Study debunks concerns over high intensity exercise for axSpA

3 minute read

Exercise doesn’t exacerbate disease activity in axSpA, and instead appears to reduce symptoms, inflammation and improves cardiovascular health

Fears that high intensity exercise may exacerbate axial spondyloarthritis (axSpA) symptoms appear to be unfounded, as new research indicates it may have the opposite effect.

A study of 100 patients with the disease showed that three months of high intensity exercise significantly reduced disease activity and inflammation, while improving cardiovascular health.

While low dose exercises are usually recommended to patients with inflammatory rheumatic diseases to relieve pain and joint mobility, clinicians often advise against high intensity exercise due to fears that it may spark flare-ups.

Given that people living with axSpA have high risk of cardiovascular disease, Dr Silje Halvorsen Sveaas, from the Diakonhjemmet Hospital in Norway, wanted to understand the effects of more rigorous cardiorespiratory and strength exercise on disease activity and cardiovascular health in these patients.

They randomly assigned 100 patients with axSpA to either an exercise group or to a no-intervention control group. Those in the exercise group did high intensity strength and cardio training twice a week under the supervision of a physiotherapist, and once individually, for three months. The control group were told to continue with their usual physical activity.

Dr Sveaas and her colleagues then tracked their disease activity, using the Ankylosing Spondylitis Disease Activity Scale and the Bath AS Disease Activity Index.

By three months, half of the patients doing high intensity exercise had achieved a substantial improvement in their disease activity, classified as at least a 20% improvement in disease activity, compared with one in 10 who were treated as usual.

More than one in three patients in the exercise group also achieved a 40% or more improvement, compared with only 4% in the control group.

The effects of exercise on disease activity were similar to TNF-inhibitors, they found.

Patients in the exercise arm of the study gained an average of 2.7mL in VO2 peak. This was substantial, given that every 1mL increase is associated with a 15% decrease in cardiovascular death, Dr Sveaas said.

“Exercise is a low-cost treatment that [does] not result in harmful effects,” she wrote.

“Together with significant reduction in abdominal fat and inflammation, the exercise program in this study resulted in a considerably more beneficial CV disease risk-profile.”

Dr Sveaas noted that TNF-inhibitors can increase adherence to exercise, suggesting that “the optimal treatment for patients with axSpA is therefore likely to be a combination of pharmacological treatment and exercise”.

“The results are important, as they prove the efficacy and safety of high-intensity exercises,” Dr Sveaas said. “And patients with axSpA can thereby take advantage of the CV-health effects of such exercises.”

Br J Sports Med 2020, Feb 11



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