Exercise Interventions for Rheumatoid Arthritis: A Sequential Bibliometric and Content Analysis — An Evidence Mapping Study
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Background
This two-stage sequential study combined bibliometric data with standardised full-text coding to build a modality-outcome evidence matrix for RA exercise research, testing whether publication hotspots align with directionally consistent clinical evidence. Conventional bibliometric studies highlight hotspots and collaboration patterns but cannot determine whether heavily discussed topics rest on clinically coherent trial evidence. The gap between thematic popularity and empirical consistency has been noted, but few studies have quantified it systematically.
Methods
We searched WoSCC and PubMed for RA exercise studies (2016–2025). Three nested datasets were defined: Dataset A (n=352) for bibliometric mapping; Dataset B (n=203) for full-text coding; and Dataset C (n=54) for evidence-matrix synthesis. Using CiteSpace and VOSviewer, we assessed publication trends, collaboration patterns and keyword bursts, and coded each trial for exercise type, outcome domain and effect direction. For directional consistency, we used an 80% threshold as a pragmatic cut-off, with sensitivity tests at 70% and 85% (Supplementary Table S6). RoB 2.0 and GRADE were not performed; the study was not PROSPERO-registered—both are explicit limitations.
Results
Publications rose from 24 (2016) to 49 (2025). Keyword bursts shifted from cardiovascular risk (2016–2019) to fatigue (2020–2022) to quality of life (2023–2025). Aerobic and resistance training showed the highest evidence concentration (≥15 studies/outcome) and directional consistency (≥85%). Mind-body exercise had moderate volume (n=16) but weaker consistency (60-70%), largely due to heterogeneous protocols. HIIT, BFRT, cardiovascular risk, and body composition remain underexplored (≤5 studies/outcome).
Conclusion
This descriptive evidence map shows aerobic and resistance training are the most thoroughly studied modalities; mind-body and novel interventions need standardised protocols and larger trials. Our framework distinguishes research visibility from evidence coherence. The matrix summarises volume and directional agreement only—not a clinical guideline or comparative-effectiveness assessment.
