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Nordén KR, Semb AG, Dagfinrud H, Hisdal J, Sexton J, Fongen C, Bakke E, Ødegård S, Skandsen J, Blanck T, Metsios GS, Tveter AT. Effect of high-intensity interval training in physiotherapy primary care for patients with inflammatory arthritis: the ExeHeart randomised controlled trial. RMD Open 2024; 10:e003440. [PMID: 38242550 PMCID: PMC10806524 DOI: 10.1136/rmdopen-2023-003440] [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: 06/27/2023] [Accepted: 12/25/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES To assess the effect of high-intensity interval training (HIIT) delivered in physiotherapy primary care on the primary outcome of cardiorespiratory fitness (CRF) in patients with inflammatory arthritis (IA). Additionally, to explore the effects of HIIT on secondary outcomes, including cardiovascular disease (CVD) risk factors and disease activity. METHODS Single-blinded randomised controlled trial with 60 patients randomly assigned to either a control group receiving usual care or an exercise group receiving usual care and 12 weeks of individualised HIIT at 90%-95% peak heart rate. Outcomes were assessed at baseline, 3 months and 6 months post baseline and included CRF measured as peak oxygen uptake (VO2peak), classic CVD risk factors, disease activity, anthropometry and patient-reported physical activity, pain, fatigue, disease impact and exercise beliefs and self-efficacy. RESULTS Intention-to-treat analysis demonstrated a significant between-group difference in VO2peak at 3 months (2.5 mL/kg/min, 95% CI 0.9 to 4.0) and 6 months (2.6 mL/kg/min, 95% CI 0.8 to 4.3) in favour of the exercise group. A beneficial change in self-reported physical activity in favour of the exercise group was observed at 3 and 6 months. The HIIT intervention was well-tolerated with minimal adverse events and no apparent impact on disease activity. Differences in secondary outcomes related to CVD risk factors, disease impact, pain, fatigue and exercise beliefs and self-efficacy were generally small and non-significant. CONCLUSION After 12 weeks of supervised HIIT delivered in physiotherapy primary care, patients with IA demonstrated a favourable improvement in CRF, with sustained effects at 6-month follow-up. TRIAL REGISTRATION NUMBER NCT04922840.
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Affiliation(s)
- Kristine Røren Nordén
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Hanne Dagfinrud
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Emilie Bakke
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Sigrid Ødegård
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skandsen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Thalita Blanck
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - George S Metsios
- Department of Nutrition and Dietetics, University of Thessaly, Volos, Greece
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Health Sciences, Institute of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Akershus, Norway
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Nordén KR, Dagfinrud H, Semb AG, Hisdal J, Metsios GS, Sexton J, Fongen C, Bakke EA, Tveter AT. Criterion Validity and Responsiveness of Estimated Cardiorespiratory Fitness Models in Patients with Inflammatory Joint Disease. J Clin Med 2023; 12:6753. [PMID: 37959219 PMCID: PMC10650593 DOI: 10.3390/jcm12216753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Cardiorespiratory fitness (CRF) is an excellent marker of overall health. This study aimed to assess criterion validity and responsiveness of estimated CRF models (eCRF) in patients with inflammatory joint disease (IJD). CRF was measured directly as peak oxygen uptake (VO2peak) by a Cardiopulmonary Exercise Test (CPET), while one generic eCRF model (eCRFGEN) and two disease-specific eCRF models (eCRFALT and eCRFPGA) were used to estimate CRF at baseline and after 3 months in 55 Norwegian patients with IJD. Moderate correlations were observed between eCRFGEN, eCRFALT, eCRFPGA, and VO2peak at baseline (ICC 0.60, 0.64 and 0.62, respectively) and 3 months (ICC 0.62, 0.65 and 0.57, respectively). All eCRF models overestimated measured VO2peak, and there was large variability in agreement of individual measurements at baseline and at 3 months. Weak correlations were observed for responsiveness of eCRFGEN (ICC 0.39), eCRFALT (ICC 0.40) and eCRFPGA (ICC 0.39). Mean differences between change in eCRF models and change in VO2peak were small, but the wide limits of agreement exceeded the pre-defined clinically acceptable margins. The eCRF models possessed adequate ability to detect ≥3.5 mL/kg/min improvement in VO2peak. eCRF may suffice for group-level assessment, but caution is advised when applying eCRF to individual patients with IJD.
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Affiliation(s)
- Kristine Røren Nordén
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Division of Rheumatology and Research, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway;
- Department of Vascular Surgery, Oslo University Hospital—Aker, 0586 Oslo, Norway
| | - George S. Metsios
- Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Division of Rheumatology and Research, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Camilla Fongen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Emilie Andrea Bakke
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Anne Therese Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
- Faculty of Health Sciences, Institute of Rehabilitation Science and Health Technology, Oslo Metropolitan University, 0166 Oslo, Norway
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Acar Y, İlçin N, Sarı IS, Önen F. Functional exercise capacity in patients with ankylosing spondylitis. Physiother Theory Pract 2023:1-7. [PMID: 37776295 DOI: 10.1080/09593985.2023.2263778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE This study aimed to measure the functional exercise capacity of patients with ankylosing spondylitis (AS) with the incremental shuttle walk test (ISWT), and to determine the factors associated with this test. METHODS This cross-sectional study included 54 patients with AS (29 males, 25 females). The ISWT was performed to determine functional exercise capacity. The number of completed shuttles was recorded, and the total incremental shuttle walk distance (ISWD) was calculated. Disease activity was assessed with the Bath AS Disease Activity Index (BASDAI), physical functioning was assessed with the Bath AS Functional Index (BASFI), and spinal mobility was assessed with the Bath AS Mobility Index (BASMI). Upper body and core endurance were assessed by sit-up and push-up tests. Tests were performed in a single session in the order listed. RESULTS The mean ISWD of the patients was 462.41 ± 97.96 m, and the subjects reached 50.48% of the predicted ISWD. The ISWD of male subjects was significantly higher than that of females (p < .05). At the end of the test, male subjects reached 60.87% of the age-predicted maximal heart rate, and female subjects reached 55.25%. There was a significant positive moderate correlation between ISWD and height (r = 0.535, p < .01), sit-up test (r = 0.617, p < .01), and push-up test (r = 0.495, p < .01), while there was a negative weak correlation between BASFI (r = -0.344, p = .011) and BASMI (r = -0.280, p = .040). CONCLUSION The study showed that functional exercise capacity as assessed by the ISWT decreased in patients with AS. ISWT performance was associated with sex, height, functionality, spinal mobility, and muscular endurance.
