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Rouse PC, Ingram T, Standage M, Sengupta R. Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey. Rheumatol Int 2024; 44:933-941. [PMID: 38506923 PMCID: PMC10980646 DOI: 10.1007/s00296-024-05557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/09/2024] [Indexed: 03/22/2024]
Abstract
The objective of this study is to examine the contribution of pain catastrophising to Axial Spondyloarthritis (axSpA) patient's physical function and to test the mediating role of fear of movement, and uniquely, the contribution of competence frustration to the fear-avoidance model. Participants (N = 98, 70% female, M age = 45.62, SD 12.16) completed an online survey (December 2020-May 2021) distributed in the United Kingdom via the National Axial Spondyloarthritis Society (n ≈ 3500; NASS, 2019). The PROCESS SPSS macro was used to test three mediation models using percentile bootstrap 95% confidence intervals (PBCI). A significant indirect effect on the relationship between pain and physical function via fear of movement (β = 0.10, 95% PBCI = 0.030-0.183) was observed (Model 1). Model 2 showed the relationship between pain catastrophising and physical function to be significantly mediated by fear of movement (β = 0.16, 95% PBCI = 0.005-0.322). Finally, Model 3 showed a significant indirect effect on the relationship between pain catastrophising and physical function via competence frustration (β = 0.15, 95% PBCI = 0.014-0.309) but not through fear of movement (β = 0.062, 95% PBCI = - 0.134 to 0.248). To our knowledge, this is the first study to examine and demonstrate the unique contribution of competence need frustration to the Fear-avoidance model in people that live with axSpA. Identifying modifiable factors that contribute to disease outcomes such as physical function can improve the care and quality of life for people living with a disease currently without a cure.
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Affiliation(s)
- Peter C Rouse
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Thomas Ingram
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Martyn Standage
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Combe Park, Bath, Avon, BA1 3NG, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
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Paul L, McDonald MT, McConnachie A, Siebert S, Coulter EH. Online physiotherapy for people with axial spondyloarthritis: quantitative and qualitative data from a cohort study. Rheumatol Int 2024; 44:145-156. [PMID: 37733042 PMCID: PMC10766789 DOI: 10.1007/s00296-023-05456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
Life-long exercise is essential in axial spondyloarthritis (axSpA) management; however, long-term adherence is challenging. Online exercise programmes are an alternative to face-to-face physiotherapy. (1) To measure adherence to a 12-month, individualised, online physiotherapy programme for people with axSpA, and investigate the effects on disease activity, spinal mobility, work ability, quality of life and function. (2) To investigate associations between programme adherence and outcomes. (3) To explore participants' views of the programme and factors affecting adherence. Participants were 'non-exercisers' recruited from rheumatology outpatient services. Adherence was measured using online diary entries. Outcomes included the BATH indices, health status (EQ5D), Ankylosing Spondylitis Quality of Life (ASQOL), exercise capacity (6MWT), Work, Productivity and Activity Impairment in AS (WPAI), Exercise Attitude Questionnaire (EAQ) and Exercise Motivations Inventory-2 (EMI-2) at baseline, 6 and 12 months. Interviews determined views on the intervention and factors affecting adherence. Fifty participants were recruited. Over the 52-week intervention, adherence (five times/week) ranged from 19% (± 30%) to 44% (± 35%). Significant improvements were found in disease activity (BASDAI), spinal mobility (BASMI), 6MWT, AsQoL and EQ5D-VAS at 6 and 12 months. There were no associations between adherence and baseline variables or demographics. Interviews suggested support from others, routine, and feeling the benefit positively affected adherence. Conversely, lack of motivation, life events and symptoms negatively affected adherence. A 12-month online physiotherapy programme significantly improved symptoms in people with axSpA who were not regular exercisers. Adherence reduced over the intervention period. Online exercise programmes may benefit people with axSpA; however, strategies to improve adherence are required.
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Affiliation(s)
- L Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - M T McDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - A McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - E H Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, UK.
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Oksüz S, Unal E. Comparison of the effects of aerobic training alone versus aerobic training combined with clinical Pilates exercises on the functional and psychosocial status of patients with ankylosing spondylitis: A randomized controlled trial. Physiother Theory Pract 2023; 39:61-71. [PMID: 34791973 DOI: 10.1080/09593985.2021.2005199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To compare the effects of aerobic training versus aerobic training combined with clinical Pilates exercises (CPE) on the functional and psychosocial status of patients with ankylosing spondylitis (AS). Twenty-eight patients with ankylosing spondylitis (AS) were randomized into 2 groups. Group 1 (n = 14) performed both aerobic training and CPE, whereas group 2 (n = 14) performed aerobic training alone. Functional status of the patients was assessed using the Bath Ankylosing Mobility Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), back scratch test (BST), single leg stance test, functional reach test, a dynamometer, chair sit and stand test, and 6-minute walk test (6MWT), and the psychosocial status of the patients was assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, the Multidimensional Assessment of Fatigue (MAF), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety Depression Scale (HADS), and Tampa Scale of Kinesiophobia (TSK). Both training programs were conducted for 8 weeks, and then, the assessments were repeated. A statistically significant improvement was observed in the BASMI (p = .001), BASDAI (p = .001), BASFI (p = .002), BST (right, p = .05; left, p = .025), functional reach test (p = .013), back muscle strength (p = .033), 6MWT (p = .011), ASQoL (p < .001), MAF (p = .01), and PSQI (p = .013) scores in group 1. A significant difference was observed in the BASDAI (p = .028), chair sit and stand test (p = .022), 6MWT (p = .04), and ASQoL (p = .04) scores in group 2. CPE in addition to aerobic training was more effective in improving the functional and psychosocial status of the patients with AS.
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Affiliation(s)
- Sevim Oksüz
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Eastern Mediterranean University, Famagusta Turkey
| | - Edibe Unal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazar Ankara, Turkey
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Hilberdink B, van der Giesen F, Vliet Vlieland T, van Bodegom-Vos L, Van Weely S. Implementing enhancements in supervised group exercise for people with axial spondyloarthritis: a hybrid effectiveness-implementation study. Scand J Rheumatol 2023; 52:60-68. [PMID: 34788187 DOI: 10.1080/03009742.2021.1992845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The content of supervised group exercise (SGE) for axial spondyloarthritis (axSpA) has hardly changed in recent decades, despite new evidence-based insights to improve SGE quality. This pilot implementation study evaluated the effects and feasibility of enhancements in axSpA-specific SGE in four regions in the Netherlands. METHOD The implemented enhancements included: more high-intensity aerobic exercise; exercise personalization with periodic assessments; and patient education on home exercise. The implementation strategy included a one-day supervisor training course and telephone support. To evaluate effects, aerobic capacity [Six-Minute Walk Test (6MWT)], physical functioning [Ankylosing Spondylitis Performance-based Improvement (ASPI); improved/not improved], health status [Assessment of SpondyloArthritis international Society Health Index (ASAS HI) questionnaire], and home exercise engagement [Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH)] were assessed at baseline and after one year in 60 participants. Changes were analysed with the Wilcoxon signed-rank test. To evaluate feasibility, a survey of participants and semi-structured interviews with four SGE supervisors assessed uptake and satisfaction with the enhancements. RESULTS Aerobic capacity increased significantly and 35% of participants improved functioning, whereas health status and home exercise engagement did not change. The participants' survey and supervisors' interviews showed that high-intensity aerobic exercise was implemented successfully, exercise personalization and periodic assessments were implemented partially, and patient education was not implemented at all. Most participants were satisfied with the changes. CONCLUSIONS After this pilot implementation, SGE enhancements were only partially implemented. Nevertheless, aerobic capacity improved significantly and satisfaction with accomplished changes was high. Nationwide implementation would require adaptations to improve feasibility.
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Affiliation(s)
- B Hilberdink
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - F van der Giesen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - S Van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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Salbaş E, Karahan AY. The effectiveness of hippotherapy simulation exercises for muscle strength, disease activity and quality of life in sedentary adults with ankylosing spondylitis. Ann Med 2023; 55:2249822. [PMID: 37643349 PMCID: PMC10467537 DOI: 10.1080/07853890.2023.2249822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION/OBJECTIVE Newly created systems called hippotherapy simulators (HS) mimic the primitive movements of a live horse. As they are new systems, research examining their usefulness has been well received. The aim of this study is to research the effects of HS on disease activity, quality of life and muscle strength in patients with ankylosing spondylitis (AS). METHODS In a prospective, assessor-blinded, block-randomized trial, 48 AS patients were randomly assigned in a 1:1 ratio to receive either HS or conventional home (CH) exercise therapy. All Participants received 48 sessions, that is 4 sessions a week for 12 consecutive weeks. The primary outcome measures included the quadriceps muscle strength, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Ankylosing Spondylitis Quality of Life Scale (ASQoL). RESULTS Both groups demonstrated significant improvement in BASDAI, BASFI, BASMI, ASQoL and muscle strength scores compared to the baseline (p < 0.05). BASDAI, BASFI and BASMI scores decreased significantly in the HS group compared to the CH group at week 12 (p=.005, p=.003, p=.045, respectively), but there was no significant difference between the groups in terms of ASQoL and muscle strength scores at week 12 (p=.245, p=.212, respectively). CONCLUSIONS The results of this clinical trial of HS exercises for AS patients indicate a positive effect on disease activity, quality of life and muscle strength. Therefore, horse-riding simulator exercises can be used as an alternative method for the management of individuals with AS.
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Affiliation(s)
- Ender Salbaş
- Physical Medicine and Rehabilitation, Bandirma Training and Research Hospital, Balikesir, Turkey
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Lane B, McCullagh R, Cardoso JR, McVeigh JG. The effectiveness of group and home-based exercise on psychological status in people with ankylosing spondylitis: A systematic review and meta-analysis. Musculoskeletal Care 2022; 20:758-771. [PMID: 35437893 DOI: 10.1002/msc.1641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is an inflammatory rheumatic disease in which the physical impact has been evaluated; however, the psychological consequences are less well explored. The primary aim of this review was to determine the effectiveness of group versus home-based exercises on psychological status of patients with AS. METHODS Six databases were searched until January 2020. Eligible studies were randomised controlled trials including group or home-based exercise interventions. Risk of bias (RoB) was evaluated using the Cochrane RoB 2.0 tool. Relative percentage difference (RPD) between groups and effect sizes were presented as standardised mean differences (SMDs) with 95% confidence intervals (CI). RESULTS Five studies met the inclusion criteria (n = 240), outcomes of interest were depression, anxiety and mental health. Three studies were low-risk RoB, one study was high-risk RoB and one study there was 'some concerns' of bias. Group-based exercise was more effective than home-based exercise for improving depression at 6-week (RPD 18%) and 3-month (RPD 42%), anxiety (RPD 17%) and mental health (RPD 20%). Home-based exercise was more effective than control interventions for improving depression (RPD 33%). A meta-analysis demonstrated group-based exercises compared to home exercises, improved depression (SMD: -0.54; 95% CI: [-0.89; -0.18]; p = 0.003) and physical function (SMD: -0.49; 95% CI: [-0.84; -0.14]; p = 0.006). CONCLUSION Supervised group-based demonstrated improvements in depression, anxiety and mental health compared to home-based exercise. Individualised home-based exercise is more effective than no intervention for improving depression in people with AS.
