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Zaggelidou E, Theodoridou A, Michou V, Gika H, Panayiotou G, Dimitroulas T, Kouidi E. The Effects of Pilates Exercise Training Combined with Walking on Cardiorespiratory Fitness, Functional Capacity, and Disease Activity in Patients with Non-Radiologically Confirmed Axial Spondylitis. J Funct Morphol Kinesiol 2023; 8:140. [PMID: 37873899 PMCID: PMC10594526 DOI: 10.3390/jfmk8040140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023] Open
Abstract
The objective of the study was to examine the effects of Pilates exercise training combined with walking on cardiorespiratory fitness, functional capacity, and disease activity in patients with non-radiologically confirmed axial spondylitis (nr-axSpA). Thirty patients with nr-axSpA (seven women (90%), with a mean age of 46.07 ± 10.48 years old and C-reactive protein (CRP) 2.26 ± 2.14 mg/L) were randomly divided into two groups: A (n1 = 15 patients) and B (n2 = 15 patients). Group A followed a 6-month home-based Pilates exercise training program, while Group B remained untrained until the end of the study. A cardiopulmonary exercise test (CPET), timed up and go test (TUG), five times sit-to-stand test (5×STS), sit-and-reach test (SR), back scratch test for the right (BSR) and the left arm (BSL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were applied to all patients, both at the beginning and at the end of the study. After 6 months, Group A showed higher values in exercise time by 37.41% (p = 0.001), higher peak oxygen uptake (VO2peak) by 25.41% (p = 0.01), a higher ratio between oxygen uptake and maximum heart rate (VO2/HRmax) by 14.83% (p = 0.04), and higher SR by 18.70% (p = 0.007), while lower values were observed in TUG by 24.32% (p = 0.001), 5×STS by 12.13% (p = 0.001), BASDAI score by 20.00% (p = 0.04) and ASDAS score by 23.41% (p = 0.03), compared to Group B. Furthermore, linear regression analysis showed a positive correlation in Group A between BASDAI and 5×STS (r = 0.584, p = 0.02), BASDAI and TUG (r = 0.538, p = 0.03), and ASDAS and 5×STS (r = 0.538, p = 0.03), while a negative correlation was found between BASDAI and VO2peak (r = -0.782, p < 0.001), ASDAS and SR (r = -0.548, p = 0.03), and ASDAS and VO2peak (r = -0.659, p = 0.008). To sum up, cardiorespiratory fitness, functional capacity, and disease activity improved after a long-term Pilates exercise training program in patients with nr-axSpA.
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Affiliation(s)
- Eleni Zaggelidou
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece; (E.Z.); (V.M.)
| | - Athina Theodoridou
- 4th Department of Internal Medicine, Hippokrateion General Hospital of Thessaloniki, School of Medicine, Aristotle University, 54642 Thessaloniki, Greece; (A.T.); (T.D.)
| | - Vassiliki Michou
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece; (E.Z.); (V.M.)
| | - Helen Gika
- Forensic Medicine and Toxicology, Aristotle University of Thessaloniki Medical School, 54124 Thessaloniki, Greece;
| | - George Panayiotou
- S Laboratory of Exercise, Health and Human Performance, Applied Sport Science Postgraduate Program, Department of Life Sciences, School of Sciences, European University Cyprus, 2404 Nicosia, Cyprus;
| | - Theodoros Dimitroulas
- 4th Department of Internal Medicine, Hippokrateion General Hospital of Thessaloniki, School of Medicine, Aristotle University, 54642 Thessaloniki, Greece; (A.T.); (T.D.)
| | - Evangelia Kouidi
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece; (E.Z.); (V.M.)
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Brady SM, Veldhuijzen van Zanten JJCS, Dinas PC, Nightingale TE, Metsios GS, Elmsmari SMA, Duda JL, Kitas GD, Fenton SAM. Effects of lifestyle physical activity and sedentary behaviour interventions on disease activity and patient- and clinician- important health outcomes in rheumatoid arthritis: a systematic review with meta-analysis. BMC Rheumatol 2023; 7:27. [PMID: 37674187 PMCID: PMC10481589 DOI: 10.1186/s41927-023-00352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Lifestyle physical activity (PA) is defined as any type of PA undertaken as part of daily life. It can include engagement in activities of daily living (i.e., household chores, gardening, walking to work), incidental PA, walking and/or reducing sedentary or sitting behaviours (SB). Regular PA is recommended for people with Rheumatoid Arthritis (RA) to reduce disease activity and systemic inflammation, as well as to improve patient- and clinician-important health outcomes. However, there is no summarised evidence of the effectiveness of interventions specifically targeting lifestyle PA and SB in this population. The aims of this systematic review with meta-analysis were to evaluate interventions targeting lifestyle PA and/or SB on 1) disease activity; 2) PA, SB and 3) patient- and clinician-important outcomes in people with RA. METHODS Eight databases [Medline, Cochrane Library CENTRAL, Web of Science, PsychINFO, Cumulative Index to Nursing & Allied Health Literature, Scopus, Excerpta Medica database and Physiotherapy Evidence Database] were searched from inception-August 2022. Inclusion criteria required interventions to target lifestyle PA and/or SB, conducted in adults with RA, assessing patient- and/or clinician-important outcomes. RESULTS Of 880 relevant articles, 16 interventions met the inclusion criteria. Meta-analyses showed statistically significant effects of interventions on disease activity (standardised mean difference = -0.12 (95% confidence interval = -0.23 to -0.01, I2 = 6%, z = 2.19, p = .03), moderate-to-vigorous PA, light/leisure PA, steps, functional ability, and fatigue. Whereas, no intervention effects were visualised for total PA, pain, anxiety or quality of life. CONCLUSIONS Lifestyle PA interventions led to increased PA, reductions in SB and improvements in disease activity and other patient- and/or clinician-important health outcomes in people with RA. Future interventions should be less heterogenous in content, structure, focus and outcome measures used to aid understanding of the most effective intervention components for improving health. More SB interventions are needed to determine their effectiveness at producing clinical benefits.
