{"id":11416,"date":"2024-12-16T16:58:59","date_gmt":"2024-12-16T15:58:59","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11416"},"modified":"2024-12-16T17:00:54","modified_gmt":"2024-12-16T16:00:54","slug":"physical-activity-in-axial-spondyloarthritis-what-should-we-be-telling-our-patients","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2024\/12\/16\/physical-activity-in-axial-spondyloarthritis-what-should-we-be-telling-our-patients\/","title":{"rendered":"Physical activity in axial spondyloarthritis \u2013 what should we be telling our patients?"},"content":{"rendered":"<p><em><b>Authors: <\/b>Kaley Ainsworth and Raj Amarnani<\/em><\/p>\n<blockquote><p>This blog explores the evidence based physical activity guidelines and resources available for patients with axial spondyloarthritis<\/p><\/blockquote>\n<h3>Introduction<\/h3>\n<p><span style=\"font-weight: 400\">The importance and benefits of exercise in patients with chronic disease, in particular axial spondyloarthritis (AxSpA), is evident within existing literature. <\/span><span style=\"font-weight: 400\">The inclusion of exercise programmes within the management of patients with <\/span><span style=\"font-weight: 400\">AxSpA<\/span><span style=\"font-weight: 400\"> has the potential to:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Reduce disease symptoms, such as pain, fatigue and stiffness (1)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Reduce<\/span><span style=\"font-weight: 400\"> disease activity (2)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Improve disease outcomes (3)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Moving Medicine is an initiative with the aim to improve physical activity conversations across healthcare as well as supporting physical activity delivery to patients (4). Specifically, in 2018, an \u201cinflammatory rheumatic diseases\u201d scoping review was produced. We updated this review in 2022 to include further findings with regards to the effects of physical activity on AxSpA as well as looking at motivators, facilitators and barriers for patients and healthcare professionals towards exercise programmes (5). Barriers towards exercise programmes for patients included <\/span><span style=\"font-weight: 400\">lack of time, fatigue, pain and economic concern.<\/span><\/p>\n<h3>Axial Spondyloarthritis<\/h3>\n<p><span style=\"font-weight: 400\">AxSpA is a chronic inflammatory arthritis that mainly affects joints of the chest, spine and pelvis with the most common symptoms being back pain and joint stiffness (6). AxSpA can also affect other parts of the body such as the eyes, heart, skin and bowel (7). AxSpA can have a variety of negative effects on patients including pain and fatigue which can restrict activities of daily living and reduce quality of life (8). In our Moving Medicine scoping review, there was good quality evidence that physical activity has a number of benefits in patients with AxSpA. This included improvement in function and activities of daily living, reduced disease activity and fatigue (9-11). There was also some low-quality evidence that physical activity can improve sleep, mood, pain and stiffness (12,13). Importantly, no harm from physical activity was found in any of the identified research.<\/span><\/p>\n<h3>Physical activity and exercise<\/h3>\n<p><em>The information in the following two paragraphs summarised from a recent narrative review (5).\u00a0<\/em><\/p>\n<p><span style=\"font-weight: 400\">AxSpA poses unique challenges in managing physical activity due to its impact on the axial skeleton. From our evidence, we believe that a pragmatic exercise program tailored to patients with AxSpA should prioritise flexibility, strength, and cardiovascular fitness while mitigating the risk of exacerbating symptoms. Patients should engage in a combination of low-impact aerobic exercises such as swimming, cycling, or brisk walking to improve cardiovascular health without imposing excessive strain on the spine and sacroiliac joints. Flexibility exercises, including yoga and pilates, can enhance range of motion and alleviate stiffness commonly associated with AxSpA. However, caution may need to be exercised to avoid hyperextension or high-impact movements that may strain the spine, exacerbate inflammation, and potentially worsen symptoms. Although the evidence in the literature has not found harms with this explicitly, a patient centred pragmatic approach ought to be taken if the patient desires to take part in such exercises.