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Affiliation(s)
- Yasemin Acar
- Graduate School of Health Sciences, Physical Therapy and Rehabilitation Department, Dokuz Eylül University, Izmir, Turkey
| | - Nursen İlçin
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - I Smail Sarı
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Balcova, Izmir, Turkey
| | - Fatoş Önen
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Balcova, Izmir, Turkey
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Nordén KR, Semb AG, Dagfinrud H, Hisdal J, Ødegård S, Sexton J, Fongen C, Skandsen J, Blanck T, Metsios GS, Tveter AT. Associations between cardiovascular risk factors, disease activity and cardiorespiratory fitness in patients with inflammatory joint disease: a cross-sectional analysis. BMC Sports Sci Med Rehabil 2023; 15:63. [PMID: 37085935 PMCID: PMC10120183 DOI: 10.1186/s13102-023-00678-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/19/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Inflammatory joint diseases (IJD) are accompanied by an increased risk of cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable CVD risk factor and low levels of CRF associate with an elevated CVD risk. This study aimed to investigate the associations between CVD risk factors, disease activity and CRF in patients with IJD and to explore differences between patients with normal versus low levels of CRF. METHODS CRF was measured as peak oxygen uptake (VO2peak) with a cardiopulmonary exercise test. Participants were also evaluated for: Body composition, blood pressure, blood lipids, inflammatory markers and disease activity. Patient-reported use of cigarettes/snuff, medication, disease duration, pain, fatigue, CVD history, habitual physical activity and exercise beliefs and self-efficacy were collected by questionnaire. Cross-sectional associations between CVD risk factors, disease-related factors and CRF were analyzed by multiple linear regression. CRF was categorized to normal CRF (VO2peak ≥ 80%) or low CRF (VO2peak < 80%) according to age- and gender-stratified reference data. Differences in demographic, CVD and disease-related factors between patients with normal versus low CRF were explored. RESULTS In 60 Norwegian patients with IJD [34 females, age 59 years (IQR: 52-63)], mean VO2peak was 30.2 (± 6.9) mL/kg/min, corresponding to 83% (± 18) of normative reference values. Age (coefficient: - 0.18 years, p = 0.01) and fat mass (coefficient: - 0.67 %, p < 0.001) were inversely associated with CRF, while physical activity index (coefficient: 0.13 points, p = 0.05) was positively associated with CRF (R2 = 0.66). There were no significant associations between CRF, classical CVD risk factors and disease-related variables. Compared to patients with low CRF (n = 30), patients with normal CRF (n = 30) had higher peak oxygen uptake (+ 9.4 mL/kg/min, p < 0.001), high-density lipoprotein cholesterol (+ 0.5 mmol L-1, p < 0.001), and exercise self-efficacy (+ 6.9, p < 0.01) as well as lower fat mass (- 8.7%, p < 0.001), resting heart rate (- 8.0 beats/min, p < 0.01) and triglycerides (- 0.5 mmol L-1, p < 0.01). CONCLUSIONS In this sample of IJD-patients, age, fatmass and physical activity level were associated with CRF. CRF was lower than reference values and patients with normal CRF presented with a more favorable health profile. There is a continued need for exercise interventions to improve CRF in patients with IJD. TRIAL REGISTRATION NCT04922840.
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Affiliation(s)
- Kristine Røren Nordén
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway.
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.
| | - Anne Grete Semb
- The Preventive Cardio-Rheuma Clinic, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital-Aker, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigrid Ødegård
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway
| | - Camilla Fongen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skandsen
- Patient Advisory Board, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Thalita Blanck
- Patient Advisory Board, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - George S Metsios
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Thessaly, Greece
| | - Anne Therese Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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Fenton SAM, O’Brien CM, Kitas GD, Duda JL, Veldhuijzen van Zanten JJCS, Metsios GS. The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go? Rheumatol Adv Pract 2023; 7:rkac097. [PMID: 36699551 PMCID: PMC9870708 DOI: 10.1093/rap/rkac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?
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Affiliation(s)
- Sally A M Fenton
- Correspondence to: Sally A. M. Fenton, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. E-mail:
| | - Ciara M O’Brien
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK,Department of Rheumatology, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK,Department of Rheumatology, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - George S Metsios
- Department of Rheumatology, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK,Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Volos, Greece
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Rausch Osthoff AK, Nast I, Niedermann K. Understanding beliefs related to physical activity in people living with axial Spondyloarthritis: a theory-informed qualitative study. BMC Rheumatol 2022; 6:40. [PMID: 35871641 PMCID: PMC9310396 DOI: 10.1186/s41927-022-00270-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background People living with axial Spondyloarthrtis (axSpA) have an increased risk of cardiovascular diseases, which can be reduced by regular physical activity (PA) and its subset of cardiorespiratory training (CRT). To fulfil their crucial role in PA promotion, physiotherapists and other health professionals need to understand the beliefs that people living with axSpA possess concerning general PA and CRT. The aim of this study is to explore these behavioural, normative and control beliefs.
Methods A qualitative descriptive design approach was chosen. Five semi-structured focus group interviews with 24 individuals living with axSpA were performed. Data was analysed using structured thematic qualitative content analysis.
Results People with axSpA possessed multifaceted behavioural, normative and control beliefs concerning general PA and CRT. Behavioural beliefs revealed a positive attitude towards general PA, with participants mentioning numerous physical, psychological, and social benefits and only few risks. However, the conceptual difference between general PA and CRT, and the relevance of CRT, was unclear to some participants. Normative beliefs were expressed as the beliefs of significant others that influenced their motivation to comply with such beliefs, e.g. spouses, other people living with axSpA, rheumatologists. Regarding control beliefs, general PA and CRT were both mentioned as effective self-management strategies to control the disease. From experience, a high level of self-discipline, as well as technology, were shown to be useful.
Conclusions General PA is understood to be an important self-management strategy for people with axSpA and most participants build general PA into their daily routines. They believe that general PA beneficially impacts personal health and wellbeing. However, some participants are unaware of the difference between general PA and CRT and the important impact that this difference could have on their health. The consequences of CRT promotion for people living with axSpA should be the subject of further research. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00270-2.
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Soulard J, Carlin T, Knitza J, Vuillerme N. Wearables for Measuring the Physical Activity and Sedentary Behavior of Patients With Axial Spondyloarthritis: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e34734. [PMID: 35994315 PMCID: PMC9446133 DOI: 10.2196/34734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/02/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease associated with chronic back pain and restricted mobility and physical function. Increasing physical activity is a viable strategy for improving the health and quality of life of patients with axSpA. Thus, quantifying physical activity and sedentary behavior in this population is relevant to clinical outcomes and disease management. However, to the best of our knowledge, no systematic review to date has identified and synthesized the available evidence on the use of wearable devices to objectively measure the physical activity or sedentary behavior of patients with axSpA. OBJECTIVE This study aimed to review the literature on the use of wearable activity trackers as outcome measures for physical activity and sedentary behavior in patients with axSpA. METHODS PubMed, PEDro, and Cochrane electronic databases were searched in July 2021 for relevant original articles, with no limits on publication dates. Studies were included if they were original articles, targeted adults with a diagnosis of axSpA, and reported wearable device-measured physical activity or sedentary behavior among patients with axSpA. Data regarding the study's characteristics, the sample description, the methods used for measuring physical activity and sedentary behavior (eg, wearable devices, assessment methods, and outcomes), and the main results of the physical activity and sedentary behavior assessments were extracted. RESULTS A total of 31 studies were initially identified; 13 (13/31, 42%) met the inclusion criteria, including 819 patients with axSpA. All the studies used accelerometer-based wearable devices to assess physical activity. Of the 13 studies, 4 (4/31, 31%) studies also reported outcomes related to sedentary behavior. Wearable devices were secured on the wrists (3/13 studies, 23%), lower back (3/13, 23%), right hip (3/13, 23%), waist (2/13, 15%), anterior thigh (1/13, 8%), or right arm (1/13, 8%). The methods for reporting physical activity and sedentary behavior were heterogeneous. Approximately 77% (10/13) of studies had a monitoring period of 1 week, including weekend days. CONCLUSIONS To date, few studies have used wearable devices to quantify the physical activity and sedentary behavior of patients with axSpA. The methodologies and results were heterogeneous, and none of these studies assessed the psychometric properties of these wearables in this specific population. Further investigation in this direction is needed before using wearable device-measured physical activity and sedentary behavior as outcome measures in intervention studies in patients with axSpA. TRIAL REGISTRATION PROSPERO CRD42020182398; https://tinyurl.com/ec22jzkt. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/23359.
