Elsevier

Joint Bone Spine

Volume 76, Issue 2, March 2009, Pages 150-155
Joint Bone Spine

Original article
Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis

https://doi.org/10.1016/j.jbspin.2008.06.013Get rights and content

Abstract

Objective

The aim of this study was to evaluate the impact of two different home-based daily exercise programs on pulmonary functions in the patients with ankylosing spondylitis (AS).

Methods

Fifty-one patients with AS were distributed into three groups. Group 1 (n = 19) was given a conventional exercise regimen. Group 2 (n = 19) received exercises based on the Global Posture Reeducation (GPR) method. Group 3 (n = 13) was accepted as the control group. Patients were assessed according to pain, functional capacity (The Bath Ankylosing Spondylitis Functional Index – BASFI), disease activity (The Bath Ankylosing Spondylitis Disease Activity Index – BASDAI), chest expansion, pulmonary function parameters, and 6-min walk distance (6MWD) test.

Results

Although there were significant improvements for BASDAI and BASFI scores in all groups, significant improvements in the VAS pain, chest expansion, pulmonary function parameters and 6MWD test were observed in the exercise groups. The improvements in pain, functional capacity, disease activity, chest expansion, pulmonary function parameters and 6MWD test were better in the exercise groups than in the control group. The GPR method resulted in greater improvements than the conventional exercise program in specific pulmonary function parameters like forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow parameters.

Conclusion

Both exercises are efficient in improving pulmonary functions. Since the improvements in pulmonary function tests were greater in the patients who performed the exercise according to GPR method, motivated patients should be encouraged to perform this exercise program.

Introduction

Ankylosing spondylitis (AS) is a chronic systemic inflammatory rheumatic disease of uncertain etiology that primarily affects the axial skeleton which progressively limits spinal and thoracic mobility throughout the course of the disease and causes serious functional impairment. Extra-articular manifestations can develop in AS, and in some patients these features may contribute significantly to morbidity and mortality [1], [2], [3]. Previously it was shown that pulmonary involvement is common in patients with AS and might have disturbed functionality and may affect quality of life [4], [5]. Rigidity of the thorax occurs in AS with bony ankylosis of the thoracic vertebrae, costovertebral, costotransverse, sternoclavicular and sternomanubrial joints. The pulmonary function tests in AS have revealed a high prevalence of restrictive defect, characterized by a low forced vital capacity frequently associated to a low thoracic expansibility [5], [6].

The goal of the physiotherapy is to improve general functioning and quality of life in patients with AS [7]. Beneficial effects of exercise on pain, spinal mobility, muscle strength, functional capacity, disease activity, cardiovascular capacity, and psychological status have been reported previously [8], [9], [10]. Various types of exercises have been described for the patients with AS, i.e. supervised individualized therapy, unsupervised self-administered individualized therapy or home-based exercises, and supervised group therapy [7], [10]. Cochrane Musculoskeletal Group suggested that exercise programs should be specific for patients with AS. There are different exercise protocols for AS [8], [9], [11], [12]. Recently Fernandez-de-Las-Penas et al. [11] assessed the influence of the “Global Posture Reeducation” (GPR) method based on deals with the existence of different muscle chains on functional and mobility outcomes. Authors demonstrated that AS patients treated with an exercise regimen based on the GPR and focused on specific strengthening and flexibility exercises of the affected muscle chains in AS showed a greater improvement in functional and mobility outcomes than those patients who received a conventional regimen of analytic exercises.

The aim of this study was to evaluate the impact of a 12-week comprehensive protocol of GPR method and conventional method for patients with AS on pulmonary functions, functionality and disease activity. To the best of our knowledge, this is the first controlled study analyzing different exercise protocols on pulmonary functions in patients with AS.

Section snippets

Methods

Fifty-six patients with diagnosis of AS according to the modified New York criteria were included in the study. A demographic data including age, gender, body mass index (BMI) (kg/m2), duration of symptoms, activity, and smoking status were recorded. Physical examination was performed by the same physician (DD). All subjects underwent chest X-ray and pulmonary function tests. None of the patients had an apical fibro-bullous disease. Patients were excluded if they had a medical condition that

Results

Fifty-one patients completed the study (three patients in the exercise groups were out of contact, two from the control group did not come to the assessment after twelve weeks). Demographic properties of the patients are shown in Table 1. There was no statistically significant difference for age, gender, BMI, disease duration, medication, and smoking status between groups (p > 0.05).

Although there were significant improvements for BASDAI and BASFI scores in all groups, a significant improvement

Discussion

This controlled study was performed in patients with AS to evaluate the influence of two different home-based daily exercise programs on pain, functional capacity and disease activity as well as pulmonary functions. The results showed significant improvements in pulmonary functions, pain, functional capacity and disease activity in both exercise groups. The benefits with the GPR method was greater than with the conventional exercise intervention in pulmonary function tests such as FVC, FEV1 and

Acknowledgements

This study was presented at Annual European Congress of Rheumatology, Barcelona, 13–16 June, 2007.

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