Combined spa–exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial

Abstract

Objective. To determine the efficacy of combined spa-exercise therapy in addition to standard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis (AS). Methods. A total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients each. Group 1 (mean age 48 ؎ 10 years; male:female ratio 25:15) was treated in a spa resort in Bad Hofgastein, Austria; group 2 (mean age 49 ؎ 9 years; male:female ratio 28:12) in a spa resort in Arcen, The Netherlands. The control group (mean age 48 ؎ 10 years; male:female ratio 34:6) stayed at home and continued their usual drug treatment and weekly group physical therapy during the intervention weeks. Standardized spa-exercise therapy of 3 weeks duration consisted of group physical exercises, walking, correction therapy (lying supine on a bed), hydrotherapy, sports, and visits to either the Gasteiner Heilstollen (Austria) or sauna (Netherlands). After spa-exercise therapy all patients followed weekly group physical therapy for another 37 weeks. Primary outcomes were functional ability, patient's global well-being, pain, and duration of morning stiffness, aggregated in a pooled index of change (PIC). Results. Analysis of variance showed a statistically significant time-effect (P < 0.001) and time-by-treatment interaction (P ‫؍‬ 0.004), indicating that the 3 groups differed over time with respect to the course of the PIC. Four weeks after start of spa-exercise therapy, the mean difference in PIC between group 1 and controls was 0.49 (95% confidence interval [CI] 0.16 -0.82, P ‫؍‬ 0.004) and between group 2 and controls was 0.46 (95% CI 0.15-0.78, P ‫؍‬ 0.005). At 16 weeks, the difference between group 1 and controls was 0.63 (95% CI 0.23-1.02, P ‫؍‬ 0.002) and between group 2 and controls was 0.34 (95% CI ؊ 0.05-0.73; P ‫؍‬ 0.086). At 28 and 40 weeks, more improvement was found for group 1 compared with controls (P ‫؍‬ 0.012 and P ‫؍‬ 0.062, respectively) but not for group 2 compared with controls. Conclusion.In patients with AS, a 3-week course of combined spa-exercise therapy, in addition to drug treatment and weekly group physical therapy alone, provides beneficial effects. These beneficial effects may last for at least 40 weeks.

Exercise therapy for spondyloarthritis: a systematic review

“…the calculations employed a random effects model. In trials comparing two similar exercise groups and one control group, the exercise group results were pooled for comparative purposes [12,13]. In the event that the published data from included studies were insufficient to calculate pooled effects, study authors were contacted requesting additional data.…”

“…1 [20]. Frequency of exercise varied from twice daily [19] to once weekly [21][22][23], with individual session duration ranging from 30 min [18,[24][25][26][27][28][29]] to 3 h [13]. traditional therapeutic exercises targeting flexibility, posture and respiration predominated.…”

The Effectiveness of Exergames in Patients with Ankylosing Spondylitis: A Randomized Controlled Trial

“…Also, home exercise of this kind is time-efficient, economical and convenient [6][7][8][9][10]. Alternative exercise programs such as swimming, spa-exercise therapy and tai chi programs have also been studied in AS patients, and led to a significant reduction in disease activity and improvement in function compared to the control groups [30][31][32][33]. But the major challenge is the widely observed fact that most AS patients do not exercise on a regular basis.…”

Ankylosing spondylitis: recent developments and anaesthetic implications

“…Daily hydrotherapy and swimming can improve general fitness while protecting the joints. Although a Cochrane review concluded that there is little evidence for the effectiveness of non-pharmacological management, expert opinion and clinical experience suggest that individuals benefit from intensive physiotherapy [29].…”