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Affiliation(s)
- Julie Soulard
- Université Grenoble Alpes, AGEIS, La Tronche, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
- Grenoble Alpes University Hospital, Grenoble, France
| | - Thomas Carlin
- Université Grenoble Alpes, AGEIS, La Tronche, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
| | - Johannes Knitza
- Université Grenoble Alpes, AGEIS, La Tronche, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University, Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, La Tronche, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
- Institut Universitaire de France, Paris, France
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Kim MY, Hong YS, Park SH, Kang KY. Physical activity is associated with physical and global function in patients with axial spondyloarthritis, independent of disease activity. Semin Arthritis Rheum 2022; 56:152067. [PMID: 35849891 DOI: 10.1016/j.semarthrit.2022.152067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate whether physical activity is independently associated with physical and global function in patients with axial spondyloarthritis (axSpA), and to analyse the relationship between subtypes of physical activity (work, transport, and recreation) and functional impairment. METHODS One-hundred-and-eighty-five patients were included. Physical function was assessed using BASFI, and global function was assessed using the ASAS health index (HI). Physical activity was measured using the Global Physical Activity Questionnaire. Levels of physical activity were categorised as low, moderate or high. The associations between levels of physical activity and the BASFI and ASAS HI scores were analysed using multivariate regression analysis. RESULTS Of the 185 patients, 46, 63 and 76 reported low, moderate and high levels of physical activity, respectively. There was a negative correlation between the BASFI and total physical activity. Multivariate linear regression analysis revealed that a high level of physical activity was independently associated with BASFI after adjusting for age, ASDAS. sacroiliitis and syndesmophyte number (ß (95% CI) =-0.88 (-1.49--0.26); p=0.006). One-hundred-and-forty-six had good global functioning (ASAS HI≤5). Multivariate logistic regression analysis revealed that moderate physical activity was independently associated with good global functioning (OR (95% CI) = 2.82 (1.02-7.86); p = 0.047). Recreational activity, but not work- and transport-related activity, showed a significant relationship with ASAS HI scores (ß (95% CI) =-0.55 (-1.02-0.08); p = 0.023). CONCLUSIONS Physical activity in those with axSpA is associated independently with physical and global functioning. Among the subtypes of physical activity, recreational activity is related to global functioning.
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Affiliation(s)
- Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.
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Correlates of physical activity in adults with spondyloarthritis and rheumatoid arthritis: a systematic review. Rheumatol Int 2022; 42:1693-1713. [PMID: 35672508 PMCID: PMC9439989 DOI: 10.1007/s00296-022-05142-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
Physical activity (PA) is a primary non-pharmacological treatment option for those living with rheumatoid arthritis (RA) and spondyloarthritis (SpA). The aim of this systematic literature review was to summarize and present an updated synthesis of the factors associated with PA in the RA and SpA populations. A tailored search of PubMed (inc. Medline), Web of Science, Embase, APA PsycNET, and Scopus was conducted for research published between 2004 and June 2019. Methodological quality was assessed using The National Institutes of Health (NIH) Quality Assessment Tools for Observational Cohort and Cross-sectional Studies, Case–Control Studies, and Controlled Intervention Studies. Forty RA and eleven SpA articles met the inclusion criteria. Methodological quality was generally fair to good, with two RA studies rated as poor. Correlates are discussed in the sociodemographic, physical, psychological, social, and environmental categories. Environmental factors were not measured in any RA study. In individuals living with RA, consistent positive associations were found between PA and high-density lipoprotein, self-efficacy, and motivation. Consistent negative associations were found for functional disability and fatigue. In individuals with SpA, consistent positive associations were found between PA and quality of life, and consistent negative associations with functional disability. Physical and psychological factors are most consistently related with PA parameters in those living with RA and SpA. Many variables were inconsistently studied and showed indeterminant associations. Studies with prospective designs are needed to further understand the factors associated with PA in these populations, especially in those living with SpA.
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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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Nordén KR, Dagfinrud H, Semb AG, Hisdal J, Viktil KK, Sexton J, Fongen C, Skandsen J, Blanck T, Metsios GS, Tveter AT. Effect of high-intensity exercise on cardiorespiratory fitness, cardiovascular disease risk and disease activity in patients with inflammatory joint disease: protocol for the ExeHeart randomised controlled trial. BMJ Open 2022; 12:e058634. [PMID: 35177467 PMCID: PMC8860070 DOI: 10.1136/bmjopen-2021-058634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Inflammatory joint disease (IJD) is associated with increased risk of cardiovascular disease (CVD) fostered by systemic inflammation and a high prevalence of CVD risk factors. Cardiorespiratory fitness (CRF) is an important health parameter and CRF-measures are advocated in routine health evaluations. CRF associates with CVD risk, and exercise modalities such as high intensity interval training (HIIT) can increase CRF and mitigate CVD risk factors. In IJD, exercise is rarely used in CVD risk management and the cardioprotective effect of HIIT is unclear. Furthermore, the clinical applicability of HIIT to primary care settings is largely unknown and warrants investigation. The primary aim is to assess the effect of a HIIT programme on CRF in patients with IJD. Second, we will evaluate the effect of HIIT on CVD risk and disease activity in patients with IJD, feasibility of HIIT in primary care and validity of non-exercise algorithms to detect change in CRF. METHODS AND ANALYSIS ExeHeart is a single-blinded, randomised controlled trial. Sixty patients with IJD will be recruited from the Preventive Cardio-Rheuma clinic at Diakonhjemmet Hospital, Norway. Patients will be assigned to receive standard care (relevant lifestyle advice and cardio-preventive medication) or standard care plus a 12-week HIIT intervention by physiotherapists in primary care. HIIT sessions will be prescribed at 90%-95% of peak heart rate. Outcomes include CRF (primary outcome), CVD risk factors, anthropometric measures, disease activity and patient-reported outcomes related to pain, fatigue, disease, physical activity and exercise and will be assessed at baseline, 3 months (primary endpoint) and 6 months postbaseline. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Regional Committee for Medical and Health Research Ethics (201227). Participants are required to sign a written informed consent form. Results will be discussed with patient representatives, submitted to peer-reviewed journals and presented at relevant platforms. TRIAL REGISTRATION NUMBER NCT04922840.
