Efficacy of high intensity exercise on disease activity and cardiovascular risk in active axial spondyloarthritis: a randomized controlled pilot study

Silje Halvorsen Sveaas; Inger Jorid Berg; Sella Aarrestad Provan; Anne Grete Semb; Kåre Birger Hagen; Nina Vøllestad; Camilla Fongen; Inge C Olsen; Annika Michelsen; Thor Ueland; Pål Aukrust; Tore K Kvien; Hanne Dagfinrud

doi:10.1371/journal.pone.0108688

Efficacy of high intensity exercise on disease activity and cardiovascular risk in active axial spondyloarthritis: a randomized controlled pilot study

PLoS One. 2014 Sep 30;9(9):e108688. doi: 10.1371/journal.pone.0108688. eCollection 2014.

Affiliations

¹ National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Health Sciences, University of Oslo, Oslo, Norway.
² Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
³ Department of Health Sciences, University of Oslo, Oslo, Norway.
⁴ National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
⁵ Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁶ Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷ Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.

Abstract

Background: Physical therapy is recommended for the management of axial spondyloarthritis (axSpA) and flexibility exercises have traditionally been the main focus. Cardiovascular (CV) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases. Therefore, the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA.

Methods: In a single blinded randomized controlled pilot study the exercise group (EG) performed 12 weeks of endurance and strength exercise while the control group (CG) received treatment as usual. The primary outcome was the Ankylosing Spondylitis (AS) Disease Activity Score (ASDAS). Secondary outcomes included patient reported disease activity (Bath AS Disease Activity Index [BASDAI]), physical function (Bath AS Functional Index [BASFI]), and CV risk factors measured by arterial stiffness (Augmentation Index [Alx]) and Pulse Wave Velocity [PWV]), cardiorespiratory fitness (VO2 peak) and body composition. ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences, and Mann Whitney U-test was used for outcomes with skewed residuals.

Results: Twenty-eight patients were included and 24 (EG, n = 10, CG, n = 14) completed the study. A mean treatment effect of -0.7 (95%CI: -1.4, 0.1) was seen in ASDAS score. Treatment effects were also observed in secondary outcomes (mean group difference [95%CI]): BASDAI: -2.0 (-3.6, -0.4), BASFI: -1.4 (-2.6, -0.3), arterial stiffness (estimated median group differences [95% CI]): AIx (%): -5.3 (-11.0, -0.5), and for PVW (m/s): -0.3 (-0.7, 0.0), VO2 peak (ml/kg/min) (mean group difference [95%CI]: 3.7 (2.1, 5.2) and trunk fat (%): -1.8 (-3.0, -0.6). No adverse events occurred.

Conclusion: High intensity exercise improved disease activity and reduced CV risk factors in patients with active axSpA. These effects will be further explored in a larger trial.

Trial registration: ClinicalTrials.gov NCT01436942.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Body Composition
Cardiovascular Diseases / prevention & control
Exercise / physiology*
Exercise Movement Techniques
Exercise Therapy*
Female
Humans
Male
Middle Aged
Oxygen Consumption
Pilot Projects
Pulse Wave Analysis
Risk
Severity of Illness Index
Spondylitis, Ankylosing / physiopathology
Spondylitis, Ankylosing / therapy*
Treatment Outcome
Vascular Stiffness

Associated data

ClinicalTrials.gov/NCT01436942

Grants and funding

The present study was supported by grants from the Norwegian Foundation for Postgraduate Physiotherapist. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.