Association of Core Muscle Endurance Times With Balance, Fatigue, Physical Activity Level, and Kyphosis Angle in Patients With Ankylosing Spondylitis

Abstract

Background/Objective: Core muscle endurance (CME), which is the ability of sustaining the activity of trunk muscles, has been shown to be lower in patients with ankylosing spondylitis (AS). The aim was to investigate the possible relationship between CME times and balance, fatigue, physical activity (PA) level, and thoracic kyphosis angle.Methods: Fifty-one patients with AS with a mean age of 41.0 years (interquartile range, 25/75 years; 29.0/51.0 years) were included in the study. Core muscle endurance times were assessed by using trunk extension, trunk flexion, and side bridge tests. Overall stability index, anteroposterior stability index, mediolateral stability index, and limits of stability were evaluated with the Biodex Balance System. Fatigue and PA levels were surveyed using Fatigue Severity Scale and International Physical Activity Questionnaire, respectively. Thoracic kyphosis angle was measured by using a digital inclinometer. Additionally, CME times were compared for "high-fatigue" versus "low-fatigue" and as "low PA" versus "moderate/high PA" groups. Spearman correlation coefficients and Mann-Whitney U test were used for statistical analysis.Results: Significant correlations were detected between overall stability index, anteroposterior stability index, Fatigue Severity Scale, International Physical Activity Questionnaire, and all CME tests (p < 0.05) and between mediolateral stability index and side bridge test (p < 0.05). Limits of stability correlated only with side bridge test (p < 0.05). Core muscle endurance significantly differed between high-fatigue and low-fatigue groups (p < 0.05), except trunk flexor test (p > 0.05). No significant differences were observed between low PA and moderate/high PA groups (p > 0.05), except side bridge test (p < 0.05).Conclusions: Core muscle endurance times seem to be related to PA level, fatigue, and balance but not with thoracic kyphosis angle. Assessing CME in patients with AS might help in planning individualized exercise programs.

T2 mapping and fat quantification of lumbar paraspinal muscle in ankylosing spondylitis: a case control study

“…However, several theories have been proposed, including (1) systemic inflammation causing the overexpression of TNF-α and other proinflammatory cytokines (interleukins 6, 1, 17, and 23), which have been reported to be involved in myofibril protein catabolism; (2) local inflammation at the site of attachment of ligaments or tendons to bone (enthesitis) or facet joint arthritis; (3) biomechanical stress; and (4) denervation or/and neuroinflammation of the spinal cord and nerve roots [ 8 , 14 , 16 , 20 – 22 , 40 – 43 ]. Other factors that have a bidirectional role (i.e., can be both a cause and consequence of vicious cycle initiation) of paraspinal muscle degeneration in AS include lower back pain, facet joint or spinal stiffness, inactivity, and fatigue [ 9 , 11 , 32 , 33 , 39 , 44 ]. In addition, recent studies indicate that MF adipose tissue is also a source of TNF-α and interleukin 6 expression [ 22 , 45 ].…”

“…Possible explanations for these conflicting results are that BASFI and BASDAI are fully patient-reported and, therefore, reflect subjective factors independent of inflammation. In addition, the ESR is unspecific and may be more easily affected by different conditions with longer half-value periods, even in subacute/chronic inflammation, compared to CRP [ 11 , 15 , 31 ]. Nonetheless, more studies are needed to understand the reasons for these results.…”

“…It has been reported that the paraspinal muscles are affected in AS. Impairment of these muscles has been proposed as a risk factor for radiological progression and has recently received attention as a cause of pain, spinal sagittal balance impairment, spinal deformity, and worsened quality of life [ 4 – 11 ]. As AS treatment advances, core strength and physical exercise have been shown to have a positive effect on disease activity and flexibility in AS [ 12 – 14 ].…”

Causal Relationships Between Total Physical Activity and Ankylosing Spondylitis: A Mendelian Randomization Study

“…Patients with AS also have lower levels of exercise as compared with normal individuals ( 39 ). Therefore, people with AS have reduced levels of PA ( 40 ); it is difficult to evaluate whether the level of exercise has an effect on the development of AS.…”

Effects of Brief Intervention of Behavioural Change on Pain, Mobility, Function, and Quality of Life in Patients with Chronic Ankylosing Spondylitis: A Randomised Clinical Trial

“…Physical activity promotion among chronic disease patients is another main challenge for policy makers and health professionals. (9,10) As suggested by global physical activity guidelines, adults should engage in at least 150 minutes (activity bouts of at least 10 minutes) of moderate-level aerobics per week, 75 minutes of intense exercise per week, or a combination of moderate and vigorous activity. All patients should do things that gradually build up their resistance, while patients over 65 should do things that help them improve their coordination and balance.…”