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Affiliation(s)
- Kristine Røren Nordén
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Dagfinrud
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of vascular surgery, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Kirsten K Viktil
- Department of Pharmacy, University of Oslo, Oslo, Norway
- Diakonhjemmet Hospital Pharmacy, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skandsen
- Patient advisory board, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Thalita Blanck
- Patient advisory board, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - George S Metsios
- Department of Nutrition and Dietetics, University of Thessaly, Volos, Thessaly, Greece
| | - Anne Therese Tveter
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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Köseoğlu Tohma E, Günendi Z, Özyemişçi Taşkıran Ö, Mengi G, Demirsoy N, Taş N. Exercise capacity in axial spondyloarthritis and associated factors: A cross-sectional controlled study. Int J Rheum Dis 2021; 24:1014-1023. [PMID: 34132483 DOI: 10.1111/1756-185x.14155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/12/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the associations between exercise capacity (EC), cardiovascular (CV) risk factors and disease-related variables in axial spondyloarthritis (AxSpA) patients. METHODS In this cross-sectional controlled study, CV risk profile data, physical activity, 10-year CV event risk estimated by the Framingham model and Ankylosing Spondylitis Disease Activity Score - C-reactive protein were recorded. A maximal treadmill exercise test by Bruce protocol was administered. Analyses of covariance were performed with adjustments for age, smoking status and physical activity level. Linear regression analysis was performed to study the association between EC and related CV risk factors. RESULTS Thirty-eight patients and 38 age-gender matched controls were recruited between May and October 2014. Patients had significantly lower EC than controls (MD 2.2; metabolic equivalents 0.91-3.49; P = .001). The difference remained significant after adjustments (P = .001). There were significant correlations between EC and age, 10-year CV event risk, body mass index (BMI) and waist circumference for patients and controls (P < .001 and P < .05, respectively). There was a significant relationship between EC and total cholesterol, triglycerides and heart rate recovery (HRR) in patients (P = .04, P < .001 and P = .006, respectively). High-density lipoprotein - cholesterol was significantly higher, and BMI was significantly lower in nonradiographic AxSpA patients (P = .026 and P = .03 respectively). Age and triglyceride levels were found as the significant predictors for EC in the AxSpa group (for age β = -.105, P = .003; for triglycerides β = -.016 P = .003). CONCLUSION Exercise capacity was significantly lower and attenuated HRR was significantly associated with low EC and high 10-year CV event risk in AxSpA patients.
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Affiliation(s)
- Ebru Köseoğlu Tohma
- Department of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Ankara, Turkey
| | - Zafer Günendi
- Department of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Ankara, Turkey
| | - Özden Özyemişçi Taşkıran
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, İstanbul, Turkey
| | - Gönen Mengi
- Department of Physical Medicine and Rehabilitation, Muğla Sıtkı Koçman University Hospital, Muğla, Turkey
| | - Nesrin Demirsoy
- Department of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Ankara, Turkey
| | - Nihal Taş
- Department of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Ankara, Turkey
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Tsang HHL, Wong CKH, Cheung PWH, Lau CS, Chung HY, Cheung JPY. Responsiveness of the EuroQoL 5-Dimension (EQ-5D) questionnaire in patients with spondyloarthritis. BMC Musculoskelet Disord 2021; 22:439. [PMID: 33990193 PMCID: PMC8122540 DOI: 10.1186/s12891-021-04315-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Spondyloarthritis (SpA) has a significant impact on patients’ quality of life due to functional impairments. Generic health instruments like the EuroQoL 5-dimension (EQ-5D) is important for cost-utility analysis of health care interventions and calculation of quality-adjusted life-years. It has been validated in patients with SpA. However, its responsiveness property is unclear. Hence, the aim of study is to test the responsiveness properties of the EQ-5D health measure for Chinese patients with SpA. Methods Prospective and consecutive recruitment of 151 Chinese patients with SpA was conducted with follow-up assessments 6 months later. Demographic data including smoking and drinking habits, education level, income and occupation was collected. Disease-associated data including disease duration, presence of back pain, peripheral arthritis, dactylitis, enthesitis, uveitis, psoriasis, and inflammatory bowel disease was also recorded. Questionnaires regarding disease activity and functional disability (BASDAI, BASFI, BASGI, BASMI, ASDAS), mental health (HADS) and the EQ-5D scores were recorded. Responsiveness was tested against the global rating of change scale (GRC) and changes in disease activity using BASDAI and ASDAS-CRP. Results A total of 113 (74.8%) patients completed the follow-up assessments. Most patients (61.6%) had low disease activity level with BASDAI <4 and 39.7% of patients had inactive disease by ASDAS-CRP. EQ-5D scores was well discriminated along with BASDAI and BASFI scores. EQ-5D scores also correlated well with HADS. The GRC was not able to discriminate adequately. No significant ceiling or floor effect was observed. Conclusions EQ-5D demonstrates satisfactory responsiveness property for assessment of changes in SpA disease activity. Level of evidence II
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Affiliation(s)
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China
| | - Chak Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ho Yin Chung
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
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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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Yuksel Karsli T, Bayraktar D, Ozer Kaya D, Oz HE, Gucenmez S, Gercik O, Solmaz D, Akar S. Comparison of physical activity levels among different sub-types of axial spondyloarthritis patients and healthy controls. Mod Rheumatol 2021; 31:1202-1207. [PMID: 33627021 DOI: 10.1080/14397595.2021.1891676] [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] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim was to compare the physical activity levels among radiographic axial spondyloarthritis (axSpA) patients, non-radiographic axSpA patients, and healthy controls and investigating the possible relationships between physical activity level and clinical features. METHODS Thirty-four patients with radiographic axSpA (24 male), 33 patients with non-radiographic axSpA (23 male), and 35 age and sex-matched healthy controls (24 male) were included. The patients were assessed with Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Ankylosing Spondylitis Quality of Life Questionnaire, Hospital Anxiety and Depression Scale, Tampa Scale of Kinesiophobia. Physical activity was measured by using an accelerometer (Actigraph wGT3X-BT). RESULTS Physical and disease-related characteristics were comparable between groups (p > .05). Radiographic axSpA patients showed lesser physical activity compared to non-radiographic axSpA patients and healthy controls (p < .05). No difference was detected between non-radiographic axSpA patients and healthy controls (p > .05). Physical activity levels were correlated with different clinical features for each sub-type of axSpA. Decreased spinal mobility is the most correlated disease characteristic with lower physical activity level for both sub-types. CONCLUSION It seems that disease sub-type in axSpA may alter the physical activity levels. Increasing physical activity levels might need different approaches for different sub-types of axSpA.
