HIGH INTENSITY EXERCISE FOR 3 MONTHS REDUCES DISEASE ACTIVITY IN AXIAL SPONDYLOARTHRITIS (AXSPA): A MULTICENTER RANDOMISED TRIAL OF 100 PATIENTS

Review written by Dr Fiona Wilson info

BACKGROUND & OBJECTIVE

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease and the leading feature is inflammatory back pain. Axial SpA is also associated with an increased risk of cardiovascular disease. Modern drug therapies have resulted in significantly improved management of symptoms and disease control in this population. Recent research has focused on exercise interventions to address deconditioning associated with the disease, although traditional approaches have examined relatively low dose prescriptions; primarily due to fear of causing a flare-up of disease activity. This study examined the effect of a 3-month high intensity exercise prescription on disease activity.

METHODS

100 patients with axSpA were randomly assigned to a 3-month exercise or no-intervention group. The exercise group performed three high intensity cardiorespiratory sessions per week. Two of the three sessions consisted of a 10-minute warm up at 70% of HRmax then 4x4 minute intervals of treadmill running or bike ergometer at 90-95% HRmax, with 3-minute of active rest at 70% HRmax in between sets. The third session was home-based consisting of 40 minutes at 70% HRmax of running or cycling. Strength exercises were also performed twice a week (2-3 sets of 8-10 reps, focusing on major muscle groups). Pain 5/10 on a 0-10 scale was allowed. The control group received ‘standard care’ and were told to continue normal physical activity. The primary outcome measure was disease activity using the AS Disease Activity Scale (ASDAS) and the Bath AS Disease Activity Scale (BASDAI). Inflammatory markers, physical function, cardiovascular health and muscle mass (DXA) were also assessed.

RESULTS

There was significant improvement in both the ASDAS and BASDAI for the intervention group. For ASDAS, there was a 23% improvement for the intervention compared to 4% improvement in the control group. For BASDAI there was a 33% improvement in

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