Supervised Group Exercise in Axial Spondyloarthritis: Patients' Satisfaction and Perspective on Evidence‐Based Enhancements

Abstract

Objective. Supervised group exercise (SGE) has been proven effective in patients with axial spondyloarthritis (SpA), but its contents and dosage do not always comply with current scientific insight. This aim of this study was to describe axial SpA patients' satisfaction with current SGE and perspective on potential evidence-based SGE enhancements.Methods. Patients with axial SpA who participated in SGE in 4 regions in The Netherlands (n = 118) completed a cross-sectional survey on their satisfaction with features of their current SGE (8 questions scored on a 3-point Likert scale; 1 overall grade, scored according to an 11-point scale) and their perspective on the introduction of appropriately dosed cardiorespiratory and strengthening exercise, monitoring of exercise intensity, periodic reassessments, patient education, and supervision by physical therapists with specific expertise (4 dichotomous questions and one 5-point Likert scale).Results. Most patients were satisfied with the current total intensity (84 of 112 patients [75%]), duration (93 of 111 patients [84%]), and load (89 of 117 patients [76%]) of the program and the proportion of mobility (102 of 114 patients [90%]), strengthening (90 of 115 patients [78%]), and cardiorespiratory exercise (82 of 114 patients [72%]). The median overall grade of the program was a 7 (interquartile range 7-8). Most patients agreed with the implementation of more frequent (home) exercise (73 of 117 patients [62%]), heart-rate monitoring (97 of 117 patients [83%]), and annual reassessments (97 of 118 patients [82%]), whereas 50% agreed with the introduction of patient education (37 of 74 patients). The majority found supervision by therapists specializing in axial SpA to be of high importance (105 of 118 patients [89%]).Conclusion. The majority of SGE participants with axial SpA were satisfied with current SGE but also agreed with enhancements in line with scientific evidence. Current satisfaction levels indicate that a planned implementation strategy, including education and addressing potential barriers and facilitators for the uptake of enhancements, is warranted.

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

“…Similar to patients without PT, only half of those with PT met the vigorous-intensity PA recommendation. This finding could be related to results from previous studies, showing that appropriately dosed aerobic PA is often not included in (PT) exercise programs [33,34]. A recent study on content of PT in axSpA patients found that in the Netherlands, aerobic exercises are only performed during individual PT in 22% of patients [32].…”

“…Ninety-nine patients had PT treatment at the time the study was conducted: 77 had individual PT treatment in a private practice only, 11 participated in axSpA-specific group exercise therapy only and 11 had both individual PT treatment in a private practice and group exercise therapy (on two different days). The group exercise therapy consisted of a standardized program comprising weekly land- and water based mobility and strengthening exercises and sports (mostly volleyball) in most patients [ 34 ]. Table 2 shows the duration, frequency and contents of current individual PT treatment.…”

“…There were no statistically significant differences between the proportions of participants with and without PT engaging in the different types of aerobic activities, besides engagement in group exercise and aqua-aerobics; these types of aerobic PA were executed by significantly more patients with PT. This difference is likely to be due to participants with group PT, which often consists of group exercise and hydrotherapy in the Netherlands [ 34 ]. In both groups, it appeared that walking (69%) and cycling (57%) were the most frequently performed aerobic activities.…”

“…In the Netherlands, PT for people with axSpA can both be offered on an individual basis or by means of axSpA-specific supervised group exercise. This group exercise usually consists of weekly land-and water based exercises supervised by a physical therapist and is organized by local patient associations for people with a rheumatic disease [34]. The study obtained ethical approval from the Leiden University Hospital Ethical committee (P14.326).…”

“…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][34][35].…”