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Affiliation(s)
- Brian Lane
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jefferson R Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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Vogt UP, Rausch AK, Niedermann K. Welche Kommunikationstechniken sind bei Physiotherapeut*innen während einer Bewegungsberatung mit Personen mit axialer Spondyloarthritis identifizierbar? – Eine Querschnittstudie. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1684-4508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Zusammenfassung
Hintergrund Die Schweizerische Vereinigung Morbus Bechterew (SVMB) hat kürzlich das BeFit-Konzept in der Gruppentherapie für Personen mit axialer Spondyloarthritis (axSpA, umgangssprachlich M. Bechterew) implementiert. Ein wichtiger Bestandteil des BeFit-Konzepts ist eine gezielte Bewegungsberatung zur Förderung von selbstständigem Training. Die Kommunikationskompetenz von Physiotherapeut*innen (PT) gilt dabei als Voraussetzung für eine gelungene und wirksame Patientenedukation (PE), ist bisher aber wenig untersucht.
Ziel Analyse, welche Kommunikationstechniken PT während der Bewegungsberatung mit Personen mit axSpA anwenden.
Methode Es wurde eine Querschnittstudie mit PT und Personen mit axSpA der SVMB-Gruppentherapien durchgeführt. Die Bewegungsberatungen wurden mit Audio aufgenommen, die Kommunikationstechniken anhand des Manuals „The Calgary Cambridge Referenced Observation Guide One“ identifiziert. Das Manual enthält 5 Gesprächsabschnitte (1. Einleiten der Sitzung, 2. Informationssammlung, 3. Strukturierung der Konsultation, 4. Beziehungsaufbau, 5. Beenden der Sitzung) mit 38 Techniken, wovon 6 nicht analysiert werden konnten. Eingeschlossen wurden die Techniken, die mindestens einmal identifiziert wurden. Je strukturierter die Beratung war und je mehr Techniken identifiziert wurden, desto besser konnte die Kommunikation der PT während der Beratungsgespräche bewertet werden.
Ergebnisse Es nahmen 12 PT und 41 Personen mit axSpA teil. Somit wurden 41 Bewegungsberatungen ausgewertet. Insgesamt wurden bei 10 von 12 (85 %) der PT in allen Beratungen die 32 eingeschlossenen Kommunikationstechniken mit einer Häufigkeit der einzelnen Techniken zwischen einmal und 41-mal identifiziert. Der Gesprächsabschnitt „Strukturierung der Konsultation“ zeigte die höchste Häufigkeit zwischen 29- und 41-mal.
Schlussfolgerung Die strukturierte Kommunikation ist ein wesentlicher Bestandteil der PE. Die Ergebnisse zeigen, dass die Mehrheit der PT die Bewegungsberatungen mit Patient*innen mit axSpA strukturiert durchführten und die Kommunikationstechniken umfassend identifiziert werden konnten. Die unterschiedlich häufige Anwendung der einzelnen Techniken kann dazu genutzt werden, die Kommunikation der PT in den Bewegungsberatungen für Personen mit axSpA gezielt zu schulen und zu optimieren.
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Affiliation(s)
- Ulisse Patrizio Vogt
- Zürcher Hochschule für Angewandte Wissenschaften (ZHAW), Institut für Physiotherapie, Winterthur, Schweiz
| | - Anne-Kathrin Rausch
- Zürcher Hochschule für Angewandte Wissenschaften (ZHAW), Institut für Physiotherapie, Winterthur, Schweiz
| | - Karin Niedermann
- Zürcher Hochschule für Angewandte Wissenschaften (ZHAW), Institut für Physiotherapie, Winterthur, Schweiz
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Hilberdink B, Carbo M, Paap D, Arends S, Vlieland TV, van der Giesen F, Spoorenberg A, van Weely S. Differences in characteristics, health status and fulfilment of exercise recommendations between axial spondyloarthritis patients with and without supervised group exercise. Semin Arthritis Rheum 2022; 55:152035. [DOI: 10.1016/j.semarthrit.2022.152035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
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Cho K, Kang A. Home-based rehabilitation in patients over 60 with stabilized ankylosing spondylitis during the COVID-19 pandemic. J Back Musculoskelet Rehabil 2022; 35:261-269. [PMID: 34806597 DOI: 10.3233/bmr-210153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND COVID-19 has become a significant healthcare issue, particularly challenging for patients with ankylosing spondylitis (AS), because immune-related diseases and their treatments could adversely affect the susceptibility to or severity of a viral infection. OBJECTIVE This study is conducted to present an exercise rehabilitation program that patients older than 60 years with AS can do at home during the COVID-19 pandemic. METHODS Three Delphi surveys were conducted to reach a consensus on home-based rehabilitation programs. This study recruited ten experts and performed three Delphi rounds for a month. RESULTS The expert panel suggested that home-based rehabilitation for the patients should be carried out with a clear rehabilitation goal. Their final recommendations are to institute a program aimed to ease symptoms, such as pain and stiffness; encourage patients to consult with experts regularly to ensure that they perform exercise rehabilitation properly at home; add fast walking and stretching to the rehabilitation program; and see if indoor cycling, Pilates, or yoga could be appropriate. CONCLUSIONS This study suggests that patients with AS over 60 should repeat low-intensity exercises, such as stretching, for an hour a day, four to six times a week during the COVID-19 pandemic.
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Affiliation(s)
- Kyunghwan Cho
- Department of Health Rehabilitation, Hanshin University, Korea
| | - Austin Kang
- Department of Forensic Medicine, Seoul National University, Korea
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Botta RM, Palermi S, Tarantino D. High-intensity interval training for chronic pain conditions: a narrative review. J Exerc Rehabil 2022; 18:10-19. [PMID: 35356137 PMCID: PMC8934613 DOI: 10.12965/jer.2142718.359] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Chronic pain is defined as pain that persists past the normal healing time. Physical activity and exercise programs are increasingly being promoted and used for a variety of chronic pain conditions. Evidence suggests that physical exercise is an intervention with few adverse events that may improve pain severity and physical function, thus improving the quality of life. High-intensity interval training (HIIT) has been shown to improve physical outcome measures and to decrease disorder-related disability in people with chronic disorders. Since an overview of the benefits of HIIT on chronic pain conditions has not been published yet, this review aims to report the effects of HIIT alone or in combination with other forms of training on different kind of chronic pain conditions. A search in the main scientific electronic databases was performed. The results of the studies included in this review showed that HIIT is beneficial for several chronic pain conditions, improving pain and physical function. Since HIIT could represent a valid help to conventional drug therapies, it could improve the quality of life of these subjects. The actual quality of evidence remains very low, and further high evidence studies are needed to confirm the promising outcomes reported in this review.
