Abstract
BackgroundExercise forms an important component in the management of ankylosing spondylitis (AS). The objective of our study was to determine the effects of a 6-month swimming, land-based stretching, strengthening and breathing exercise intervention in AS patients.Methods/designA total of 29 (14 females, 15 males) patients diagnosed with AS according to the Modified New York Criteria participated in our study. Participants were randomly assigned to an exercise group (ASE) (16 participants) and a control group (ASC) (13 participants). Erythrocyte sedimentation rate and C-reactive protein (CRP); anthropometric measurements; pulmonary function; aerobic capacity; balance; Bath AS Metrology Index; Bath AS Disease Activity Index and the Bath AS Functional Index were assessed.DiscussionErythrocyte sedimentation rate and CRP did not change notably within or between the groups from pre- to post-intervention. The between group analyses of the physical assessments favoured the ASE with observable improvements in chest expansion (p = 0.002), forced expiration volume (p = 0.012), absolute (p = 0.017) and relative (p = 0.003) maximal oxygen consumption, absolute (p = 0.028) and relative (p = 0.001) physical work capacity. Within the ASE, there is statistical evidence of improvements in 11 of the 19 physical variables. Within the ASC, five of the physical variables deteriorated substantially (p between 0.004 and 0.037) and only balance overall stability on the right improved (p = 0.016). The three functional assessments in the ASE improved (p < 0.007) compared with the ASC post-intervention. A 6-month combined exercise programme may improve physical and functional capacity of AS patients.ConclusionA multimodal exercise intervention may be useful in the management of ankylosing spondylitis.Clinical implicationsAn unsupervised well -explained exercise programme combining swimming, land-based strengthening and stretching exercises and breathing exercises may be an option for patients with ankylosing spondylitis.Trial registrationRegistration not undertaken at the time of writing.
Highlights
Ankylosing spondylitis (AS) is a chronic, systemic, rheumatic disease that is a prototype of seronegative spondyloarthropathies and characterised by inflammation, primarily of the spine (Ince, Sarpel & Durgun 2006)
Large p-values confirmed that it is unlikely that the two groups differ with respect to their demographic characteristics
For the an exercise group (ASE) group reasons included: time constraints, difficulty travelling and the motivation to continue with the exercise programme over a relatively long period of time
Summary
Ankylosing spondylitis (AS) is a chronic, systemic, rheumatic disease that is a prototype of seronegative spondyloarthropathies and characterised by inflammation, primarily of the spine (Ince, Sarpel & Durgun 2006). The main clinical characteristics of AS are reduced physical activity, pain, stiffness, sleep disturbances, decreased spinal mobility and psychological consequences such as depression (Lim, Lim & Lee 2005). Ankylosing spondylitis management strategies should focus on reducing disease activity, improving lumbar spinal mobility and functional status (Özdemir 2011). Treatment of AS usually includes the use of anti-inflammatory drugs to reduce pain and stiffness and disease modifying drugs to try to stop or prevent disease progression. Patients are advised to exercise to maintain mobility of the spine and peripheral joints (Hidding et al 1993). Exercise forms an important component in the management of ankylosing spondylitis (AS). The objective of our study was to determine the effects of a 6-month swimming, land-based stretching, strengthening and breathing exercise intervention in AS patients
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