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Affiliation(s)
- Tugce Yuksel Karsli
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Hande Ece Oz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Sercan Gucenmez
- Izmir Katip Celebi University, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Onay Gercik
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Dilek Solmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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Bilberg A, Dagfinrud H, Sveaas SH. Supervised intensive Exercise strengthen Exercise Health Beliefs in Patients with Axial Spondyloarthritis: A Multicentre Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2021; 74:1196-1204. [PMID: 33423392 DOI: 10.1002/acr.24556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the effect of a three-month supervised high-intensity exercise program, on exercise health beliefs in patients with Axial Spondyloarthritis. METHODS This was secondary analysis of a randomized controlled trial. Participants (ages 23-69 years), were randomized to an exercise group (n=50) or a control group (n=50). The intervention was an individually guided cardiorespiratory and strength exercise program performed two times per week, plus an additional individual exercise session of personal choice. The control group received standard care and instructions to maintain their physical activity level. Exercise health beliefs using the Exercise health beliefs questionnaire (ranges 20-100, 100= best) i.e. barriers, benefits, self-efficacy and exercise impact on arthritis and physical activity were assessed with self-reported questionnaires at baseline, three months and 12 months after inclusion. RESULTS The majority, (76%) of the participants in the exercise group followed ≥ 80% of the prescribed exercise protocol. There was a significant effect of the intervention on exercise health beliefs at 3 months (estimated mean group differences 4.0 [95%CI 1.4, 6.6], p=0.003) and the effect persisted at 12 months follow-up (estimated mean group differences 3.8 [95%CI 1.0, 6.6], p=0.008). Participants with higher exercise health beliefs had a higher odds ratio (1.1 [95%CI 1.0, 1.20], p=0.003) for being physically active at 12 months follow-up. CONCLUSIONS A supervised high intensity exercise program had beneficial short- and long-term effects on participants' exercise health beliefs. Stronger exercise health beliefs were positively associated with a higher chance to be physically active on a health enhancing level at 12-months follow-up.
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Affiliation(s)
- Annelie Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation Physiotherapy Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Hanne Dagfinrud
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Silje H Sveaas
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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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, 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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TOSUN AYDİN G, DEMİRBUKEN İ, KAYA MUTLU E, POLAT MG. Does Kinesiophobia Effect One Day Physical Activity Behaviour and Functionality of Young People with Ankylosing Spondylitis? CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2020. [DOI: 10.33808/clinexphealthsci.533527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Coulter EH, McDonald MT, Cameron S, Siebert S, Paul L. Physical activity and sedentary behaviour and their associations with clinical measures in axial spondyloarthritis. Rheumatol Int 2019; 40:375-381. [PMID: 31848736 PMCID: PMC7002460 DOI: 10.1007/s00296-019-04494-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
Engaging in physical activity (PA) is a key aspect in the management of axial spondyloarthritis (axial SpA), however, its relationship with clinical measures is unknown. Previous research has mainly focused on subjective methods of measuring PA and sedentary behaviour (SB). The aim of this study was to explore the associations between objectively measured PA and SB with clinical measures in people with established axial SpA. Fifty participants were recruited from secondary-care rheumatology outpatient services in Glasgow, UK. Clinical measures collected included; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQOL) and the Six Minute Walk Test (6MWT). PA and SB were measured using the activPAL3 tri-axial accelerometer. Data from forty-five participants were included (23 males, average age 49 ± 12 years). Participants accumulated an average of 93.2 ± 41.5 min/day walking with an average of 7200 ± 3397 steps/day. The majority of the day (65%) was spent sitting, accumulated in prolonged bouts. Walking time and steps taken/day were associated with better BASFI (r = − 0.395, p = 0.007 and r = − 0.404, p = 0.006), ASQOL (r = − 0.375, p = 0.011 and r = − 0.361, p = 0.015) and 6MWT (r = 0.396, p = 0.007 and r = 0.421, p = 0.004); while longer walking events were associated with better BASMI (rho = − 0.352, p = 0.018), BASFI (rho = − 0.316, p = 0.034) and 6MWT (rho = 0.404, p = 0.006). SB was associated with worse ASQOL (r = 0.380, p = 0.010) and 6MWT (6MWT, r = − 0.357, p = 0.016). In people with axial SpA PA is associated with better function, exercise capacity and spinal mobility, while SB is associated with lower exercise capacity and poor quality of life. These findings support the promotion of PA and reduction of SB in people with axial SpA.
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Affiliation(s)
- Elaine H Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Marie Therese McDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK. .,Rheumatology Service, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK. .,Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davies Building, University Place, Glasgow, UK.
| | - Sara Cameron
- School of Medicine, Dentistry and Nursing, University of Glasgow, Oakfield Avenue, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Sir Graeme Davies Building, University Place, Glasgow, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
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Sveaas SH, Dagfinrud H, Johansen MW, Pedersen E, Wold OM, Bilberg A. Longterm Effect on Leisure Time Physical Activity Level in Individuals with Axial Spondyloarthritis: Secondary Analysis of a Randomized Controlled Trial. J Rheumatol 2019; 47:1189-1197. [PMID: 31732552 DOI: 10.3899/jrheum.190317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore the longterm effect of a 3-month exercise program on leisure time physical activity level in individuals with axial spondyloarthritis (axSpA). METHODS A secondary analysis was performed on data from 100 individuals with axSpA who were included in a randomized controlled trial. The exercise group (EG) participated in a 3-month exercise program while the control group (CG) received no intervention. Physical activity during leisure time was measured with a questionnaire (physically active: ≥ 1 h/week with moderate/vigorous intensity physical activity). Disease activity was measured with the Ankylosing Spondylitis Disease Activity Scale (ASDAS; higher score = worst). Statistical analyses were performed on an intention-to-treat basis using chi-square tests, logistic regression, and mixed models. RESULTS At the 12-month followup, significantly more individuals in the EG than in the CG were physically active [29 (67%) vs 13 (30%), p < 0.001] and exercised 2-3 times/week [25 (58%) vs 15 (34%), p = 0.02], and fewer exercised at light intensity [3 (8%) vs 14 (44%), p = 0.002]. "Participation in the EG" (OR 6.7, 95% CI 2.4-18.6, p < 0.001) and "being physically active at baseline" (OR 4.7, 95% CI 1.4-15.8, p = 0.01) were the factors most associated with being physically active. There were no differences between the groups in ASDAS (p = 0.79). CONCLUSION A 3-month exercise program had a beneficial longterm effect on leisure time physical activity in individuals with axSpA, thus indicating a more beneficial health profile. Still, few individuals continued the intensive program, and there was no difference between the groups in disease activity after 12 months. (ClinicalTrials.gov: NCT02356874).
