As we emerge from the pandemic sport has taken on a renewed importance in our lives. From the coming together during the Euro’s and the Olympics, to being able to play sport again with our friends it has helped to lift people’s spirits. So imagine, when your world revolves around sport, being told you have Axial Spondyloarthropathy (axial SpA). In my twenty plus years working in Rheumatology, it still makes me sad to meet people living with axial SpA who have given up on the sport they love as they believe it could make their condition worse.
We all know about the importance of exercise in the management of axial SpA; but do we always think about exercise in its broadest context? Yes, we know those people living with axial SpA that we work with need flexibility exercises, but do we always consider high intensity exercise? There is no greater motivational tool to exercise than doing something you are passionate about; but for many living with axial SpA the fear of making their condition worse makes them turn their backs on sport.
As Physiotherapists we have a vital role in educating and ensuring people living with axial SpA are able to live their lives to the full. With the advancements in the treatment of axial SpA it need not be a life-changing condition. Phil Mickleson’s recent win at the PGA golf championships despite having psoriatic arthritis shines a beacon of hope for all those people who have given up on sport because they have an inflammatory condition.
A recent study in the British Journal of Sports medicine helps support the message that sport is safe. Halvorsen Sveaas et al. (2020) investigated the effectiveness of high intensity exercise on disease activity in people living with axial SpA. A group of 100 participants aged between 18-70 years with an average Bath Ankylosing Disease Activity Index (BASDAI) of > 3.5 were randomly assigned to either an exercise group or a no intervention control group. The primary outcome measures used were the Ankylosing Disease Activity Score (ASDAS) and the BASDAI.
Over a 3 month period, the participants in the exercise group carried out cardiorespiratory exercises 3 days a week. Two days supervised running or walking on a treadmill/cycle ergometer and 1 day unsupervised walking, running or cycling at a fitness centre. Two days a week they carried out supervised strength training; this included squats, leg press, deadlifts, rows to chest, bench press, shoulder press, pull downs and sit ups. The strength training was individually adapted.
The exercise group were shown to have a 23% difference in the ASDAS when compared to the control group and there was a 24% difference in the BASDAI compared to the control group. As well as the reduction in disease activity there was also a significant improvement in their V02max.
These findings are important in reassuring people living with with axial SpA that they can continue with high intensity exercise, not just as a means of maintaining cardiovascular fitness but being able to continue to enjoy sport alongside their friends and family. Brophy et al. (2013) reported that intrinsic motivation, freely choosing to exercise because it is pleasurable and fun, is associated to the greatest effect on exercise levels and benefit to function. It is therefore important that when we are educating people living with axial SpA about exercise, that we discuss what they enjoy doing, and in creating a tailor made programme for that patient we include this. Hopefully, in doing so we will see better adherence with exercise and enhance all the benefits that go along with that.
There are still very few studies that look at the effects of high intensity exercise in axial SpA. There is a need for further research in this field whilst there is still the misconception that high intensity exercise will cause a flare up of axial SpA. Working to dispel this myth would be a big step forward in improving the outlook for many people living with axial SpA by ensuring they do not abandon their sporting activities and all the physical and mental improvements that they bring.
Halvorsen Sveaas S et al. (2020) High Intensity Exercise for 3 Months Reduces Disease Activity in Axial Spondyloarthritis: A Multicentre Randomised Trial of 100 Patients. British J Sports Medicine 54 (5) 292-297
Brophy S et al. (2013) The Effect of Physical Activity and Motivation on Function in Ankylosing Spondylitis. Seminars in Arthritis and Rheumatism 42 (6) 619 – 626
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