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Affiliation(s)
- Riccardo Maria Botta
- Anesthesia and Intensive Care, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro,
Italy
| | - Stefano Palermi
- Department of Public Health, University of Naples Federico II, Naples,
Italy
| | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, Naples,
Italy
- Corresponding author: Domiziano Tarantino, Department of Public Health, University of Naples Federico II, Via Sergio Pansini nr. 5, 80131 Naples, Italy,
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Wang Y, Liu X, Wang W, Shi Y, Ji X, Hu L, Wang L, Yin Y, Xie S, Zhu J, Zhang J, Jiao W, Huang F. Adherence, Efficacy, and Safety of Wearable Technology-Assisted Combined Home-Based Exercise in Chinese Patients With Ankylosing Spondylitis: Randomized Pilot Controlled Clinical Trial. J Med Internet Res 2022; 24:e29703. [PMID: 35040798 PMCID: PMC8808346 DOI: 10.2196/29703] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 10/23/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022] Open
Abstract
Background Clinical practice guidelines recommend that exercise is essential in the self-management of ankylosing spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be difficult and patients may decline participation, whereas effective home-based exercise interventions that do not require regular medical center visits are likely to be more accessible for AS patients. Objective The goal of the research was to investigate the adherence, efficacy, and safety of a wearable technology–assisted combined home-based exercise program in AS. Methods This was a 16-week investigator-initiated, assessor-blinded, randomized, pilot controlled trial conducted at Chinese People’s Liberation Army General Hospital. We enrolled patients with AS who had no regular exercise habits and had been stable in drug treatment for the preceding month. Patients were randomly assigned (1:1) using a computer algorithm. An exercise program consisting of moderate-intensity aerobic exercise and functional exercise was given to the patients in the intervention group. The exercise intensity was controlled by a Mio FUSE Heart Rate Monitor wristband, which uses photoplethysmography to measure heart rate. Patients in the control group received usual care. The primary outcome was the difference in the Ankylosing Spondylitis Disease Activity Score (ASDAS). The secondary outcomes were patient global assessment (PGA), physician global assessment (PhGA), total pain, nocturnal pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BAS Functional Index (BASFI), BAS Metrology Index (BASMI), Spondyloarthritis International Society Health Index (ASAS HI), 36-item Short Form Survey (SF-36), maximal oxygen uptake (VO2) max, body composition, range of motion of joints, and muscle endurance tests. Retention rate, adherence rate, barriers to being active, and adverse events were also assessed. Results A total of 77 patients were screened, of whom 55 (71%) patients were enrolled; 2% (1/55) withdrew without treatment after randomization. Patients were assigned to the intervention (n=26) or control group (n=28). The median adherence rate of the prescribed exercise protocol was 84.2% (IQR 48.7%-97.9%). For the primary outcome, between-group difference of ASDAS was significant, favoring the intervention (–0.2, 95% CI –0.4 to 0.02, P=.03). For the secondary outcomes, significant between-group differences at 16 weeks were detected in PGA, PhGA, total pain, BASDAI, BASDAI-fatigue, BASDAI–spinal pain, BASDAI–morning stiffness intensity, BASFI, and BASMI. Moreover, the frequency of difficulty in ASAS HI-motivation at 16 weeks was less in the intervention group (P=.03). Between-group difference for change from baseline were also detected in VO2 max, SF-36, back extensor endurance test, and the range of motion of cervical lateral flexion at 16 weeks. Lack of time, energy, and willpower were the most distinct barriers to being active. Incidences of adverse events were similar between groups (P=.11). Conclusions Our pilot study suggests that this technology-assisted combined home-based exercise program can improve the clinical outcomes of patients with AS who have no exercise habit, with good adherence and safety profile. Trial Registration Chinese Clinical Trial Registry ChiCTR1900024244; http://www.chictr.org.cn/showproj.aspx?proj=40176
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Affiliation(s)
- Yiwen Wang
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xingkang Liu
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.,College of Sport Medicine and Sport Rehabilitation, Beijing Sport University, Beijing, China
| | - Weimin Wang
- Health Management Institute, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yanyun Shi
- Health Management Institute, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaojian Ji
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lidong Hu
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lei Wang
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yiquan Yin
- Advanced Research Institute of Olympic, Beijing Sport University, Beijing, China
| | - Siyuan Xie
- College of Sport Medicine and Sport Rehabilitation, Beijing Sport University, Beijing, China
| | - Jian Zhu
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jianglin Zhang
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wei Jiao
- College of Sport Medicine and Sport Rehabilitation, Beijing Sport University, Beijing, China
| | - Feng Huang
- Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese People's Liberation Army General Hospital, Beijing, China
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Braun J, Baraliakos X, Kiltz U. Treat-to-target in axial spondyloarthritis - what about physical function and activity? Nat Rev Rheumatol 2021; 17:565-576. [PMID: 34312518 DOI: 10.1038/s41584-021-00656-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
In patients with axial spondyloarthritis (axSpA), pain, functional and structural impairments, reduced mobility and potential deformity of the axial skeleton are the most prominent health concerns. Limitations in physical function and spinal mobility are caused by both inflammation and structural damage, and therefore restrictions to physical function must be monitored throughout a patient's life. Consequently, the assessment of physical function is recommended as a key domain in the Assessment of Spondyloarthritis International Society-OMERACT Core Outcome Set. However, in comparison with disease activity, physical function seems to be a relatively neglected target of intervention in patients with axSpA, even though physical function is a major contributor to costs and disability in this disease. This Review aims to reacquaint rheumatologists with the targets for physical function, physical activity and performance by giving guidance on determinants of physical function and how physical function can be examined in patients with axSpA.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany
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Nolte K, van Rensburg DCJ, Fletcher L. Effects of a 6-month exercise programme on disease activity, physical and functional parameters in patients with ankylosing spondylitis: Randomised controlled trial. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1546. [PMID: 34230900 PMCID: PMC8252160 DOI: 10.4102/sajp.v77i1.1546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/19/2021] [Indexed: 11/01/2022] Open
Abstract
Background Exercise forms an important component in the management of ankylosing spondylitis (AS). The objective of our study was to determine the effects of a 6-month swimming, land-based stretching, strengthening and breathing exercise intervention in AS patients. Methods/design A total of 29 (14 females, 15 males) patients diagnosed with AS according to the Modified New York Criteria participated in our study. Participants were randomly assigned to an exercise group (ASE) (16 participants) and a control group (ASC) (13 participants). Erythrocyte sedimentation rate and C-reactive protein (CRP); anthropometric measurements; pulmonary function; aerobic capacity; balance; Bath AS Metrology Index; Bath AS Disease Activity Index and the Bath AS Functional Index were assessed. Discussion Erythrocyte sedimentation rate and CRP did not change notably within or between the groups from pre- to post-intervention. The between group analyses of the physical assessments favoured the ASE with observable improvements in chest expansion (p = 0.002), forced expiration volume (p = 0.012), absolute (p = 0.017) and relative (p = 0.003) maximal oxygen consumption, absolute (p = 0.028) and relative (p = 0.001) physical work capacity. Within the ASE, there is statistical evidence of improvements in 11 of the 19 physical variables. Within the ASC, five of the physical variables deteriorated substantially (p between 0.004 and 0.037) and only balance overall stability on the right improved (p = 0.016). The three functional assessments in the ASE improved (p < 0.007) compared with the ASC post-intervention. A 6-month combined exercise programme may improve physical and functional capacity of AS patients. Conclusion A multimodal exercise intervention may be useful in the management of ankylosing spondylitis. Clinical implications An unsupervised well -explained exercise programme combining swimming, land-based strengthening and stretching exercises and breathing exercises may be an option for patients with ankylosing spondylitis. Trial registration Registration not undertaken at the time of writing.
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Affiliation(s)
- Kim Nolte
- Department of Physiology, Division of Biokinetics and Sport Science, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | | | - Lizelle Fletcher
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
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Physical therapy in axial spondyloarthritis: guidelines, evidence and clinical practice. Curr Opin Rheumatol 2021; 32:365-370. [PMID: 32453037 DOI: 10.1097/bor.0000000000000714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Physical therapy is recommended for the management of axial spondyloarthritis (axSpA) with the focus of promoting physical activity and prescribing exercise within four domains, outlined recently by the European League against Rheumatism (EULAR): aerobic, resistance, flexibility and neuro-motor exercise. There is an increasing evidence base to support physical therapy interventions in axSpA. RECENT FINDINGS We present evidence supporting the use of exercise as treatment for patients with axSpA, recent updates among different exercise modalities, and make clear its critical place in the management of this condition. Recent large, multicentre data have shown that high-intensity exercise can improve disease activity and also positively impact cardiovascular risk factors in these patients. Although international treatment guidelines advocate the inclusion of physical activity and exercise for the optimal management of axSpA, specific guidance about the amount of exercise required to produce a beneficial effect is lacking. SUMMARY Exercise must be used in the management of axSpA, and whilst hydrotherapy and flexibility exercises are traditionally the main focus, other applications, such as strength training, may be underutilized domains. Further studies are needed to determine the dose-response relationship between exercise and axSpA patient subsets.
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Rausch AK, Baltisberger P, Meichtry A, Topalidis B, Ciurea A, Vliet Vlieland TPM, Niedermann K. Reliability of an adapted core strength endurance test battery in individuals with axial spondylarthritis. Clin Rheumatol 2021; 40:1353-1360. [PMID: 32959189 PMCID: PMC7943491 DOI: 10.1007/s10067-020-05408-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To adapt the core strength endurance test battery (aCSE), previously used for testing athletes, to a target group of patients with axial spondylarthritis (axSpA), to evaluate its intra-tester reliability and its associations with disease-specific factors. METHODS A cross-sectional study was conducted at axSpA exercise therapy groups, including both axSpA patients and the physiotherapist group leaders (PTs). The aCSE was used to measure the isometric strength endurance of the ventral, lateral, and dorsal core muscle chains (measured in seconds), as well as to assess the disease-specific factors of functional status, self-reported pain, and perceived strength performance. The aCSE was repeated after 7-14 days to measure intra-tester reliability for the same rater (PT group leader). Reliability was calculated as an intra-class correlation coefficient (ICC) using a nested design. The associations between ventral, lateral, and dorsal strength endurance and the disease-specific factors were calculated using Pearson correlation coefficients. RESULTS Study participants were 13 PT group leaders and 62 axSpA patients. The latter were all capable of performing the aCSE, with the exception of one individual. A moderate to substantial intra-rater reliability (ICCs (95%CI)) was found for the ventral (0.54 (0.35, 0.74)), lateral (0.52 (0.33, 0.70)), and dorsal (0.71 (0.58, 0.86)) core muscle chains. None of the aCSE measures correlated with the disease-specific factors. CONCLUSION The aCSE was found to be a reliable test battery for assessing core strength endurance in axSpA patients. Interestingly, aCSE performance was not associated with any disease-specific factors. Key Points • The adapted core strength endurance test battery measures the isometric strength of the ventral, lateral and dorsal core muscle chains. • The adapted core strength endurance test battery showed a moderate to substantial intra-rater reliability for all three muscle chains tested in axSpA patients. • No correlations were found between the adapted core strength endurance test battery and the disease-specific factors of self-reported pain, functional status and perceived strength performance.
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Affiliation(s)
- Anne-Kathrin Rausch
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, 8401, Winterthur, Switzerland.
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
| | - Philipp Baltisberger
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, 8401, Winterthur, Switzerland
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, 8401, Winterthur, Switzerland
| | - Beatrice Topalidis
- Ankylosing Spondylitis Association of Switzerland, 8050, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, 8091, Zurich, Switzerland
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
| | - Karin Niedermann
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, 8401, Winterthur, Switzerland
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Yurdakul OV, Ince OE, Bagcier F, Kara M, Kultur E, Aydin T. Evaluating the strength of spinal and proximal girdle muscles in patients with axial spondyloarthritis: Correlation with activity, disability, and functionality. Int J Rheum Dis 2021; 24:701-710. [PMID: 33750032 DOI: 10.1111/1756-185x.14102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 01/01/2023]
Abstract
AIM To compare the muscle strength of muscle groups in axial spondyloarthritis (axSpA) patients with the muscle powers of healthy volunteers and to examine the relationship of muscle strengths with disease activity, functionality, and disability. METHOD One hundred males (50 axSpA, 50 healthy) were included in the study. Bath Disease Activity Index (BASDAI), Functional Index (BASFI), and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were recorded. The maximum (max) and mean cervical flexion, extension, lateral flexion (CF, CE, CLF), truncal flexion, extension (TF, TE), root joint flexion, extension, abduction, internal and external rotation (SF, SE, SAB, SIR and SER for the shoulder; HF, HE, HAB, HIR and HER for the hip) muscle strengths of the patients in both groups were measured by a handheld dynamometer. Total muscle strength (CT, TT, ST, HT) was found according to the sum of the max and mean values for each region. RESULTS All muscle strengths were lower in the axSpA group compared to the healthy volunteers. The symptom duration was found to have a weak-moderate negative correlation with CT, TT, ST, HT and all individual muscle strengths except for the TE, CF, HIR, and HER. BASDAI and HAQ-DI had weak-moderate negative correlations with HIR and HER. BASFI had a weak-moderate negative correlation with cervical measurements, TE, TF, SF, SER, SIR, and hip measurements. CONCLUSION All muscle strengths were lower in patients compared to healthy volunteers. Strengthening specific muscle groups for the desired goal can be a reasonable strategy. The study is prospectively registered and available at www.clinicaltrials.gov (NCT04435860).