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Affiliation(s)
- Silje Halvorsen Sveaas
- From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Physiotherapy, Martina Hansens Hospital, Bærum; Department of Physiotherapy, University Hospital of North Norway, Tromsø; Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo; The Norwegian Rheumatology Association, Norway; Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,S.H. Sveaas, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; H. Dagfinrud, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; M.W. Johansen, MSc, Department of Physiotherapy, Martina Hansens Hospital; E. Pedersen, PT, the Department of Physiotherapy, University Hospital of North Norway; O.M. Wold, MSc, Department of Coaching and Psychology, Norwegian School of Sport Sciences, and The Norwegian Rheumatology Association; A. Bilberg, PhD, Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg.
| | - Hanne Dagfinrud
- From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Physiotherapy, Martina Hansens Hospital, Bærum; Department of Physiotherapy, University Hospital of North Norway, Tromsø; Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo; The Norwegian Rheumatology Association, Norway; Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,S.H. Sveaas, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; H. Dagfinrud, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; M.W. Johansen, MSc, Department of Physiotherapy, Martina Hansens Hospital; E. Pedersen, PT, the Department of Physiotherapy, University Hospital of North Norway; O.M. Wold, MSc, Department of Coaching and Psychology, Norwegian School of Sport Sciences, and The Norwegian Rheumatology Association; A. Bilberg, PhD, Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg
| | - Melissa Woll Johansen
- From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Physiotherapy, Martina Hansens Hospital, Bærum; Department of Physiotherapy, University Hospital of North Norway, Tromsø; Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo; The Norwegian Rheumatology Association, Norway; Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,S.H. Sveaas, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; H. Dagfinrud, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; M.W. Johansen, MSc, Department of Physiotherapy, Martina Hansens Hospital; E. Pedersen, PT, the Department of Physiotherapy, University Hospital of North Norway; O.M. Wold, MSc, Department of Coaching and Psychology, Norwegian School of Sport Sciences, and The Norwegian Rheumatology Association; A. Bilberg, PhD, Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg
| | - Elisabeth Pedersen
- From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Physiotherapy, Martina Hansens Hospital, Bærum; Department of Physiotherapy, University Hospital of North Norway, Tromsø; Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo; The Norwegian Rheumatology Association, Norway; Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,S.H. Sveaas, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; H. Dagfinrud, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; M.W. Johansen, MSc, Department of Physiotherapy, Martina Hansens Hospital; E. Pedersen, PT, the Department of Physiotherapy, University Hospital of North Norway; O.M. Wold, MSc, Department of Coaching and Psychology, Norwegian School of Sport Sciences, and The Norwegian Rheumatology Association; A. Bilberg, PhD, Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg
| | - Ole-Martin Wold
- From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Physiotherapy, Martina Hansens Hospital, Bærum; Department of Physiotherapy, University Hospital of North Norway, Tromsø; Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo; The Norwegian Rheumatology Association, Norway; Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,S.H. Sveaas, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; H. Dagfinrud, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; M.W. Johansen, MSc, Department of Physiotherapy, Martina Hansens Hospital; E. Pedersen, PT, the Department of Physiotherapy, University Hospital of North Norway; O.M. Wold, MSc, Department of Coaching and Psychology, Norwegian School of Sport Sciences, and The Norwegian Rheumatology Association; A. Bilberg, PhD, Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg
| | - Annelie Bilberg
- From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Physiotherapy, Martina Hansens Hospital, Bærum; Department of Physiotherapy, University Hospital of North Norway, Tromsø; Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo; The Norwegian Rheumatology Association, Norway; Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,S.H. Sveaas, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; H. Dagfinrud, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; M.W. Johansen, MSc, Department of Physiotherapy, Martina Hansens Hospital; E. Pedersen, PT, the Department of Physiotherapy, University Hospital of North Norway; O.M. Wold, MSc, Department of Coaching and Psychology, Norwegian School of Sport Sciences, and The Norwegian Rheumatology Association; A. Bilberg, PhD, Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg
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Rohde G, Berg KH, Pripp AH, Prøven A, Haugeberg G. No deterioration in health-related quality of life in patients with axial spondyloarthritis followed for 5 years in ordinary outpatient clinics in the biological treatment era. Qual Life Res 2019; 29:99-107. [PMID: 31559519 PMCID: PMC6962281 DOI: 10.1007/s11136-019-02308-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Axial spondyloarthritis (ax-SpA) causes pain, fatigue, stiffness, loss of physical function and impaired health-related quality of life (HRQOL). AIMS The study aimed to explore the changes in HRQOL over 5 years in patients with ax-SpA and to identify baseline predictors associated with changes in HRQOL assessed using three HRQOL measures. METHODS Demographic, disease, medication and HRQOL data were collected at baseline and at 5-year follow-up. HRQOL was assessed using SF-6D, 15D and SF-36. Analyses involved McNemar, independent paired t tests and multiple regression. RESULTS In the 240 (women 31%, men 69%) ax-SpA patients assessed (mean age 46 years), measures reflecting disease activity decreased and co-morbidities increased, and more patients were treated with biologic drugs during follow-up. No deterioration in HRQOL was observed between baseline and 5-year follow-up; indeed, there was a significant increase in SF-6D and SF-36 PCS scores. Improvement in HRQOL measured by SF-6D was associated with younger age, higher education, low Bath Ankylosing Spondylitis (BAS) Activity Index (BASDAI), high BAS Patient Global Score and high C-reactive protein; improvement in SF-36 PCS was associated with younger age, higher education, low BASDAI and no use of biological treatment at baseline. CONCLUSION Our ax-SpA outpatient clinic patients, with more patients treated with biologic drugs during the 5-year follow-up, did not deteriorate in HRQOL. In fact, the physical dimension in HRQOL improved over the years, as did measures reflecting disease activity. Our study adds evidence to the importance of suppressing inflammation to maintain and improve HRQOL in ax-SpA patients.
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Affiliation(s)
- Gudrun Rohde
- Faculty of Health and Sport Sciences, University of Agder, Norway and Department of Clinical Research, Sorlandet Hospital, Kristiansand, Postbox 422, 4604, Kristiansand, Norway.
| | - Kari Hansen Berg
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, OsloMet - Oslo University Hospital, Oslo, Norway
| | - Anne Prøven
- Department of Rheumatology, Martina Hansens Hospital, Baerum, Norway
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Medicine, Sorlandet Hospital HF, Kristiansand, Norwegian University of Science and Technology, Trondheim, Norway
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23
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Pulmonary Function, Aerobic Capacity and Related Variables in Patients With Ankylosing Spondylitis. Arch Rheumatol 2019; 34:317-325. [PMID: 31598598 DOI: 10.5606/archrheumatol.2019.7145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/25/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate the cardiopulmonary functions and exercise performance of patients with ankylosing spondylitis (AS) and to investigate the relationship between these parameters and disease activity, spine mobility and quality of life (QoL). Patients and methods Forty-five patients with AS (group 1; 33 males, 12 females; mean age 43.1±12.1 years; range 22 to 70 years) and 30 control subjects (group 2; 23 males, 7 females; mean age 42.8±10.0; range 23 to 70 years) were included in the study. Disease activity was assessed with the Bath Ankylosing Spondylitis Disease Activity Index and spinal mobility measures with the Bath Ankylosing Spondylitis Metrology Index (BASMI). The Ankylosing Spondylitis Quality of Life (ASQoL) Questionnaire and the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) were used. The pulmonary function test (PFT) and cardiopulmonary exercise testing (CPET) were performed. Results There was no significant difference between groups 1 and 2 in terms of mean age. The peak expiratory flow value in PFT was significantly lower in group 1 (p<0.05). In group 1, the duration of CPET was significantly shorter, and maximum work load and metabolic equivalent were significantly lower than in group 2 (p<0.001). Maximum oxygen uptake (VO2max) in peak responses, work and heart rate were significantly lower in group 1. The duration of CPET and maximum work were negatively correlated with age and BASMI (p<0.001). VO2max was negatively correlated with age, MASES and ASQoL (p<0.05). Conclusion There was no significant difference in PFT parameters between the groups. On the other hand, CPET parameters were significantly lower in the AS group. While CPET parameters are affected by spinal mobility, declining aerobic capacity affects QoL.
