High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients

Abstract

BackgroundExercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown.ObjectiveTo investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (axSpA).MethodAssessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with axSpA were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0–10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study.Results97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: −0.6 [–0.8 to –0.3], p<0.001 and BASDAI: −1.2 [–1.8 to –0.7], p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health.ConclusionHigh intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improves patients’ function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with axSpA.Trial registration numberNCT02356874.

Adequately dosed aerobic physical activity in people with axial spondyloarthritis: associations with physical therapy

“…Aerobic PA concerns PA executed with moderate or vigorous intensity. Recent studies suggest that vigorous-intensity PA is most effective in improving cardiorespiratory fitness and reducing cardiovascular risk [ 10 , 16 – 18 ] and it shows to be both beneficial and safe for people with axSpA [ 19 , 20 ]. Therefore, especially vigorous-intensity PA should be pursued by people with axSpA, at least by those without an increased risk of cardiovascular complications during exercise.…”

“…This is striking as relatively many axSpA patients have PT treatment [ 32 ] and it is generally acknowledged that apart from other health professionals, physical therapists play an important role in the promotion of PA [ 15 ]. However, it appears that aerobic PA may not be included in PT treatments often [ 32 ] and that the aerobic PA employed in exercise programs for people with axSpA is often inadequately dosed [ 20 , 33 – 35 ].…”

Obesity Increases Disease Activity of Norwegian Patients with Axial Spondyloarthritis: Results from the European Map of Axial Spondyloarthritis Survey

“…In addition to the strong link between inactivity and cardiovascular disease, which is prevalent comorbidity following these diseases [26,27], it is also growing evidence for the antiinflammatory effect of high-intensive exercise. The theoretical rationales for these mechanisms are thoroughly presented [28,29], and meta-analyses and clinical effect studies have demonstrated that intensive exercise is well tolerated and may reduce disease activity in axSpA patients [30,31].…”

“…The medical treatment options have revolutionized the field of rheumatology in the last decades, and many patients experience reduced disease burden as a result of effective biological medication [30,31,36]. Still, the axSpA patients in the EMAS cohort report the negative impact of overweight and obesity on disease activity.…”

Reliability of an adapted core strength endurance test battery in individuals with axial spondylarthritis

“…Participants exercise weekly in groups led by physiotherapists (PTs) in landbased or water-based settings. The objectives of the GET are to minimize the progressive spinal mobility restriction [17], reduce cardiovascular and biological risk factors [18], and maintain or increase muscle strength. According to the recommendations [3], annual fitness assessments are also part of the SVMB's quality concept.…”