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Affiliation(s)
- Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Ozlenen Eylul Ince
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Fatih Bagcier
- Cam and Sakura State Hospital, Physical Medicine and Rehabilitation Clinic, Istanbul, Turkey
| | - Mert Kara
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Esra Kultur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Teoman Aydin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
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Organisation and content of supervised group exercise for people with axial spondyloarthritis in The Netherlands. Rheumatol Int 2020; 41:391-401. [PMID: 33244645 PMCID: PMC7835145 DOI: 10.1007/s00296-020-04742-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 01/10/2023]
Abstract
Supervised group exercise (SGE) is recommended for people with axial spondyloarthritis (axSpA). Recent literature suggests that its contents and dosage must probably be revised. As a first step towards renewal, this study examined the current SGE organisation and content for people with axSpA in The Netherlands. A pen-and-paper survey was sent to the boards of the 82 local patient associations affiliated with the Dutch Arthritis Society in 2016. One member of each board was asked to complete questions on the nature and organisation of SGE and one of the supervising therapists to complete questions on the SGE supervision and contents. The questionnaire was returned by representatives of 67/82 (82%) local patient associations, of which 17 (25%) provided axSpA-specific SGE (16/17 SGE programmes with both land-based exercise and hydrotherapy and 1/17 with only hydrotherapy). These involved in total 56 groups with 684 participants and 59 supervisors, of whom 54 were physical therapists and 21 had had postgraduate education on rheumatic and musculoskeletal diseases (RMDs). Besides mobility and strengthening exercises and sports (17/17), most programmes included aerobic exercise (10/17), but rarely with heart rate monitoring (1/17), patient education (8/17), periodic assessments (2/17), or exercise personalisation (1/17). In the Netherlands, a quarter of local patient associations organised axSpA-specific SGE, mostly containing land-based exercises combined with sports and hydrotherapy. Most supervisors lacked postgraduate education on RMDs and most programmes lacked intensity monitoring, patient education, periodic assessments, and personalisation, which are needed for optimising exercise programmes according to current scientific insights.
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Hoogeboom TJ, Kousemaker MC, van Meeteren NL, Howe T, Bo K, Tugwell P, Ferreira M, de Bie RA, van den Ende CH, Stevens-Lapsley JE. i-CONTENT tool for assessing therapeutic quality of exercise programs employed in randomised clinical trials. Br J Sports Med 2020; 55:1153-1160. [PMID: 33144350 PMCID: PMC8479742 DOI: 10.1136/bjsports-2019-101630] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE When appraising the quality of randomised clinical trial (RCTs) on the merits of exercise therapy, we typically limit our assessment to the quality of the methods. However, heterogeneity across studies can also be caused by differences in the quality of the exercise interventions (ie, 'the potential effectiveness of a specific intervention given the potential target group of patients')-a challenging concept to assess. We propose an internationally developed, consensus-based tool that aims to assess the quality of exercise therapy programmes studied in RCTs: the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool. METHODS Forty-nine experts (from 12 different countries) in the field of physical and exercise therapy participated in a four-stage Delphi approach to develop the i-CONTENT tool: (1) item generation (Delphi round 1), (2) item selection (Delphi rounds 2 and 3), (3) item specification (focus group discussion) and (4) tool development and refinement (working group discussion and piloting). RESULTS Out of the 61 items generated in the first Delphi round, consensus was reached on 17 items, resulting in seven final items that form the i-CONTENT tool: (1) patient selection; (2) qualified supervisor; (3) type and timing of outcome assessment; (4) dosage parameters (frequency, intensity, time); (5) type of exercise; (6) safety of the exercise programme and (7) adherence to the exercise programme. CONCLUSION The i-CONTENT-tool is a step towards transparent assessment of the quality of exercise therapy programmes studied in RCTs, and ultimately, towards the development of future, higher quality, exercise interventions.
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Affiliation(s)
- Thomas J Hoogeboom
- Radboud Institute for Health Sciences, IQ healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Nico Lu van Meeteren
- Executive Director, Top Sector Life Sciences & Health (Health~Holland), The Hague; Professor, Dept Anesthesiology, Erasmus MC, Rotterdam; CEO, Topcare, The Netherlands
| | - Tracey Howe
- Global Aging, Cochrane Collaboration, London, Oxfordshire, UK
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Akershus, Norway.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manuela Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
| | - Rob A de Bie
- Department of Epidemiology, Maastricht University, Maastricht, Limburg, The Netherlands
| | | | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA
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Cetin SY, Calik BB, Ayan A, Kabul EG. The effectiveness of 10-Tai Chi movements in patients with ankylosing spondylitis receiving anti-tumor necrosis factor α therapy: A randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Adequately dosed aerobic physical activity in people with axial spondyloarthritis: associations with physical therapy. Rheumatol Int 2020; 40:1519-1528. [PMID: 32596754 PMCID: PMC7371668 DOI: 10.1007/s00296-020-04637-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/19/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION This study aimed to compare the engagement in moderate- and vigorous-intensity PA in axSpA patients with and without current physical therapy (PT). METHODS In this cross-sectional study, a survey, including current PT treatment (yes/no) and PA, using the 'Short QUestionnaire to ASsess Health-enhancing PA' (SQUASH), was sent to 458 axSpA patients from three Dutch hospitals. From the SQUASH, the proportions meeting aerobic PA recommendations (≥ 150 min/week moderate-, ≥ 75 min/week vigorous-intensity PA or equivalent combination; yes/no) were calculated. To investigate the association between PT treatment and meeting the PA recommendations, odds ratios (OR) with 95% confidence intervals (95% CI) were estimated using logistic regression models, adjusting for sex, age, health status and hospital. RESULTS The questionnaire was completed by 200 patients, of whom 68%, 50% and 82% met the moderate-, vigorous- or combined-intensity PA recommendations, respectively. Ninety-nine patients (50%) had PT treatment, and those patients were more likely to meet the moderate- (OR 2.09 [95% CI 1.09-3.99]) or combined-intensity (OR 3.35 [95% CI 1.38-8.13]) PA recommendations, but not the vigorous-intensity PA recommendation (OR 1.53 [95% CI 0.80-2.93]). Aerobic exercise was executed in 19% of individual PT programs. CONCLUSION AxSpA patients with PT were more likely to meet the moderate- and combined-intensity PA recommendations, whereas there was no difference in meeting the vigorous-intensity PA recommendation. Irrespective of having PT treatment, recommendations for vigorous-intensity PA are met by only half of the patients. Implementation should thus focus on aerobic PA in patients without PT and on vigorous-intensity PA in PT programs.
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Hilberdink B, van der Giesen F, Vliet Vlieland T, van Gaalen F, van Weely S. Supervised Group Exercise in Axial Spondyloarthritis: Patients' Satisfaction and Perspective on Evidence-Based Enhancements. Arthritis Care Res (Hoboken) 2020; 72:829-837. [PMID: 30927518 PMCID: PMC7317594 DOI: 10.1002/acr.23892] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
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.
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Sveaas SH, Dagfinrud H, Berg IJ, Provan SA, Johansen MW, Pedersen E, Bilberg A. High-Intensity Exercise Improves Fatigue, Sleep, and Mood in Patients With Axial Spondyloarthritis: Secondary Analysis of a Randomized Controlled Trial. Phys Ther 2020; 100:1323-1332. [PMID: 32367124 PMCID: PMC7439225 DOI: 10.1093/ptj/pzaa086] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 09/04/2019] [Accepted: 02/11/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Although exercise is recommended in the treatment of axial spondyloarthritis (axSpa), the focus has been on flexibility, and the effect of high-intensity exercises is unknown. The purpose of this study was to investigate the effect of high-intensity exercises on fatigue, sleep, and mood in patients with axSpA. METHODS In this secondary analysis of a randomized controlled trial, participants were recruited from outpatient clinics at 4 hospitals in Scandinavia. A total of 100 patients with axSpA were randomized to either an exercise group (n = 50) or a control group (n = 50). High-intensity exercise was provided 3 times per week for 3 months and supervised by a physical therapist. The controls received no intervention. Measurements were self-reported at baseline, 3 months, and 12 months: fatigue, using the Fatigue Severity Scale (range = 0-7, 7 = worst, ≥5 = severe); vitality, using the RAND 36-item short-form health survey (SF-36, range = 0-100, 100 = best); sleep, using the Pittsburgh Sleep Quality Index (range = 0-21, 21 = worst, >5 = poor quality); mood, using the General Health Questionnaire 12 (range = 0-36, 36 = worst); and general health, using the EUROQoL (range = 0-100, 100 = best). RESULTS A total of 38 participants (76%) in the exercise group followed ≥80% of the exercise protocol. At 3 months, there was a significant beneficial effect on fatigue (mean group differences = -0.4, 95% CI = -0.7 to -0.1), vitality (5.0, 95% CI = 1.1 to 10.5), mood (-2, 95% CI = -3.7 to -0.04), and general health (9.0, 95% CI = 3.3 to 14.7) but no effect on sleep (-1.1, 95% CI = -2.1 to 0.2). Compared with the control group, the exercise group had a reduced rate of severe fatigue and poor sleep. No differences were seen between the groups at 12 months. CONCLUSIONS A 3-month exercise program had a beneficial effect on fatigue, sleep, mood, and general health in patients with axSpA at the end of the intervention; however, no long-term effects were seen. IMPACT High-intensity cardiorespiratory and strength exercises should be considered as important in exercise programs for patients with axSpA.