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24
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Tsang HHL, Cheung JPY, Wong CKH, Cheung PWH, Lau CS, Chung HY. Psychometric validation of the EuroQoL 5-dimension (EQ-5D) questionnaire in patients with spondyloarthritis. Arthritis Res Ther 2019; 21:41. [PMID: 30700326 PMCID: PMC6354427 DOI: 10.1186/s13075-019-1826-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Spondyloarthritis (SpA) has a significant impact on patients' quality of life due to functional impairments. Generic health instruments like the EuroQoL 5-dimension (EQ-5D) is important for the cost-utility analysis of health care interventions and calculation of quality-adjusted life years. However, the applicability of the EQ-5D health measure in Chinese patients with SpA is currently unknown. Hence, the aim of the study is to test the psychometric properties and to validate the use of the EQ-5D health measure for utility analyses in Chinese patients with SpA. METHODS Prospective and consecutive recruitment of 220 Chinese patients with SpA was conducted. Demographic data including smoking and drinking habits, education level, income, and occupation was collected. Disease-associated data including disease duration, the presence of back pain, peripheral arthritis, dactylitis, enthesitis, uveitis, psoriasis, and inflammatory bowel disease was also recorded. Questionnaires regarding disease activity and functional disability (BASDAI, BASFI, BASGI, BASMI, ASDAS, ODI), mental health (HADS depression and anxiety), and the EQ-5D scores were recorded. SF-36 scores were used to verify the findings. Baseline correlations were performed along with test-retest reliability, validity, and internal consistency tests. Specifically, the relationship between EQ-5D and disease activity and functional scores was studied. RESULTS EQ-5D scores achieved acceptable internal consistency and reliability. A ceiling effect was observed for all domains of the EQ-5D except for pain/discomfort. No floor effect was observed. Significant negative correlations were observed between ODI, HADS, BASFI, BASMI, BASDAI, and ASDAS-CRP and with EQ-5D. A higher disease activity was well-differentiated by EQ-5D, as with the disability and mental health scores. CONCLUSIONS The EQ-5D demonstrates satisfactory psychometric properties for assessment of SpA patients. It has high utility for demonstrating changes in disease activity and disability.
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Affiliation(s)
| | - Jason Pui Yin Cheung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China
| | - Chak Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ho Yin Chung
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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25
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Abstract
Advances in pharmacologic management of inflammatory conditions have allowed those living with these conditions to pursue fitness activities previously difficult due to functional limitations. With that said, many patients with inflammatory arthritis are still not active enough. In this article, we review specific exercise recommendations for a number of inflammatory conditions with a focus on overall health promotion and cardiovascular disease risk reduction, discuss exercise as an adjunct to pharmacologic disease management, and review potential risks of sport participation for athletes with inflammatory arthritis conditions.
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Affiliation(s)
- Amy P Powell
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT
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26
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Hammer NM, Midtgaard J, Hetland ML, Krogh NS, Esbensen BA. Physical activity behaviour in men with inflammatory joint disease: a cross-sectional register-based study. Rheumatology (Oxford) 2018; 57:803-812. [PMID: 29390089 DOI: 10.1093/rheumatology/kex498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Indexed: 12/15/2022] Open
Abstract
Objectives Physical activity is recommended as an essential part of the non-pharmacological management of inflammatory joint disease, but previous research in this area has predominantly included women. The aim of this study was to examine physical activity behaviour in men with inflammatory joint disease. Methods The study was conducted as a cross-sectional register-based study. Data on physical activity behaviour in men with RA, PsA and AS were matched with sociodemographic and clinical variables extracted from the DANBIO registry. Logistic regression analyses using multiple imputations were performed to investigate demographic and clinical variables associated with regular engagement in physical activity (moderate-vigorous ⩾2 h/week). Descriptive statistics were applied to explore motivation, barriers and preferences for physical activity. Results A total of 325 men were included of whom 129 (40%) engaged in regular physical activity. In univariate analyses, higher age, visual analogue scale (VAS) for pain, VAS fatigue, VAS patient's global, CRP level, disease activity, functional disability and current smoking were negatively associated with regular engagement in physical activity. In the final multivariable regression model only a high VAS fatigue score (⩾61 mm) (OR = 0.228; CI: 0.119, 0.436) remained significantly independently associated with regular physical activity. Conclusion A majority of men with inflammatory joint disease do not meet the recommendations of regular physical activity. Both sociodemographic and clinical parameters were associated with engagement in physical activity, and fatigue especially seems to play a pivotal role in explaining suboptimal physical activity behaviour in this patient group.
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Affiliation(s)
- Nanna Maria Hammer
- The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Julie Midtgaard
- The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Section of Social Medicine, Copenhagen, Denmark
| | - Merete Lund Hetland
- The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Bente Appel Esbensen
- The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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27
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Deiseroth A, Marcin T, Berger C, Infanger D, Schäfer J, Bannert B, Schmidt-Trucksäss A, Voll RE, Kyburz D, Hanssen H. Retinal Vessel Diameters and Physical Activity in Patients With Mild to Moderate Rheumatic Disease Without Cardiovascular Comorbidities. Front Physiol 2018; 9:176. [PMID: 29593551 PMCID: PMC5854847 DOI: 10.3389/fphys.2018.00176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/20/2018] [Indexed: 01/23/2023] Open
Abstract
Objectives: Low-grade systemic inflammation is responsible for atherosclerotic lesions in patients with rheumatic diseases. Vascular dysfunction is a precursor of atherosclerosis and can be improved by physical activity (PA). Our aim was to asses micro- and macrovascular function as well as PA and cardiorespiratory fitness (CRF) in patients with rheumatic diseases in the absence of cardiovascular (CV) comorbidities compared to controls. Methods: Fifty-one patients without CV comorbidities were compared to 35 controls. Retinal microvascular diameters were assessed using a Retinal Vessel Analyzer. Arterial stiffness (AST) was measured by applanation tonometry. CRF was assessed as peak oxygen consumption and PA was assessed with a questionnaire. Results: Retinal venular diameters were significantly wider in patients [median 221 μm (interquartile range (IQR) 211, 231)] compared to controls [median 215 μm (IQR 196, 223); p = 0.01]. One hour increase of PA per week led to a venular constriction of -0.56 μm (95%CI -1.09, -0.03; p = 0.04). In our patients with low disease activity (median DAS28 1.9; median BASDAI 2.8), no differences in AST were evident compared to controls. The association of PA and CRF with AST was not independent of blood pressure. Conclusions: Patients with rheumatic disease and mild-to-moderate disease activity show an impairment of the retinal microvasculature but not of large artery stiffness. Retinal vessel analysis seems to be a sensitive biomarker to unmask vascular impairments even in the absence of classic CV risk factors. PA may have the potential to counteract the development of small artery disease at early stages of rheumatic disease.
