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van Wissen M, Gademan M, Vliet Vlieland T, Straathof B, Teuwen M, Peter WF, van den Ende C, van Weely S. Physical therapy in patients with rheumatoid arthritis and axial spondyloarthritis: the patients' perspective. Scand J Rheumatol 2023; 52:609-618. [PMID: 37139785 DOI: 10.1080/03009742.2023.2195726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/23/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To assess the duration, frequency, and content of individual physical therapy (PT) in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). METHOD In this cross-sectional study, an electronic questionnaire aimed at people with RA and axSpA was distributed through various communication channels of the Dutch Arthritis Foundation. It comprised questions on sociodemographic and health characteristics, received PT (currently and/or in the past year) and, if applicable, its duration, frequency, and content (active exercises, manual treatment, physical modalities, and/or counselling/education). RESULTS The study included 257 and 94 patients with self-reported diagnoses of RA and axSpA, of whom 163 (63%) and 77 (82%) currently or had recently received individual PT. The duration of individual PT was long-term (> 3 months) in 79% of RA and 83% of axSpA patients, with an average frequency of once per week in most. Although active exercises and counselling/education were each reported by ≥ 73% of the patients with RA and axSpA who received long-term individual PT, passive treatment modalities were also often offered (≥ 89%), in particular massage, kinesiotaping, and/or passive mobilization. The same pattern was seen in patients receiving short-term PT. CONCLUSION The majority of patients with RA and axSpA received PT currently or in the past year, usually individually, long-term, and at a frequency of once a week. Although active exercises and education are recommended in guidelines, passive treatment options that are not advised were relatively often reported. An implementation study to identify barriers and facilitators regarding adherence to clinical practice guidelines seems warranted.
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Affiliation(s)
- Mat van Wissen
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Mgj Gademan
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tpm Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - B Straathof
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Mmh Teuwen
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - W F Peter
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Chm van den Ende
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sfe van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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Hilberdink B, van der Giesen F, Vliet Vlieland T, van Bodegom-Vos L, Van Weely S. Implementing enhancements in supervised group exercise for people with axial spondyloarthritis: a hybrid effectiveness-implementation study. Scand J Rheumatol 2023; 52:60-68. [PMID: 34788187 DOI: 10.1080/03009742.2021.1992845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The content of supervised group exercise (SGE) for axial spondyloarthritis (axSpA) has hardly changed in recent decades, despite new evidence-based insights to improve SGE quality. This pilot implementation study evaluated the effects and feasibility of enhancements in axSpA-specific SGE in four regions in the Netherlands. METHOD The implemented enhancements included: more high-intensity aerobic exercise; exercise personalization with periodic assessments; and patient education on home exercise. The implementation strategy included a one-day supervisor training course and telephone support. To evaluate effects, aerobic capacity [Six-Minute Walk Test (6MWT)], physical functioning [Ankylosing Spondylitis Performance-based Improvement (ASPI); improved/not improved], health status [Assessment of SpondyloArthritis international Society Health Index (ASAS HI) questionnaire], and home exercise engagement [Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH)] were assessed at baseline and after one year in 60 participants. Changes were analysed with the Wilcoxon signed-rank test. To evaluate feasibility, a survey of participants and semi-structured interviews with four SGE supervisors assessed uptake and satisfaction with the enhancements. RESULTS Aerobic capacity increased significantly and 35% of participants improved functioning, whereas health status and home exercise engagement did not change. The participants' survey and supervisors' interviews showed that high-intensity aerobic exercise was implemented successfully, exercise personalization and periodic assessments were implemented partially, and patient education was not implemented at all. Most participants were satisfied with the changes. CONCLUSIONS After this pilot implementation, SGE enhancements were only partially implemented. Nevertheless, aerobic capacity improved significantly and satisfaction with accomplished changes was high. Nationwide implementation would require adaptations to improve feasibility.
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Affiliation(s)
- B Hilberdink
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - F van der Giesen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - S Van Weely
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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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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Mogard E, Bremander A, Haglund E. A combination of two or more unhealthy lifestyle factors is associated with impaired physical and mental health in patients with spondyloarthritis: a cross-sectional study. BMC Rheumatol 2022; 6:29. [PMID: 35610662 PMCID: PMC9131533 DOI: 10.1186/s41927-022-00260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA). METHODS A population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as "healthy" or "unhealthy", summarized for each patient and stratified into four groups (0-3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis. RESULTS Out of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors-more frequently patients with PsA (48%) than AS (39%) or USpA (38%)-and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes. CONCLUSION Reporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health.
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Affiliation(s)
- Elisabeth Mogard
- Department of Clinical Sciences Lund, Rheumatology, Skane University Hospital, Lund University, Lund, Sweden.
| | - Ann Bremander
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Emma Haglund
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden.,Spenshult Research and Development Centre, Halmstad, Sweden.,Rydberg Laboratory of Applied Sciences, Halmstad University, Halmstad, Sweden
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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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Jimeno-Almazán A, Pallarés JG, Buendía-Romero Á, Martínez-Cava A, Franco-López F, Sánchez-Alcaraz Martínez BJ, Bernal-Morel E, Courel-Ibáñez J. Post-COVID-19 Syndrome and the Potential Benefits of Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5329. [PMID: 34067776 PMCID: PMC8156194 DOI: 10.3390/ijerph18105329] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/25/2023]
Abstract
The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is leading to unknown and unusual health conditions that are challenging to manage. Post-COVID-19 syndrome is one of those challenges, having become increasingly common as the pandemic evolves. The latest estimates suggest that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Although research is beginning to examine this new condition, there are still serious concerns about the diagnostic identification, which limits the best therapeutic approach. Exercise programs and physical activity levels are well-known modulators of the clinical manifestations and prognosis in many chronic diseases. This narrative review summarizes the up-to-date evidence on post-COVID-19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long-term effects of COVID-19.