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Affiliation(s)
- Silje Halvorsen Sveaas
- Department of Rheumatology, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, Oslo, Norway,Address all correspondence to Dr Sveaas at:
| | - Hanne Dagfinrud
- Department of Rheumatology, Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital
| | | | | | | | - Elisabeth Pedersen
- Department of Physiotherapy, University Hospital of North Norway, Tromsø, Norway
| | - Annelie Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hilberdink B, van der Giesen F, Vliet Vlieland T, Nijkamp M, van Weely S. How to optimize exercise behavior in axial spondyloarthritis? Results of an intervention mapping study. PATIENT EDUCATION AND COUNSELING 2020; 103:952-959. [PMID: 31926668 DOI: 10.1016/j.pec.2019.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/23/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Many individuals with axial spondyloarthritis (axSpA) do not engage in adequate exercise, despite its proven health benefits. This study aimed to identify the intervention components needed to optimize exercise behavior in people with axSpA. METHODS The first three steps of the Intervention Mapping protocol were used: 1) needs assessment; 2) identification of axSpA-specific exercise barriers and facilitators (´determinants'); 3) selection of effective intervention components addressing potentially modifiable determinants. All three steps included scoping reviews and semi-structured interviews with patients (n = 2) and physical therapists (n = 2). RESULTS The scoping reviews included 28, 23 and 15 papers, respectively. Step 1 showed that only one third of axSpA patients exercise regularly, demonstrating especially a lack of strengthening and cardiorespiratory exercises. Based on eight determinants identified in Step 2, 10 intervention components were selected in Step 3: education, motivational interviewing, goal setting, action planning, monitoring, feedback, tailoring, guided practice, therapists' training and group exercise encouragement. CONCLUSION Using the Intervention Mapping method, 10 intervention components for optimizing exercise behavior in people with axSpA were identified and an intervention with behavior change guidance and a training for health professionals is proposed. PRACTICE IMPLICATIONS This study provides a foundation for the development of an axSpA-specific exercise intervention.
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Affiliation(s)
- Bas Hilberdink
- Leiden University Medical Center, Dept. of Orthopaedics, Rehabilitation and Physical Therapy, Leiden, the Netherlands.
| | | | - Thea Vliet Vlieland
- Leiden University Medical Center, Dept. of Orthopaedics, Rehabilitation and Physical Therapy, Leiden, the Netherlands
| | - Marjan Nijkamp
- Open University, Psychology and Educational Sciences, Heerlen, the Netherlands
| | - Salima van Weely
- Leiden University Medical Center, Dept. of Orthopaedics, Rehabilitation and Physical Therapy, Leiden, the Netherlands
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Basakci Calik B, Pekesen Kurtca M, Gur Kabul E, Telli Atalay O, Taskin H, Yigit M, Tasci M, Cobankara V. Investigation of the effectiveness of aerobic exercise training in individuals with ankylosing spondylitis: Randomized controlled study. Mod Rheumatol 2020; 31:442-450. [PMID: 32202181 DOI: 10.1080/14397595.2020.1745409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the effect of the addition of aerobic training to spinal mobility exercises on disease-specific outcomes and functional exercise capacity, aerobic capacity and respiratory muscle strength of ankylosing spondylitis (AS) patients. METHODS The study included 31 volunteers (mean age: 44.90 ± 11.52 years) diagnosed with AS. The demographic characteristics and disease-related data of all subjects were recorded, then, the Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI) and Bath AS Disease Function Index (BASFI), the 6-minute walk test, the Bruce Treadmill Test and spirometry were used, respectively. The intervention group attended a 12-week program of aerobic exercise sessions, plus supervised spinal mobility exercises, 3 days a week. The control group performed the supervised spinal mobility exercises only, 3 times a week, for 12 weeks. RESULTS There was a significant improvement in BASDAI (p = .002), BASMI (p = .021), 6 DYT (p = .036), VO2 max (p = .000), MIP (p = .005) and MEP (p = .022) results in the intervention group after 12 weeks of training. In the comparisons of the pre-treatment and post-treatment differences, BASDAI (p = .032) decreased and VO2 (p = .001) max increased, showing significant improvements in the intervention group and these values were maintained. CONCLUSION It is striking that improvements in all parameters except BASFI were achieved in the aerobic training group. These results demonstrate that an aerobic exercise program should be included in an individual exercise prescription for the management of AS.
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Affiliation(s)
- Bilge Basakci Calik
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | | | - Elif Gur Kabul
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Orcin Telli Atalay
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Harun Taskin
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Murat Yigit
- Department of Rheumatology, Medical School, Pamukkale University, Denizli, Turkey
| | - Murat Tasci
- Department of Rheumatology, Medical School, Pamukkale University, Denizli, Turkey
| | - Veli Cobankara
- Department of Rheumatology, Medical School, Pamukkale University, Denizli, Turkey
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Efficacite d’un programme d’entraînement individualise base sur la mesure directe du VO2max chez les malades porteurs de maladies chroniques ; le protocole PEP’C. Sci Sports 2020. [DOI: 10.1016/j.scispo.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Urkmez B, Keskin Y. Relationship between sleep quality and physical activity level in patients with ankylosing spondylitis. Mod Rheumatol 2019; 30:1053-1059. [PMID: 31810412 DOI: 10.1080/14397595.2019.1702139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: Aim of this study was to investigate whether there is a relationship between exercise level and sleep quality in AS patients.Method: In our study, 150 AS patients and 80 healthy controls were included. Physical activity levels of both groups were evaluated using International Physical Activity Questionnaire (IPAQ-s) short form. Sleep quality of the participants was evaluated using Pittsburgh Sleep Quality Index (PSQI). Disease activity and functional status were measured by Bath AS Disease Activity Index and Bath AS Functional Index.Results: Subjective sleep quality, habitual sleep efficiency, sleep disturbance and Total PSQI scores were significantly higher in the patient group compared to healthy participants. The IPAQ score was found to be significantly lower in the patient group. Sleep disturbance, one of the components of PSQI, was found to be significantly higher in patients with low IPAQ score.Conclusions: Sleep disorders were found to be higher in AS patients than normal population and physical activity levels of AS patients were lower than normal population. In addition, Sleep disturbance was found to be high in patients with low physical activity. Therefore, it should be remembered that one of the causes of sleep disorders in AS patients may be related to low physical activity.
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Affiliation(s)
- Berna Urkmez
- Deparment of Physical Therapy and Rehabilitation, Haydarpasa Numune Research and Training Hospital, Health Science University, Istanbul, Turkey
| | - Yasar Keskin
- Deparment of Physical Therapy and Rehabilitation, Bezmialem University, Istanbul, Turkey
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Regnaux J, Davergne T, Palazzo C, Roren A, Rannou F, Boutron I, Lefevre‐Colau M. Exercise programmes for ankylosing spondylitis. Cochrane Database Syst Rev 2019; 10:CD011321. [PMID: 31578051 PMCID: PMC6774752 DOI: 10.1002/14651858.cd011321.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise programmes are often recommended for managing ankylosing spondylitis (AS), to reduce pain and improve or maintain functional capacity. OBJECTIVES To assess the benefits and harms of exercise programmes for people with AS. SEARCH METHODS We searched CENTRAL, the Cochrane Library, MEDLINE Ovid, EMBASE Ovid, CINAHL EBSCO, PEDro, Scopus, and two trials registers to December 2018. We searched reference lists of identified systematic reviews and included studies, handsearched recent relevant conference proceedings, and contacted experts in the field. SELECTION CRITERIA We included reports of randomised controlled trials (RCT) of adults with AS that compared exercise therapy programmes with an inactive control (no intervention, waiting list) or usual care. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. MAIN RESULTS We included 14 RCTs with 1579 participants with AS. Most participants were male (70%), the median age was 45 years (range 39 to 47), and the mean symptom duration was nine years. The most frequently used exercises were those designed to help improve strength, flexibility, stretching, and breathing. Most exercise programmes were delivered along with drug therapy or a biological agent. We judged most of the studies at unclear or high risk of bias for several domains. All 14 studies provided data obtained immediately upon completion of the exercise programme. The median exercise programme duration was 12 weeks (interquartile range (IQR) 8 to 16). Three studies (146 participants) provided data for medium-term follow-up (< 24 weeks after completion of the exercise programmes), and one (63 participants) for long-term follow-up (> 24 weeks after completion of the exercise programmes). Nine studies compared exercise programmes to no intervention; five studies compared them to usual care (including physiotherapy, medication, or self-management).Exercise programmes versus no interventionAll data were obtained immediately upon completion of the exercise programme.For physical function, measured by a self-reporting questionnaire (the Bath Ankylosing Spondylitis Functional Index (BASFI) scale, 0 to 10; lower is better), moderate-quality evidence showed a no important clinically meaningful improvement with exercise programmes (mean difference (MD) -1.3, 95% confidence interval (CI) -1.7 to -0.9; 7 studies, 312 participants; absolute reduction 13%, 95% CI 17% to 9%).For pain, measured on a visual analogue scale (VAS, 0 to 10, lower is better), low-quality evidence showed an important clinically meaningful reduction of pain with exercise (MD -2.1, 95% CI -3.6 to -0.6; 6 studies, 288 participants; absolute reduction 21%, 95% CI 36% to 6%).For patient global assessment of disease activity, measured by a self-reporting questionnaire (the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scale, 0 to 10, lower is better), moderate-quality evidence showed no important clinically meaningful reduction with exercise (MD -0.9, 95% CI -1.3 to -0.5; 6 studies, 262 participants; absolute reduction 9%, 95% CI 13% to 5%).For spinal mobility, measured by a self-reporting questionnaire (the Bath Ankylosing Spondylitis Metrology Index (BASMI) scale, 0 to 10, lower is better), very low-quality evidence showed an improvement with exercise (MD -0.7 95%, -1.3 to -0.1; 5 studies, 232 participants) with no important clinical meaningful benefit (absolute reduction 7%, 95% CI 13% to 1%).For fatigue, measured on a VAS (0 to 10, lower is better), very low-quality evidence showed a no important clinically meaningful reduction with exercise (MD -1.4, 95% CI -2.7 to -0.1; 2 studies, 72 participants; absolute reduction 14%, 95% CI 27% to 1%).Exercise programmes versus usual careAll data were obtained immediately upon completion of the exercise programme.For physical function, measured by the BASFI scale, moderate-quality evidence showed an improvement with exercise (MD -0.4, 95% CI -0.6 to -0.2; 5 studies, 1068 participants). There was no important clinical meaningful benefit (absolute reduction 4%, 95% CI 6% to 2%).For pain, measured on a VAS (0 to 10, lower is better), moderate-quality evidence showed a reduction of pain with exercise (MD -0.5, 95% CI -0.9 to -0.1; 2 studies, 911 participants; absolute reduction 5%, 95% CI 9% to 1%). No important clinical meaningful benefit was found.For patient global assessment of disease activity, measured by the BASDAI scale, low-quality evidence showed a reduction with exercise (MD -0.7, 95% CI -1.3 to -0.1; 5 studies, 1068 participants), but it was not clinically important (absolute reduction 7%, 95% CI 13% to 1%) with important clinical meaningful benefitFor spinal mobility, measured by the BASMI scale, very low-quality evidence found a no important clinically meaningful improvement with exercise (MD -1.2, 95% CI -2.8 to 0.5; 2 studies, 85 participants; absolute reduction 12%, 95% CI 5% less to 28% more). There was no important clinical meaningful benefit.None of the studies measured fatigue.Adverse effectsWe found very low-quality evidence of the effect of exercise versus either no intervention, or usual care. We are uncertain of the potential for harm of exercises, due to low event rates, and a limited number of studies reporting events. AUTHORS' CONCLUSIONS We found moderate- to low-quality evidence that exercise programmes probably slightly improve function, may reduce pain, and probably slightly reduce global patient assessment of disease activity, when compared with no intervention, and measured upon completion of the programme. We found moderate- to low-quality evidence that exercise programmes probably have little or no effect on improving function or reducing pain, when compared with usual care, and may have little or no effect on reducing patient assessment of disease activity, when measured upon completion of the programmes. We are uncertain whether exercise programmes improve spinal mobility, reduce fatigue, or induce adverse effects.