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Affiliation(s)
- Arne Deiseroth
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Thimo Marcin
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Colette Berger
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Juliane Schäfer
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Bettina Bannert
- Rheumatology Unit, University Hospital Basel, Basel, Switzerland.,Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Villingen-Schwenningen, Germany
| | | | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Villingen-Schwenningen, Germany
| | - Diego Kyburz
- Rheumatology Unit, University Hospital Basel, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Jacquemin C, Servy H, Molto A, Sellam J, Foltz V, Gandjbakhch F, Hudry C, Mitrovic S, Fautrel B, Gossec L. Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study. JMIR Mhealth Uhealth 2018; 6:e1. [PMID: 29295810 PMCID: PMC5770578 DOI: 10.2196/mhealth.7948] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/15/2017] [Accepted: 10/30/2017] [Indexed: 01/10/2023] Open
Abstract
Background Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). Objective The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. Methods This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. Results A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. Conclusions Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases.
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Affiliation(s)
- Charlotte Jacquemin
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | | | - Anna Molto
- Rheumatology B Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM (U1153), Clinical Epidemiology and Biostatistics, Paris-Descartes University, Sorbonne Paris-Cité, Paris, France
| | - Jérémie Sellam
- Rheumatology Department, St-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,DHU i2B, INSERM UMRS_938, UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Violaine Foltz
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Frédérique Gandjbakhch
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Christophe Hudry
- Rheumatology B Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Mitrovic
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Bruno Fautrel
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Laure Gossec
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
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Rohde G, Berg KH, Prøven A, Haugeberg G. The relationship between demographic- and disease-related variables and health-related quality of life in patients with axial spondyloarthritis. BMC Musculoskelet Disord 2017; 18:328. [PMID: 28764693 PMCID: PMC5540516 DOI: 10.1186/s12891-017-1693-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background Axial spondyloarthritis (ax-SpA) is a chronic inflammatory disease of the spine causing pain, stiffness, loss in physical function, and fatigue. Therefore, the physical and psychological burden of having this chronic disease can reduce the quality of life. We aimed to explore the relationship between demographic- and disease-related variables and health-related quality of life (HRQoL) in patients with ax-SpA. Methods Demographic- and disease-related, HRQoL-related and treatment data were collected. Disease measures included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the BAS Functional Index (BASFI), the BAS Global (BAS-G) score, the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), the Health Assessment Questionnaire (HAQ) and co-morbidity. HRQoL was assessed using the SF-36 and the utility measures SF-6D and 15D. Variables associated with HRQoL were identified in unadjusted and adjusted analyses. Results We examined 380 patients with ax-SpA (67% men) with a mean age of 46 years. Among them, 86% reported exercising >1 h per week. Mean values were as follows: BASDAI, 3.17; MASES, 3.19; BASFI, 2.71; BAS-G. 3.88; and HAQ, 0.56. The percentage of current users of NSAIDs was 44%, and of DMARDs 23%. In multivariate analyses, exercising 1–3 h per week (B = 2.73, p = 0.022) and exercising >3 h per week (B = 2.71, p = 0.020), lower HAQ scores (B = −4.61, p = 0.001), lower BASFI scores (B = −1.05, p = 0.010) and lower BAS-G scores (B = −0.91, p = 0.001) were independently associated with higher SF-36-PCS scores, whereas modest alcohol consumption (B = 4.63, p = 0.018) and a lower BAS-G score (B = −1.73, p < 0.001) were independently associated with higher SF-36-MCS scores. Exercising 1–3 h per week (B = 0.032, p = 0.004) and exercising >3 h per week (B = 0.036, p = 0.001), lower HAQ scores (B = −0.051, p < 0.001), lower BAS-G scores (B = −0.010, p < 0.001) and co-morbidity (B = −0.014, p = 0.004) were independently associated with higher 15D scores. Finally, exercising 1–3 h per week (B = 0.045, p = 0.001) and exercising > 3 h per week (B = 0.053, p < 0.001), lower HAQ scores (B = −0.054, p = 0.001) and lower BAS-G scores (B = −0.020, p < 0.001) were associated with higher SF-6D scores. Conclusions In patients with ax-SpA, a low level of physical activity, impaired physical function and impaired general well-being were independently and consistently associated with a decreased HRQoL across all applied measures.
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Affiliation(s)
- Gudrun Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, 422, 4604, Kristiansand, Norway. .,Department of Clinical Research, Sorlandet Hospital, Kristiansand, 4604, Norge. .,Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, UK.
| | - Kari Hansen Berg
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, 422, 4604, Kristiansand, Norway
| | - Anne Prøven
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
| | - Glenn Haugeberg
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, 4604, Norge.,Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.,Department of Neurosciences, Rheumatology Division, INM, Norwegian University of Science and Technology, Trondheim, Norway
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O'Dwyer T, Monaghan A, Moran J, O'Shea F, Wilson F. Behaviour change intervention increases physical activity, spinal mobility and quality of life in adults with ankylosing spondylitis: a randomised trial. J Physiother 2017; 63:30-39. [PMID: 27989730 DOI: 10.1016/j.jphys.2016.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 05/23/2016] [Accepted: 11/22/2016] [Indexed: 01/24/2023] Open
Abstract
QUESTIONS Does a 3-month behaviour change intervention targeting physical activity (PA) increase habitual physical activity in adults with ankylosing spondylitis (AS)? Does the intervention improve health-related physical fitness, AS-related features, and attitude to exercise? Are any gains maintained over a 3-month follow-up? DESIGN Parallel-group, randomised, controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Forty adults with a diagnosis of AS, on stable medication, and without PA-limiting comorbidities. INTERVENTION Over a 3-month period, the experimental group engaged in individually-tailored, semi-structured consultations aiming to motivate and support individuals in participating in PA. The control group continued with usual care. OUTCOME MEASURES The primary outcome was PA measured by accelerometry over 1 week. Secondary outcomes included clinical questionnaires and measures of health-related physical fitness. Measures were taken at baseline, post-intervention, and after a 3-month follow-up period. RESULTS Baseline characteristics were similar across groups, except age and body composition. There were statistically significant, moderate-to-large time-by-group effects in health-enhancing PA (mixed-design ANOVA for overall effect F(2, 76)=14.826, p<0.001), spinal mobility (F(2, 76)=5.691, p<0.005) and quality of life (χ2(2)=8.400, p<0.015) favouring the intervention group; post-intervention improvements were sustained 3 months later. No significant effects were seen in other physical fitness outcomes or on clinical questionnaires. No adverse effects were reported during the study. CONCLUSION Health-enhancing PA, spinal mobility and quality of life were significantly improved after the intervention, and improvements were maintained at 3-month follow-up. TRIAL REGISTRATION NCT02374502. [O'Dwyer T, Monaghan A, Moran J, O'Shea F, Wilson F (2016) Behaviour change intervention increases physical activity, spinal mobility and quality of life in adults with ankylosing spondylitis: a randomised trial.Journal of PhysiotherapyXX: XX-XX].
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Affiliation(s)
- Tom O'Dwyer
- Discipline of Physiotherapy, Trinity College Dublin, Ireland
| | - Ann Monaghan
- Discipline of Physiotherapy, Trinity College Dublin, Ireland
| | - Jonathan Moran
- Discipline of Physiotherapy, Trinity College Dublin, Ireland
| | - Finbar O'Shea
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Fiona Wilson
- Discipline of Physiotherapy, Trinity College Dublin, Ireland
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