Which factors really influence the course of ankylosing spondylitis?

Exercise in Ankylosing Spondylitis: Discrepancies Between Recommendations and Reality

Objective.

To determine the type and extent of exercise used by an ankylosing spondylitis (AS) cohort and to examine patients’ perceptions of exercise. Recommendations for the management of AS identify exercise as the cornerstone of comprehensive management.

Methods.

An exercise inventory questionnaire and the Exercise Benefits and Barriers Scale (EBBS) were administered to patients attending the AS clinic of a large teaching hospital. Benefits and barriers subscales of the EBBS were analyzed to identify the perceived benefits of, and barriers to, exercise. Higher benefits scores (range 29–116) indicate a more positive perception of exercise. Higher barriers scores (range 14–56) indicate a greater perception of barriers to exercise.

Results.

Sixty-one patients with AS completed the questionnaires. Mean age was 38.0 years, and mean disease duration was 14.7 years. Walking (3 times/week) and stretching (3 times/week) were the most commonly reported types of exercise and were reported in 35.0% and 32.8%, respectively. The mean benefits EBBS score was 87.1 ± 12.5. The most frequently reported benefits of exercise were that it “increases my level of physical fitness” (96.4%) and “improves functioning of my cardiovascular system” (96.4%). The mean barriers EBBS score was 29.2 ± 5.3, and the most frequently reported barrier to exercise was that it “tires me” (71.4%).

Conclusion.

Patients with AS perceive the benefits of exercise, with average EBBS benefits scores comparable to historical controls with similar conditions. Despite positive perceptions, the majority of patients with AS did not report participating in exercise on a frequent basis.

[Physiotherapeutic and rehabilitation therapy for ankylosing spondylitis. Status quo and are they still necessary in the age of anti-cytokine therapy?]

Ankylosing spondylitis (AS) is one of the most common chronic inflammatory rheumatic diseases characterized by erosions and bone proliferation with consecutive morphologic and functional deficits. Physiotherapeutic and rehabilitation measures are often necessary for AS patients for their whole life. In recent years, biologicals have substantially improved the outcome in AS patients, but their positive influence on vertebral and joint functions still requires differential indicative physiotherapeutic strategies and rehabilitation, in most cases in combination with effective analgesic and anti-inflammatory medication. Although physical therapy and rehabilitation have not been investigated in large controlled trials, they are essential for the multimodal therapeutic concept of AS.