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Affiliation(s)
- Jean‐Philippe Regnaux
- Université Rennes, EHESP, F‐3500 Rennes, France. ² Université de Paris , Equipe Epi Ageing, Inserm, CRESS‐ UMR1153ParisFrance
- EHESP School of Public HealthRennesFrance35043
- Centre Cochrane FrançaisParisFrance
| | | | - Clémence Palazzo
- Assistance Publique des Hôpitaux de Paris (AP‐HP.5), Hôpital CochinDepartment of Physical Medicine and Rehabilitation27, Rue du Faubourg Saint‐JacquesParisFrance75679
| | | | - François Rannou
- Sorbonne Paris Cité, Faculté de MédecineParis Descartes UniversityParisFrance
| | - Isabelle Boutron
- French Cochrane CenterParisFrance75004
- Sorbonne Paris Cité, Faculté de MédecineParis Descartes UniversityParisFrance
- INSERM U1153METHODS teamParisFrance
- AP‐HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel DieuCentre d'Épidémiologie Clinique1, place du Parvis Notre‐DameParisFrance
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Dreher M, Kosz M, Schwarting A. [Physical activity, exercise and nutrition in rheumatism : Adjuvant treatment options for inflammatory-rheumatic diseases]. DER ORTHOPADE 2019; 48:917-926. [PMID: 31562547 DOI: 10.1007/s00132-019-03808-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The positive effects of physical activity, physical training and an adaptation of diet on health have been scientifically proven for many diseases. Focusing on inflammatory rheumatic diseases and their potential comorbidities, positive effects are assumed from these two adjuvant treatment opportunities, which are examined in more detail in this review. MATERIAL AND METHODS Based on a literature search, randomized controlled trials (RCTs), non-RCT studies, reviews and recommendations from professional societies were included. RESULTS Physical activity and training show positive effects on the disease itself and also on its comorbidities with existing certainty. In addition, the exercise and training recommendations of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) provide recommendations, which were adapted by the European League Against Rheumatism (EULAR) to control intensity, duration and training extent. Nutritional medical approaches also provide preventive and rehabilitative beneficial possibilities. DISCUSSION The increase of physical activity, regular physical training and the adaptation of diet should be a basic additive component of the treatment of inflammatory rheumatic diseases. In individual sub-aspects, the study situation is very heterogeneous and requires further research.
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Affiliation(s)
- M Dreher
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - M Kosz
- ACURA Rheumazentrum Rheinland-Pfalz, Bad Kreuznach, Deutschland
| | - A Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland. .,ACURA Rheumazentrum Rheinland-Pfalz, Bad Kreuznach, Deutschland.
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Rouse PC, Standage M, Sengupta R. Living with ankylosing spondylitis: an open response survey exploring physical activity experiences. Rheumatol Adv Pract 2019; 3:rkz016. [PMID: 31528839 PMCID: PMC6735966 DOI: 10.1093/rap/rkz016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
Objective The aim was to gather in-depth, rich accounts of physical activity experiences of people living with AS, to include symptom management, consequences for symptoms, factors that encourage and disrupt physical activity, and motivations that underpin participation in physical activity. Methods Participants (n = 149; 60% female) completed a Bristol Online Survey that consisted of open questions to capture rich qualitative data. In total, 96% of participants self-reported having AS (1% other arthritis; 3% missing), and 51% had this diagnosis for >20 years. A content analysis was conducted to identify the key themes/factors from within the open question responses. A frequency analysis was used to ascertain the most commonly identified themes and factors. Results Fifty different physical activities were participated in over the previous month. Physical activity can improve and worsen arthritis symptoms, and fluctuations in participation exist even in the most active. Pain and fatigue were the two most frequently identified factors that stopped people with AS from being physically active. Participants reported more autonomously driven motivations than controlled motivations for participating in physical activity. Conclusion People with AS can and do participate in a diverse range of physical activities, but fluctuations in activity levels occur owing to disease- and non-disease-specific factors. Individually tailored plans and self-monitoring are important to optimize levels of physical activity and maximize benefits for people living with AS. Multiple reasons why AS patients participate in physical activity were revealed that included both adaptive (i.e. autonomous) and maladaptive (i.e. controlled) forms of motivation.
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Affiliation(s)
- Peter C Rouse
- Department for Health, Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
| | - Martyn Standage
- Department for Health, Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
| | - Raj Sengupta
- Rhuematology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath, Bath, UK
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Sveaas SH, Bilberg A, Berg IJ, Provan SA, Rollefstad S, Semb AG, Hagen KB, Johansen MW, Pedersen E, Dagfinrud H. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. Br J Sports Med 2019; 54:292-297. [DOI: 10.1136/bjsports-2018-099943] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/04/2022]
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.
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McDonald MT, Siebert S, Coulter EH, McDonald DA, Paul L. Level of adherence to prescribed exercise in spondyloarthritis and factors affecting this adherence: a systematic review. Rheumatol Int 2019; 39:187-201. [PMID: 30649569 PMCID: PMC6513902 DOI: 10.1007/s00296-018-4225-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 01/07/2023]
Abstract
Adherence is a primary determinant of the effectiveness of any intervention. Exercise is considered essential in the management of spondyloarthritis (SpA); however, the overall adherence to exercise programmes and factors affecting adherence are unknown. The aim of this systematic review was to examine measures of, and factors influencing adherence to, prescribed exercise programmes in people with SpA. A search was performed in August 2018 using five data bases; the Cochrane library, CINAHL, EMBASE, MEDLINE, and Web of Science Collections. Inclusion criteria were: studies with adults (> 18 years) with SpA, with a prescribed exercise intervention or educational programme with the aim of increasing exercise participation. Article quality was independently assessed by two assessors. Extracted descriptive data included: populations, interventions, measures of adherence and factors affecting adherence. Percentage adherence rates to prescribed exercises were calculated if not reported. Nine studies were included with a total of 658 participants, 95% of participants had a diagnosis of ankylosing spondylitis. Interventions and measurement of adherence varied, making comparisons difficult. Rates of adherence ranged from 51.4 to 95%. Single studies identified; adherence improved following educational programmes, and higher disease severity and longer diagnostic delays were associated with higher adherence. Conflicting evidence was found as to whether supervision of exercise improved adherence. Three consecutive studies demonstrated adherence reduced over time. Adherence to prescribed exercise in SpA was poorly reported and predominately for people with AS. The levels of adherence and factors affecting prescribed exercise in SpA remain unclear. Future research should measure adherence across a longer time period and investigate possible factors which may influence adherence.
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Affiliation(s)
- M T McDonald
- Rheumatology Service, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK. .,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK. .,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland, UK.
| | - S Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland, UK
| | - E H Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - D A McDonald
- Nursing Midwife and Allied Health Professional Research Unit, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - L Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
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Sang Y, Dong C, Fu T, Zhao R, Ge X, Zhou W, Ji J, Gu Z. Associated factors with adherence to standard exercise therapy and health-related quality of life in Chinese patients with ankylosing spondylitis. Mod Rheumatol 2018; 30:149-154. [PMID: 30561239 DOI: 10.1080/14397595.2018.1559966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: The aim of this study is to assess the current situations of standard exercise treatment and predictors of non-standard exercise in Chinese patients with ankylosing spondylitis (AS). An analysis of the effect of standard exercise on health-related quality of life (HR-QoL) was also conducted.Methods: In the cross-sectional study, a total of 259 AS patients were constantly invited to participate in this study and complete the questionnaire under the researchers' supervision in a clinical setting including sociodemographic variables, clinical variables, psychological variables, and HR-QoL. Data were analyzed by Mann-Whitney U test, Chi-square test as well as multivariable analysis of Binary Stepwise Logistic Regression.Results: The data showed that just 20.5% of them could complete the standard exercise. Exercise adherence was associated with employment, educational level, marital status, place of residence, treatment of Tumor Necrosis Factor-α inhibitor, knowledge about exercise, disease duration, clinical variables, and anxiety. The HR-QoL in the group of standard exercise was better than that in the non-standard exercise group. Logistic Regression Analysis showed that lower educational level, less knowledge about benefits of exercise treatment and higher score of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were the independent risk factors of exercise treatment non-adherence.Conclusion: AS patients educated less than 9 years or with higher BASDAI score were more likely not to adhere to standard exercise treatment. Non-adherence to exercise treatment among AS patients is exceedingly common, particularly in patients without knowledge about benefits of exercise treatment. Standard exercise treatment can also improve HR-QoL of AS patients.
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Affiliation(s)
- Yan Sang
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Chen Dong
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China.,Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Ting Fu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Rui Zhao
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Xingyu Ge
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Wei Zhou
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Juan Ji
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhifeng Gu
- Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China.,Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
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Verhoeven F, Guillot X, Prati C, Mougin F, Tordi N, Demougeot C, Wendling D. Aerobic exercise for axial spondyloarthritis - its effects on disease activity and function as compared to standard physiotherapy: A systematic review and meta-analysis. Int J Rheum Dis 2018; 22:234-241. [PMID: 30187695 DOI: 10.1111/1756-185x.13385] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/25/2017] [Accepted: 08/05/2018] [Indexed: 01/09/2023]
Abstract
AIM To evaluate the impact of an aerobic fitness program on disease activity, defined by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and the Bath Ankylosing Spondylitis Functional Index (BASFI) in case of axial spondyloarthritis. METHODS A systematic review of the literature, following the Prisma recommendations, was performed by two reviewers on the PubMed and Embase databases. Controlled trials assessing the efficacy of aerobic exercises compared to physiotherapy on axial spondyloarthritis disease activity were included. The diagnosis of axial spondyloarthritis was meeting the New York criteria and/or the Assessment in Axial Spondyloarthritis International Working Group criteria. Aerobic fitness was defined as an exercise performed at 50%-90% of the maximal heart rate or between 50% and 80% oxygen consumption (VO2 ) peak. RESULTS Five hundred and twenty abstracts were identified and 93 abstracts were analyzed. Eight studies met the selection criteria and 6 were finally included in this study because of the presence of a control group. Both groups were similar in terms of age, sex ratio, disease duration. Aerobic exercise provided a positive impact on the BASDAI in the intervention group (148 patients) (weighted mean difference [WMD]: -0.52 [95% CI: -0.9 to -0.13]) (I2 : 10.3%, P = 0.35). However, when compared to a control group (152 patients), the improvement of BASDAI didn't reach significance (WMD: -0.25 [95% CI: -0.83 to 0.32]) (I2 : 0%, P = 0.41). Aerobic exercise did not improve BASFI, CRP or ESR. CONCLUSION Aerobic exercise did not provide beneficial effects either on disease activity or on physical function and biological parameters when compared to a control group in axial spondyloarthritis.
