Abstract 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.
Cruz-López et al. (2026) studied this question.