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High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients
  1. Silje Halvorsen Sveaas1,
  2. Annelie Bilberg2,
  3. Inger Jorid Berg3,
  4. Sella Arrestad Provan3,
  5. Silvia Rollefstad4,
  6. Anne Grete Semb4,
  7. Kåre Birger Hagen1,
  8. Melissa Woll Johansen5,
  9. Elisabeth Pedersen6,
  10. Hanne Dagfinrud1
  1. 1National Advisory Unit for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  3. 3Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  4. 4Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemme Hospital, Oslo, Norway
  5. 5Department of Physiotherapy, Martina Hansens Hospital, Bærum, Norway
  6. 6Department of Physiotherapy, University Hospital of North Norway, Tromsø, Norway
  1. Correspondence to Dr Silje Halvorsen Sveaas, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; s.h.sveaas{at}medisin.uio.no

Abstract

Background Exercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown.

Objective To investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (axSpA).

Method Assessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with axSpA were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0–10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study.

Results 97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: −0.6 [–0.8 to –0.3], p<0.001 and BASDAI: −1.2 [–1.8 to –0.7], p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health.

Conclusion High intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improves patients’ function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with axSpA.

Trial registration number NCT02356874.

  • exercise
  • exercise rehabilitation
  • randomised controlled trial

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Footnotes

  • Contributors SHS designed the trial, recruited participants, collected, analysed and interpreted data and wrote the report. AB recruited participants, interpreted data and reviewed the manuscript. IJB and SP designed the trial, recruited participants, interpreted data and reviewed the manuscript. SR collected data and reviewed the manuscript. AGS designed the trial and reviewed the manuscript. KBH designed the trial and reviewed the manuscript. MWJ and EP recruited participants, supervised the exercise group and reviewed the manuscript. HD designed the trial, analysed and interpreted data and wrote the report. All authors have approved the final draft to be published.

  • Funding This trial was supported by The Norwegian Fund for Post-Graduate Training in Physiotherapy and the Norwegian Rheumatology Association.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study protocol and consent documents were approved by the Regional Committee for Medical and Health Research Ethics (REK South East 2015/86) in Norway and the Regional Ethical Review Board Gothenburg in Sweden (032-16).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors agree to share anonymised data upon reasonable request.

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