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Affiliation(s)
- Frank Verhoeven
- Department of Rheumatology, CHRU Besançon, Besançon, France.,EA 4267 "PEPITE", FHU Increase, Université Bourgogne-Franche Comte, UFR SMP, Besançon, France
| | - Xavier Guillot
- Department of Rheumatology, CHRU Besançon, Besançon, France.,EA 4267 "PEPITE", FHU Increase, Université Bourgogne-Franche Comte, UFR SMP, Besançon, France
| | - Clément Prati
- Department of Rheumatology, CHRU Besançon, Besançon, France.,EA 4267 "PEPITE", FHU Increase, Université Bourgogne-Franche Comte, UFR SMP, Besançon, France
| | - Fabienne Mougin
- EA 3920 EPSI, Université Bourgogne-Franche Comté, Besançon, France
| | - Nicolas Tordi
- EA 4267 "PEPITE", FHU Increase, Université Bourgogne-Franche Comte, UFR SMP, Besançon, France
| | - Céline Demougeot
- EA 4267 "PEPITE", FHU Increase, Université Bourgogne-Franche Comte, UFR SMP, Besançon, France
| | - Daniel Wendling
- Department of Rheumatology, CHRU Besançon, Besançon, France.,EA 4266, Université Bourgogne-Franche Comte UFR SMP, Besançon, France
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Flórez MT, Almodóvar R, García Pérez F, Rodríguez Cambrón AB, Carmona L, Pérez Manzanero MÁ, Aboitiz Cantalapiedra J, Urruticoechea-Arana A, Rodríguez Lozano CJ, Castro C, Fernández-Carballido C, de Miguel E, Galíndez E, Álvarez Vega JL, Torre Alonso JC, Linares LF, Moreno M, Navarro-Compán V, Juanola X, Zarco P. The EJES-3D tool for personalized prescription of exercise in axial spondyloarthritis through multimedia animations: pilot study. Rheumatol Int 2018; 38:1277-1284. [PMID: 29786781 DOI: 10.1007/s00296-018-4049-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
To develop and evaluate a web application based on multimedia animations, combined with a training program, to improve the prescription of exercises in spondyloarthritis (SpA). After a review of exercises included in the main clinical trials and recommendations of international societies, a multidisciplinary team-rehabilitators, rheumatologists, physiotherapists, computer scientists and graphic designers-developed a web application for the prescription of exercises (EJES-3D). Once completed, this was presented to 12 pairs of rehabilitators-rheumatologists from the same hospital in a workshop. Knowledge about exercise was tested in rheumatologists before and 6 months after the workshop, when they also evaluated the application. The EJES-3D application includes 38 multimedia videos and allows prescribing predesigned programs or customizing them. A patient can consult the prescribed exercises at any time from a device with internet connection (mobile, tablet, or computer). The vast majority of the evaluators (89%) were satisfied or very satisfied and considered that their expectations regarding the usefulness of the web application had been met. They highlighted the ability to tailor exercises adapted to the different stages of the disease and the quality and variety of the videos. They also indicated some limitations of the application and operational problems. The EJES-3D tool was positively evaluated by experts in SpA, potentially the most demanding group of users with the most critical capacity. This allows a preliminary validation of the contents, usefulness, and ease of use. Analyzing and correcting the errors and limitations detected is allowing us to improve the EJES-3D tool.
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Affiliation(s)
- Mariano Tomás Flórez
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain.
| | - Raquel Almodóvar
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Fernando García Pérez
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - María Ángeles Pérez Manzanero
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | - Juan Aboitiz Cantalapiedra
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | | | | | - Carmen Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Eugenio de Miguel
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario de Basurto, Bilbao, Spain
| | - José Luis Álvarez Vega
- Servicio de Reumatología, Hospital Regional Universitario Infanta Cristina, Badajoz, Spain
| | | | - Luis F Linares
- Servicio de Reumatología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mireia Moreno
- Servicio de Reumatología, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | | | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Pedro Zarco
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Flórez García MT, Carmona L, Almodóvar R, Fernández de Las Peñas C, García Pérez F, Pérez Manzanero MÁ, García García JM, Soriano Segarra L, Jiménez Díaz JF, Mendoza Laiz N, de Miguel Mendieta E, Torre Alonso JC, Linares Ferrando LF, Collantes Estévez E, Sanz Sanz J, Zarco Montejo P. Recommendations for the prescription of physical exercise for patients with spondyloarthritis. ACTA ACUST UNITED AC 2017; 15:77-83. [PMID: 28807651 DOI: 10.1016/j.reuma.2017.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/12/2017] [Accepted: 06/25/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop expert-based recommendations on physical activity and exercise for patients with spondyloarthritis (SpA). METHODS Two discussion groups, one of physical therapists, rehabilitation physicians, and professionals of physical activity and sports, and another of rheumatologists interested in SpA, were held to discuss the results of a survey of rheumatologists on exercise and two focus groups with patients on barriers to exercise. Preliminary recommendations were drafted. These were submitted to the opinion of the experts in both groups according to a two round Delphi methodology. RESULTS Twenty one recommendations covering general aspects of exercise, adaptation to patient, how to deliver messages, pain management, and type of exercise and monitoring were issued. The level of agreement varied slightly between expert groups but it was high overall. Items with poor agreement were removed from the consensus. CONCLUSIONS We present recommendations on when and how to prescribe and monitor exercise in patients with SpA based on the opinion of experts in exercise and in SpA. We must now test whether these recommendations are useful for clinical practice and have an effect on patients with SpA seen by rheumatologists.
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Affiliation(s)
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, España
| | - Raquel Almodóvar
- Servicio de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - Fernando García Pérez
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - José Manuel García García
- Facultad de Ciencias de Actividad Física y Deporte, Universidad de Castilla La Mancha, Toledo, España
| | | | | | - Nuria Mendoza Laiz
- Facultad de Ciencias de Actividad Física y Deporte, Universidad de Castilla La Mancha, Toledo, España
| | | | | | | | | | - Jesús Sanz Sanz
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Pedro Zarco Montejo
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Sveaas SH, Smedslund G, Hagen KB, Dagfinrud H. Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis. Br J Sports Med 2017; 51:1065-1072. [PMID: 28455366 DOI: 10.1136/bjsports-2016-097149] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the effects of cardiorespiratory and strength exercises on disease activity for patients with inflammatory rheumatic diseases (IRDs). DESIGN A systematic review with meta-analysis registered at PROSPERO (CRD42015020004). PARTICIPANTS Patients with IRDs. DATA SOURCES The databases MEDLINE, AMED, Embase and CINAHL were searched from inception up to April 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Trials were included if they were randomised controlled trials of adults with IRDs, comparing the effect of cardiorespiratory and strength exercises with usual care on disease activity and followed the American College of Sports Medicine's exercise recommendations. The primary outcome was disease activity in terms of inflammation, joint damage and symptoms. DATA SYNTHESIS Data were pooled in a random-effect model for all outcomes, and standardised mean differences (SMDs) were calculated. The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Twenty-six trials with a total of 1286 participants were included. There was high to moderate quality evidence, for a small beneficial effect on disease activity scores (0.19 (95% CI 0.05 to 0.33), p<0.01) and joint damage (SMD 0.27 (95% CI 0.07 to 0.46), p<0.01). Furthermore, moderate quality evidence for a small beneficial effect on erythrocyte sedimentation rate (SMD 0.20 (95% CI 0.0 to 0.39), p=0.04) and for no effect on C reactive protein (SMD -0.14 (95% CI -0.37 to 0.08), p=0.21). Beneficial effects were also seen for symptoms. CONCLUSIONS The results of this review suggest beneficial effects of exercises on inflammation, joint damage and symptoms in patients with IRDs.
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Affiliation(s)
- Silje Halvorsen Sveaas
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Geir Smedslund
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
- The Norwegian Knowledge Center for the Health Services, The Norwegian Institute of Public Health, Oslo, Norway
| | - Kåre Birger Hagen
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hanne Dagfinrud
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
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Curbelo Rodríguez R, Zarco Montejo P, Almodóvar González R, Flórez García M, Carmona Ortells L. Barreras y facilitadores para la práctica del ejercicio físico en pacientes con espondiloartritis: estudio cualitativo de grupos focales (EJES-3D). ACTA ACUST UNITED AC 2017; 13:91-96. [DOI: 10.1016/j.reuma.2016.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/26/2016] [Accepted: 03/04/2016] [Indexed: 11/25/2022]
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Souza MCD, Jennings F, Morimoto H, Natour J. Swiss ball exercises improve muscle strength and walking performance in ankylosing spondylitis: a randomized controlled trial. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:45-55. [PMID: 28137402 DOI: 10.1016/j.rbre.2016.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/28/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The purpose was to evaluate the effectiveness of a progressive muscle strengthening program using a Swiss ball for AS patients. METHODS Sixty patients with AS were randomized into the intervention group (IG) or the control group (CG). Eight exercises were performed by the IG patients with free weights on a Swiss ball two times per week for 16 weeks. The evaluations were performed by a blinded evaluator at baseline and after 4, 8, 12 and 16 weeks using the following instruments: the one-repetition maximum test (1 RM), BASMI, BASFI, HAQ-S, SF-36, 6-minute walk test, time up and go test, BASDAI, ASDAS, ESR and CRP dosage and Likert scale. RESULTS There was a statistical difference between groups for: strength (1 RM capacity) in the following exercises: abdominal, rowing, squat, triceps and reverse fly (p<0.005); 6-minute walk test (p<0.001); timed up and go test (p=0.025) and Likert scale (p<0.001), all of them with better results for the IG. No differences were observed between the groups with respect to the functional capacity evaluation using the BASFI, HAQ-S, BASMI, SF-36, TUG, ASDAS, ESR and CPR dosage. CONCLUSIONS Progressive muscle strengthening using a Swiss ball is effective for improving muscle strength and walking performance in patients with AS.
