The mean change in SF‐36 Physical Function score with aerobic exercise and strength training was 8.9 (3.2) | MD 1.5 higher (0.8 higher to 2.2 higher) | ⊕⊝⊝⊝ Very lowa,c | May have little or no effect on quality of life‐physical function |
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Quality of life Assessed with SF‐36 Mental Health Scale from 0 to 100 (where 100 is optimal) Follow‐up: mean 24 weeks 21 participants (1 RCT) |
The mean change in SF‐36 Mental Health score without aerobic exercise and strength training was an increase of 3.1 (4.1) | The mean change in SF‐36 Mental Health score with aerobic exercise and strength training was an increase of 8.1 (3.7) | MD 5.0 higher (1.7 higher to 8.4 higher) | ⊕⊝⊝⊝ Very lowa,c | May improve quality of life‐mental health slightly |
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Quality of life Assessed with NHP‐Energy Scale from 0 to 100 (where 0 is no perceived problems and 100 is maximum problems) Follow‐up: mean 24 weeks 19 participants (1 RCT) |
The mean change in NHP‐Energy score without aerobic exercise and strength training was −3.1 (23.9) | The mean change in NHP‐Energy score with aerobic exercise and strength training was 21.1 (37.3) | MD 18.0 lower (45.9 lower to 9.9 higher) | ⊕⊝⊝⊝ Very lowa,c | The effect on quality of life‐energy is uncertain |
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Quality of life Assessed with NHP‐Pain Scale from 0 to 100 (where 0 is no perceived problems and 100 is maximum problems) Follow‐up: mean 24 weeks 19 participants (1 RCT) |
The mean change in NHP‐Pain score without aerobic exercise and strength training was −4.3 (0.1) | The mean change in NHP‐Pain score with aerobic exercise and strength training was a decrease of 7.4 (14.7) | MD 3.1 lower (12.22 lower to 6.0 higher) | ⊕⊝⊝⊝ Very lowa,c | The effect on quality of life‐pain is uncertain |
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Quality of life Assessed with NHP‐Sleep Scale from 0 to 100 (where 0 is no perceived problems and 100 is maximum problems) Follow‐up: mean 24 weeks 19 participants (1 RCT) |
The mean change in NHP‐Sleep score without aerobic exercise and strength training was −13.7 (6.1) | The mean change in NHP‐Sleep score with aerobic exercise and strength training was a decrease of 6.4 (27.1) | MD 7.3 higher (10.0 lower to 24.6 higher) | ⊕⊝⊝⊝ Very lowb,c | The effect on quality of life‐sleep is uncertain |
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Quality of life Assessed with NHP‐Social Scale from 0 to 100 (where 0 is no perceived problems and 100 is maximum problems) Follow‐up: mean 24 weeks 19 participants (1 RCT) |
The mean change in NHP‐Social score without aerobic exercise and strength training was −5.4 (0.1) | The mean change in NHP‐Social score with aerobic exercise and strength training was a decrease of 4.3 (25.0) | MD 1.1 higher (14.4 lower to 16.6 higher) | ⊕⊝⊝⊝ Very lowa,c | The effect on quality of life‐social is uncertain |
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Quality of life Assessed with NHP‐Emotional Scale from 0 to 100 (where 0 is no perceived problems and 100 is maximum problems) Follow‐up: mean 24 weeks 19 participants (1 RCT) |
The mean change in NHP‐Emotional score without aerobic exercise and strength training was −7.1 (9.7) | The mean change in NHP‐Emotional score with aerobic exercise and strength training was an increase of 29.1 (29.4) | MD 22.3 lower (41.4 lower to 3.2 lower) | ⊕⊝⊝⊝ Very lowa,c | The effect on quality of life‐emotional is uncertain |
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Quality of life Assessed with NHP‐Physical Scale from 0 to 100 (where 0 is no perceived problems and 100 is maximum problems) Follow‐up: mean 24 weeks 19 participants (1 RCT) |
The mean change in NHP‐Physical score without aerobic exercise and strength training was a decrease of 8.5 (1.7) | The mean change in NHP‐ Physical score with aerobic exercise and strength training was a decrease of 10.3 (0.9) | MD 1.8 lower (3.0 lower to 0.6 lower) | ⊕⊝⊝⊝ Very lowa,c | The effect on quality of life‐physical is uncertain |
| 5RM: 5 voluntary repetitions; CI: confidence interval; MD: mean difference; MMT‐8: manual muscle testing of eight muscle groups; NHP: Nottingham Health Profile; RCT: randomised controlled trial SD: standard deviation; SMD: standardised mean difference; SF‐36: Short Form 36 Health Survey | |||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
aDowngraded two levels for study limitations. In one trial, quote: "One patient in the exercise group was not able to perform the exercise programme and was excluded from the analysis". Follow‐up was therefore incomplete and analysis was not by intention‐to‐treat. Quote: "We aimed for nine patients in the exercise group, but some analyses were performed with N = 7 (VO2 max measurements) or N = 3 (mitochondrial enzyme activities). (...). "All measurements were not successfully performed both before and after training in each subject". Blinding of participants and personnel was not possible in either trial. bDowngraded one level for imprecision: small samples. cDowngraded two levels for serious imprecision: Quote: "An important limitation is the lack of power analysis and the low number of patients, conditions that may explain lack of significant between‐group differences, with frequent dropouts further hampering the analyses and conclusion.(...). Possible indirectness: the exercise intensity level was defined only for the aerobic walks, not for the resistive home exercise programme".