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Alongside this, resistance training focusing on core stability and muscle strength is integral to the exercise regimen for axSpA patients. Targeting muscles around the spine and pelvis through exercises like planks, bridges, and modified squats can enhance spinal support and reduce the risk of injury. It is imperative to emphasise proper form and technique to prevent overloading vulnerable joints while gradually increasing resistance and intensity over time. By adhering to a tailored exercise program that balances cardiovascular fitness, flexibility, and strength training while avoiding provocative movements, patients with AxSpA can optimise their physical function and quality of life<\/span><\/p>\n<h3>Conclusion<\/h3>\n<p><span style=\"font-weight: 400\">Exercise programmes and physical activity have an important role in the management of patients with AxSpA. In order for patients with AxSpA to benefit fully from the positive effects of exercise, this requires a balance of motivation from the patient as well as support from healthcare professionals. Moving Medicine provides guidance for healthcare professionals with the aim of encouraging patients to become more physically active. In order to address particular barriers towards exercise programmes from patients, structured programmes formed between both the patient and healthcare professional have the potential to be beneficial in encouraging physical activity. These would be individualised to the patient and would enable progress to be monitored and the exercise programme adjusted accordingly. Further research is required to fully understand the extent to which physical activity can have a positive effect on disease symptoms, activity and outcomes. This could include looking at disease activity on laboratory tests as well as through radiology and imaging.\u00a0<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11418\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/Infographic-BJSM-blog-2-120x300.png\" alt=\"\" width=\"537\" height=\"1343\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/Infographic-BJSM-blog-2-120x300.png 120w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/12\/Infographic-BJSM-blog-2.png 600w\" sizes=\"auto, (max-width: 537px) 100vw, 537px\" \/><\/p>\n<h4>Author information<\/h4>\n<p><b>Kaley Ainsworth<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400\">FY2 Foundation Doctor<\/span><span style=\"font-weight: 400\"><br \/>\n<\/span><span style=\"font-weight: 400\">South Tyneside and Sunderland NHS Foundation trust<\/span><\/p>\n<p><b>Raj Amarnani <\/b><b><br \/>\n<\/b><span style=\"font-weight: 400\">Sport and Exercise Medicine Specialist Registrar <\/span><span style=\"font-weight: 400\"><br \/>\n<\/span><span style=\"font-weight: 400\">Institute of Sport, Exercise and Health. University College London Hospitals NHS Foundation Trust. <\/span><span style=\"font-weight: 400\"><br \/>\n<\/span><span style=\"font-weight: 400\">@DrRajAmar<\/span><\/p>\n<p><b>References:<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Sveaas SH;Bilberg A;Berg IJ;Provan SA;Rollefstad S;Semb AG;Hagen KB;Johansen MW;Pedersen E;Dagfinrud H; (no date) <\/span><i><span style=\"font-weight: 400\">High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): A multicentre randomised trial of 100 patients<\/span><\/i><span style=\"font-weight: 400\">, <\/span><i><span style=\"font-weight: 400\">British journal of sports medicine<\/span><\/i><span style=\"font-weight: 400\">. Available at: https:\/\/pubmed.ncbi.nlm.nih.gov\/30745314\/ (Accessed: 30 June 2023).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Molto A, Gossec L, Poiraudeau S, Claudepierre P, Soubrier M, Fayet F, Wendling D, Gaudin P, Dernis E, Guis S, Pouplin S, Ruyssen-Witrand A, Chales G, Mariette X, Beauvais C, Combe B, Flipo RM, Richette P, Chary-Valckenaere I, Saraux A, Sibilia J, Schaeverbeke T, Dougados M. Evaluation of the impact of a nurse-led program of patient self-assessment and self-management in axial spondyloarthritis: results of a prospective, multicentre, randomized, controlled trial (COMEDSPA). Rheumatology (Oxford). 2021 Feb 1;60(2):888-895. doi: 10.1093\/rheumatology\/keaa480. PMID: 33063096.