Efficacy of High Intensity Exercise on Disease Activity and Cardiovascular Risk in Active Axial Spondyloarthritis: A Randomized Controlled Pilot Study

Abstract

BackgroundPhysical therapy is recommended for the management of axial spondyloarthritis (axSpA) and flexibility exercises have traditionally been the main focus. Cardiovascular (CV) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases. Therefore, the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA.MethodsIn a single blinded randomized controlled pilot study the exercise group (EG) performed 12 weeks of endurance and strength exercise while the control group (CG) received treatment as usual. The primary outcome was the Ankylosing Spondylitis (AS) Disease Activity Score (ASDAS). Secondary outcomes included patient reported disease activity (Bath AS Disease Activity Index [BASDAI]), physical function (Bath AS Functional Index [BASFI]), and CV risk factors measured by arterial stiffness (Augmentation Index [Alx]) and Pulse Wave Velocity [PWV]), cardiorespiratory fitness (VO2 peak) and body composition. ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences, and Mann Whitney U-test was used for outcomes with skewed residuals.ResultsTwenty-eight patients were included and 24 (EG, n = 10, CG, n = 14) completed the study. A mean treatment effect of −0.7 (95%CI: −1.4, 0.1) was seen in ASDAS score. Treatment effects were also observed in secondary outcomes (mean group difference [95%CI]): BASDAI: −2.0 (−3.6, −0.4), BASFI: −1.4 (−2.6, −0.3), arterial stiffness (estimated median group differences [95% CI]): AIx (%): −5.3 (−11.0, −0.5), and for PVW (m/s): −0.3 (−0.7, 0.0), VO2 peak (ml/kg/min) (mean group difference [95%CI]: 3.7 (2.1, 5.2) and trunk fat (%): −1.8 (−3.0, −0.6). No adverse events occurred.ConclusionHigh intensity exercise improved disease activity and reduced CV risk factors in patients with active axSpA. These effects will be further explored in a larger trial.Trial RegistrationClinicalTrials.gov NCT01436942

Decreased health-related physical fitness in adults with ankylosing spondylitis: a cross-sectional controlled study

“…Flexibility is the fitness component traditionally most targeted by exercise interventions in AS cohorts. More recently, exercise interventions have also been directed towards aerobic and muscular fitness [22][23][24]44]. With aerobic capacity being significantly associated with ASQoL score, aerobic training could potentially offer additional improvements in patient QoL.…”

“…Exercise-based interventions have traditionally focused on flexibility and spinal mobility [19]. Multimodal exercise programmes, integrating aerobic and strength components, have shown additional beneficial effects on physical fitness [21][22][23][24]. The optimal exercise programme remains unclear [19,20].…”

Barriers and Facilitators of Vigorous Cardiorespiratory Training in Axial Spondyloarthritis: Surveys Among Patients, Physiotherapists, and Rheumatologists

“…Large observation studies provide strong evidence that the intensity, but not the amount, of cardiorespiratory exercise is of significance for an effective reduction of the CVD risk in healthy individuals (6,7). Given the increased CVD risk in patients with axial SpA and the potential protective effect of cardiorespiratory fitness (8) and its safety (9), the inclusion of vigorous cardiorespiratory training (CRT) in exercise programs for patients with axial SpA is highly relevant. Vigorous CRT corresponds to 65-90% of maximum heart rate or energy expenditure of ≥6 metabolic equivalents for ≥20 minutes performed ≥3 days/week (5).…”

Le risque cardiovasculaire dans la spondyloarthrite axiale

“…Le rapport cholestérol total/cholestérol HDL doit être utilisé ; les statines, les inhibiteurs de l'enzyme de conversion et/ou les antagonistes de l'angiotensine II doivent être utilisés de préférence en raison de leurs effets pléiotropes ; les corticoïdes et AINS sont à utiliser avec précaution avec la plus petite dose possible ; le tabac doit être arrêté. L'activité physique, et plus particulièrement l'exercice cardiorespiratoire, a démontré son efficacité en améliorant le profil de risque cardiovasculaire chez les patients ayant une SA en diminuant les facteurs de risque cardiovasculaire comme par exemple le syndrome métabolique [30,31].…”