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Affiliation(s)
- Amaya Jimeno-Almazán
- Department of Infectious Diseases, Hospital Universitario Santa Lucía, Cartagena, 30202 Murcia, Spain;
- Human Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, Spain; (J.G.P.); (Á.B.-R.); (A.M.-C.); (F.F.-L.)
| | - Jesús G. Pallarés
- Human Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, Spain; (J.G.P.); (Á.B.-R.); (A.M.-C.); (F.F.-L.)
| | - Ángel Buendía-Romero
- Human Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, Spain; (J.G.P.); (Á.B.-R.); (A.M.-C.); (F.F.-L.)
| | - Alejandro Martínez-Cava
- Human Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, Spain; (J.G.P.); (Á.B.-R.); (A.M.-C.); (F.F.-L.)
| | - Francisco Franco-López
- Human Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, Spain; (J.G.P.); (Á.B.-R.); (A.M.-C.); (F.F.-L.)
| | | | - Enrique Bernal-Morel
- Department of Infectious Diseases, Hospital General Universitario Reina Sofía, University of Murcia, IMIB, 30003 Murcia, Spain;
| | - Javier Courel-Ibáñez
- Human Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, Spain; (J.G.P.); (Á.B.-R.); (A.M.-C.); (F.F.-L.)
- Department of Physical Training, Post-COVID-19 Rehabilitation Unit, Hospital QuirónSalud, 30011 Murcia, Spain
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Organisation and content of supervised group exercise for people with axial spondyloarthritis in The Netherlands. Rheumatol Int 2020; 41:391-401. [PMID: 33244645 PMCID: PMC7835145 DOI: 10.1007/s00296-020-04742-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/28/2020] [Indexed: 01/10/2023]
Abstract
Supervised group exercise (SGE) is recommended for people with axial spondyloarthritis (axSpA). Recent literature suggests that its contents and dosage must probably be revised. As a first step towards renewal, this study examined the current SGE organisation and content for people with axSpA in The Netherlands. A pen-and-paper survey was sent to the boards of the 82 local patient associations affiliated with the Dutch Arthritis Society in 2016. One member of each board was asked to complete questions on the nature and organisation of SGE and one of the supervising therapists to complete questions on the SGE supervision and contents. The questionnaire was returned by representatives of 67/82 (82%) local patient associations, of which 17 (25%) provided axSpA-specific SGE (16/17 SGE programmes with both land-based exercise and hydrotherapy and 1/17 with only hydrotherapy). These involved in total 56 groups with 684 participants and 59 supervisors, of whom 54 were physical therapists and 21 had had postgraduate education on rheumatic and musculoskeletal diseases (RMDs). Besides mobility and strengthening exercises and sports (17/17), most programmes included aerobic exercise (10/17), but rarely with heart rate monitoring (1/17), patient education (8/17), periodic assessments (2/17), or exercise personalisation (1/17). In the Netherlands, a quarter of local patient associations organised axSpA-specific SGE, mostly containing land-based exercises combined with sports and hydrotherapy. Most supervisors lacked postgraduate education on RMDs and most programmes lacked intensity monitoring, patient education, periodic assessments, and personalisation, which are needed for optimising exercise programmes according to current scientific insights.
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Liu SH, Shridharmurthy D, Lapane KL, Dubé CE, Gravallese EM, Kay J. Physical Activity and Attitudes Toward Exercise in People With Axial and Peripheral Spondyloarthritis. J Rheumatol 2020; 48:513-519. [PMID: 33060306 DOI: 10.3899/jrheum.200354] [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] [Accepted: 10/02/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate physical activity and attitudes toward exercise among people with axial (ax-) and peripheral (p-) spondyloarthritis (SpA). METHODS Using baseline information from an ongoing, longitudinal, prospective SpA cohort study (n = 264), self-reported attitudes and beliefs toward exercise were assessed using questionnaires. Total metabolic equivalent (MET) hours of self-reported physical activity per week, time spent in activities, and activity levels were calculated from the Nurses' Health Study Physical Activity Questionnaire II (NHSPAQ II). Adjusted multivariable linear models estimated the relationship between physical activity and disease status (axial vs peripheral). RESULTS Regardless of predominant anatomic distribution of disease, most participants were well-educated, non-Hispanic White men. Approximately 40% met the US Department of Health and Human Services physical activity recommendations. Positive attitudes, beliefs, and perceived benefits toward exercise were similar by anatomic distribution of disease. Despite similar MET h/week, participants with axial disease had greater concerns regarding discomfort and joint injuries than those with peripheral disease. Compared to those with pSpA (n = 201), participants with axSpA (n = 63) spent less time engaging in light and moderate activities (adjusted β in light activity: -1.94 min/week, 95% CI -2.96 to -0.93; adjusted β in moderate activity: -1.05 min/week, 95% CI -2.12 to 0.02). CONCLUSION Participants with axSpA had greater concerns regarding discomfort and injuries from exercise than those with pSpA. Although no differences in time spent in vigorous activities were observed, participants with axSpA spent less time than those with pSpA in light to moderate activities.
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Affiliation(s)
- Shao-Hsien Liu
- S.H. Liu, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts;
| | - Divya Shridharmurthy
- D. Shridharmurthy, MPH, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- K.L. Lapane, PhD, C. Dubé, EdD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Catherine E Dubé
- K.L. Lapane, PhD, C. Dubé, EdD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ellen M Gravallese
- E.M. Gravallese, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jonathan Kay
- J. Kay, MD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, and Division of Rheumatology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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