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Affiliation(s)
- Marcelo Cardoso de Souza
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), Disciplina de Reumatologia, São Paulo, SP, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairí (Facisa), Curso de Fisioterapia, Santa Cruz, RN, Brazil
| | - Fábio Jennings
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), Disciplina de Reumatologia, São Paulo, SP, Brazil
| | - Hisa Morimoto
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), Disciplina de Reumatologia, São Paulo, SP, Brazil
| | - Jamil Natour
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), Disciplina de Reumatologia, São Paulo, SP, Brazil.
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Souza MCD, Jennings F, Morimoto H, Natour J. Exercícios na bola suíça melhoram a força muscular e o desempenho na caminhada na espondilite anquilosante: estudo clínico, controlado e randomizado. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Saracoglu I, Kurt G, Okur EO, Afsar E, Seyyar GK, Calik BB, Taspinar F. The effectiveness of specific exercise types on cardiopulmonary functions in patients with ankylosing spondylitis: a systematic review. Rheumatol Int 2016; 37:409-421. [PMID: 27837263 DOI: 10.1007/s00296-016-3603-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/04/2016] [Indexed: 01/12/2023]
Abstract
The aim of this review was to assess the effectiveness of specific exercise types on pulmonary functions, aerobic and functional capacity in patients with ankylosing spondylitis (AS). A systematic search of Cochrane Database of Systematic Review, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, AMED, EMBASE (OVID) was conducted in January 2016. The outcome measures were spirometric measurements, chest expansion, 6 minute walk distance (6MWD), pVO2, Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The search strategy was applied with limitation of date and language and this initial electronic search resulted in 143 relevant studies. After duplicates were removed, the titles and abstracts of 52 articles were screened. Of these, 14 full-text articles met initial criteria and were retrieved for review, with eight studies meeting final inclusion criteria. Both specific and conventional exercise groups showed significant improvements in BASDAI and BASFI scores (p < 0.05) in patients with AS, although there was no significant difference between two exercise groups. As for pulmonary functions, the specific exercise groups have greater improvements than conventional group in spirometric measurement, chest expansion (p < 0.05). However, there was no significant difference between specific conventional exercise types in 6MWD (p > 0.05). Specific exercises are an effective adjuvant therapy to enhance cardiopulmonary functions in patients with AS; therefore, it is assumed that in addition to the medical treatments, specific exercise therapy might reduce the cardiopulmonary complications related with AS.
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Affiliation(s)
- Ismail Saracoglu
- Department of Physiotherapy and Rehabilitation, School of Health Science, Dumlupinar University, Kutahya, Turkey.
| | - Gamze Kurt
- Department of Physiotherapy and Rehabilitation, School of Health Science, Dumlupinar University, Kutahya, Turkey
| | - Eda Ozge Okur
- Department of Physiotherapy and Rehabilitation, School of Health Science, Dumlupinar University, Kutahya, Turkey
| | - Emrah Afsar
- Department of Physiotherapy and Rehabilitation, School of Health Science, Dumlupinar University, Kutahya, Turkey
| | - Gulce Kallem Seyyar
- Department of Physiotherapy and Rehabilitation, School of Health Science, Dumlupinar University, Kutahya, Turkey
| | - Bilge Basakci Calik
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ferruh Taspinar
- Department of Physiotherapy and Rehabilitation, School of Health Science, Dumlupinar University, Kutahya, Turkey
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Cruz JC, Liberali R, Cruz TMFD, Netto MIA. The Pilates method in the rehabilitation of musculoskeletal disorders: a systematic review. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.003.ao19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Joseph Pilates created an authentic method of physical and mental conditioning, which he called Contrology and defined as the complete coordination of body, mind and spirit. Recent studies indicate that the Pilates Method is a useful tool in rehabilitation can improve overall health, sports performance and help in the prevention and attenuation of injuries and disorders of the musculoskeletal system. Musculoskeletal disorders are prevalent and costly conditions that develop gradually, presenting a chronic course and often remain untreated. Objective: This study aimed to identify the effects of the Pilates Method in the rehabilitation of musculoskeletal disorders through a systematic review. Methods: An active search was performed in the PubMed, PEDro, Scielo and Bireme databases. A total of 24 studies were pre-selected and their methodological quality was evaluated based on the PEDro scale. Of these, 14 fulfilled the selection criteria. Results: The studies analyzed indicate that Pilates can be effective both for the treatment of conditions such as scoliosis, back pain, ankylosing spondylitis and breast cancer, and for preventing injuries in adults, elderly people and athletes. Conclusion: The high methodological variability requires that these studies be viewed with caution. It indicates the need for the performance of new studies with high methodological quality and standardization of evaluation instruments.
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Affiliation(s)
- Josiane Cristiane Cruz
- Universidade Gama Filho, Brazil; Universidade Federal dos Vales do Jequitinhonha e Mucuri, Brazil
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Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin Arthritis Rheum 2016; 45:411-27. [DOI: 10.1016/j.semarthrit.2015.08.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/02/2015] [Accepted: 08/11/2015] [Indexed: 12/17/2022]
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Tumour necrosis factor alpha inhibitor therapy and rehabilitation for the treatment of ankylosing spondylitis: A systematic review. Semin Arthritis Rheum 2015; 44:542-550. [DOI: 10.1016/j.semarthrit.2014.09.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/08/2014] [Accepted: 09/19/2014] [Indexed: 12/22/2022]
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Can we just call everything physiotherapy? Physiotherapy 2015; 101:394. [PMID: 25747200 DOI: 10.1016/j.physio.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/16/2015] [Indexed: 11/23/2022]
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Rohekar S, Chan J, Tse SM, Haroon N, Chandran V, Bessette L, Mosher D, Flanagan C, Keen KJ, Adams K, Mallinson M, Thorne C, Rahman P, Gladman DD, Inman RD. 2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations. J Rheumatol 2015; 42:665-81. [DOI: 10.3899/jrheum.141001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 01/01/2023]
Abstract
Objective.The Canadian Rheumatology Association (CRA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) have collaborated to update the recommendations for the management of spondyloarthritis (SpA).Methods.A working group was assembled and consisted of the SPARCC executive committee, rheumatologist leaders from SPARCC collaborating sites, Canadian rheumatologists from across the country with an interest in SpA (both academic and community), a rheumatology trainee with an interest in SpA, an epidemiologist/health services researcher, a member of the CRA executive, a member of the CRA therapeutics committee, and a patient representative from the Canadian Spondylitis Association. An extensive review was conducted of literature published from 2007 to 2014 involving the management of SpA. The working group created draft recommendations using multiple rounds of Web-based surveys and an in-person conference.Results.Recommendations for the management of SpA were created. Part II: Specific Management Recommendations addresses management with nonpharmacologic methods, nonsteroidal anti-inflammatories and analgesics, disease-modifying antirheumatic drugs, antibiotics, tumor necrosis factor inhibitors, other biologic agents, and surgery. Also included are 10 modifications for application to juvenile SpA.Conclusion.These recommendations were developed based on current literature and applied to a Canadian healthcare context. It is hoped that implementation of these recommendations will promote best practices in the treatment of SpA.
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MEIER FLORIANM, MÜLLER-LADNER ULF, LANGE UWE. Efficacy of Intensive Physiotherapy in Combination with Low-dose Etanercept in Active Spondyloarthritis: A Monocentric Pilot Study. J Rheumatol 2014; 41:1897-8. [DOI: 10.3899/jrheum.131431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Baraliakos X, Deodhar A. Unanswered questions in the management of axial spondyloarthritis: an opinion piece. Clin Rheumatol 2014; 33:1359-65. [PMID: 24941929 DOI: 10.1007/s10067-014-2740-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Niedermann K, Sidelnikov E, Muggli C, Dagfinrud H, Hermann M, Tamborrini G, Ciurea A, Bischoff-Ferrari H. Effect of cardiovascular training on fitness and perceived disease activity in people with ankylosing spondylitis. Arthritis Care Res (Hoboken) 2014; 65:1844-52. [PMID: 23836515 DOI: 10.1002/acr.22062] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/27/2013] [Accepted: 06/06/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Several studies suggest that patients with ankylosing spondylitis (AS) have an increased risk of cardiovascular disease. This study aimed to evaluate the effects of a 12-week, individually monitored, with moderate heart rate level intensity cardiovascular training on cardiovascular fitness and perceived disease activity in AS patients. METHODS Patients diagnosed with AS according to the modified New York criteria were randomized to either cardiovascular training or attention control. The training group performed 3 cardiovascular training units per week. All participants attended 1 weekly usual care flexibility training session. Attention control contained regular discussion groups on coping strategies. Adherence was self-monitored. Assessments were performed at baseline and after the intervention period of 3 months. Physical fitness was the primary end point, measured in watts using a submaximal bicycle test following the physical work capacity 75% protocol. All analyses controlled for sex, age, body mass index,baseline fitness and physical activity levels, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). RESULTS Of 106 AS patients enrolled, 40% were women and the mean ± SD age was 49 ± 12 years. A total of 74.6% of the training group reported exercising at least 3 times a week. At the 3-month followup, the fitness level in the training group was significantly higher than in the control group (mean ± SE 90.32W ± 4.52W versus 109.84W ± 4.72W; P = 0.001), independent of other covariates. The mean BASDAI total score was 0.31 points lower (P = 0.31) in the training group, reaching significance for the peripheral pain subscore (1.19; P = 0.01) but not for back pain or fatigue. CONCLUSION Cardiovascular training, in addition to flexibility exercise, increased fitness in AS patients and reduced their peripheral pain.
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Effects of physical therapy for the management of patients with ankylosing spondylitis in the biological era. Clin Rheumatol 2014; 33:1217-30. [DOI: 10.1007/s10067-014-2647-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/18/2014] [Accepted: 04/20/2014] [Indexed: 02/07/2023]
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Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial. Rheumatol Int 2014; 34:1505-11. [DOI: 10.1007/s00296-014-2980-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/28/2014] [Indexed: 02/07/2023]
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