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Perrotta, F.M., Lories, R. and Lubrano, E. (2021) <\/span><i><span style=\"font-weight: 400\">To move or not to move: The paradoxical effect of physical exercise in axial spondyloarthritis<\/span><\/i><span style=\"font-weight: 400\">, <\/span><i><span style=\"font-weight: 400\">RMD Open<\/span><\/i><span style=\"font-weight: 400\">. Available at: https:\/\/rmdopen.bmj.com\/content\/7\/1\/e001480 (Accessed: 30 June 2023).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><i><span style=\"font-weight: 400\">Moving Medicine- About Us<\/span><\/i><span style=\"font-weight: 400\"> (2021) <\/span><i><span style=\"font-weight: 400\">Moving Medicine<\/span><\/i><span style=\"font-weight: 400\">. Available at: https:\/\/movingmedicine.ac.uk\/about-us-2\/about-us\/ (Accessed: 30 June 2023).<\/span><\/li>\n<li style=\"font-weight: 400\">Mundell, A., Amarnani, R., Ainsworth, K. <i>et al.<\/i> The Effects of Exercise and Physical Activity in Inflammatory Rheumatic Diseases \u2013 a Narrative Review. <i>J. of SCI. IN SPORT AND EXERCISE<\/i>(2024). https:\/\/doi.org\/10.1007\/s42978-024-00303-x<\/li>\n<li style=\"font-weight: 400\"><i><span style=\"font-weight: 400\">What is axial spa?<\/span><\/i><span style=\"font-weight: 400\"> (2023) <\/span><i><span style=\"font-weight: 400\">National Axial Spondyloarthritis Society<\/span><\/i><span style=\"font-weight: 400\">. Available at: https:\/\/nass.co.uk\/about-as\/what-is-as\/ (Accessed: 30 June 2023).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet (London, England) [Internet]. 2017;390(10089):73\u201384. Available from: <\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28110981\"><span style=\"font-weight: 400\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28110981<\/span><\/a><\/li>\n<li style=\"font-weight: 400\"><i><span style=\"font-weight: 400\">Axial spondyloarthritis and quality of life<\/span><\/i><span style=\"font-weight: 400\"> (2021a) <\/span><i><span style=\"font-weight: 400\">AJMC<\/span><\/i><span style=\"font-weight: 400\">. Available at: https:\/\/www.ajmc.com\/view\/axial-spondyloarthritis-and-quality-of-life (Accessed: 11 July 2023).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Sveaas SH, Bilberg A, Berg IJ, Provan SA, Rollefstad S, Semb AG, et al. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. Br J Sports Med [Internet]. 2020 Mar;54(5):292\u20137. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30745314<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Verhoeven F, Guillot X, Prati C, Mougin F, Tordi N, Demougeot C, et al. Aerobic exercise for axial spondyloarthritis &#8211; its effects on disease activity and function as compared to standard physiotherapy: A systematic review and meta-analysis. Int J Rheum Dis [Internet]. 2019 Feb;22(2):234\u201341. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30187695<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Basakci Calik B, Gur Kabul E, Task\u0131n H, Telli Atalay O, Bas Aslan U, Tasc\u0131 M, et al. The efficiency of inspiratory muscle training in patients with ankylosing spondylitis. Rheumatol Int [Internet]. 2018 Sep;38(9):1713\u201320. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29943207<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Regnaux J-P, Davergne T, Palazzo C, Roren A, Rannou F, Boutron I, et al. Exercise programmes for ankylosing spondylitis. Cochrane database Syst Rev [Internet]. 2019 Oct 2;10:CD011321. Available from: <\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31578051\"><span style=\"font-weight: 400\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31578051<\/span><\/a><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Hu X, Chen J, Tang W, Chen W, Sang Y, Jia L. Effects of exercise programmes on pain, disease activity and function in ankylosing spondylitis: A meta<\/span><span style=\"font-weight: 400\">\u2010<\/span><span style=\"font-weight: 400\">analysis of randomized controlled trials. Eur J Clin Invest [Internet]. 2020 Dec 11;50(12). Available from: https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/eci.13352<\/span><\/li>\n<\/ol>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Authors: Kaley Ainsworth and Raj Amarnani This blog explores the evidence based physical activity guidelines and resources available for patients with axial spondyloarthritis Introduction The importance and benefits of exercise in patients with chronic disease, in particular axial spondyloarthritis (AxSpA), is evident within existing literature. 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