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Affiliation(s)
- Sophia M Brady
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Rheumatology Department, Dudley Group NHS Foundation Trust, Dudley, UK
- Medical Research Council- Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Birmingham, UK
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Rheumatology Department, Dudley Group NHS Foundation Trust, Dudley, UK
- Medical Research Council- Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Birmingham, UK
| | - Petros C Dinas
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Thessaly, Greece
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | - George S Metsios
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Thessaly, Greece
| | - Saleh M A Elmsmari
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Institute of Mental Health, University of Birmingham, Birmingham, UK
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Rheumatology Department, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Sally A M Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- Rheumatology Department, Dudley Group NHS Foundation Trust, Dudley, UK.
- Medical Research Council- Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Birmingham, UK.
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Fenton SAM, O’Brien CM, Kitas GD, Duda JL, Veldhuijzen van Zanten JJCS, Metsios GS. The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go? Rheumatol Adv Pract 2023; 7:rkac097. [PMID: 36699551 PMCID: PMC9870708 DOI: 10.1093/rap/rkac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?
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Affiliation(s)
- Sally A M Fenton
- Correspondence to: Sally A. M. Fenton, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. E-mail:
| | - Ciara M O’Brien
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK,Department of Rheumatology, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jet J C S Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK,Department of Rheumatology, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - George S Metsios
- Department of Rheumatology, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK,Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Volos, Greece
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Chaplin H, Sekhon M, Godfrey E. The challenge of exercise (non-)adherence: a scoping review of methods and techniques applied to improve adherence to physical activity and exercise in people with inflammatory arthritis. Rheumatol Adv Pract 2023; 7:rkac096. [PMID: 36726735 PMCID: PMC9880978 DOI: 10.1093/rap/rkac096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives The aims were to explore the nature of methods/techniques applied to improve adherence to physical activity (PA) and exercise in people with inflammatory arthritis and to identify whether studies were theory based and/or used behaviour change techniques (BCTs). Methods Searches were undertaken of English language articles within four databases: Embase, Medline, PsycINFO and Cochrane. Articles were included if they assessed adherence to a PA and/or exercise intervention. A narrative synthesis of the findings is reported. Results Of 1909 studies screened, 18 studies met inclusion criteria. Adherence was most frequently included as a secondary outcome. Reporting of adherence measures was poor, in that 13 studies did not use a validated measure of adherence, with only three validated measures being identified. The majority of studies were not theory driven (n = 13), although the health belief model was the most used theoretical framework (n = 5). Only two studies mentioned both theory and BCTs. Four studies reported components that were mapped onto BCTs, with goal setting being the most prevalent. Conclusion This scoping review found that adherence to PA and/or exercise interventions was rarely the focus of research, despite its importance in maintaining health in people with inflammatory arthritis. Where research has been conducted in this area, serious shortcomings were revealed, in that psychological theory, evidence-based BCTs derived from theory and valid adherence measures were not used to inform intervention design and target adherence, meaning that interventions were suboptimal. These results suggest that there is considerable room for improvement and that more high-quality research is required to investigate determinants of adherence and develop impactful interventions.
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Affiliation(s)
- Hema Chaplin
- Department of Psychology, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
| | - Mandeep Sekhon
- Population Health Research Institute, St George’s, University of
London, London, UK
| | - Emma Godfrey
- Correspondence to: Emma Godfrey, Health Psychology Section, 5th
Floor Bermondsey Wing, Guy’s Campus, London SE1 9RT, UK. E-mail:
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Anyfanti P, Dara A, Angeloudi E, Bekiari E, Dimitroulas T, Kitas GD. Monitoring and Managing Cardiovascular Risk in Immune Mediated Inflammatory Diseases. J Inflamm Res 2021; 14:6893-6906. [PMID: 34934338 PMCID: PMC8684400 DOI: 10.2147/jir.s276986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/20/2021] [Indexed: 01/03/2023] Open
Abstract
Cardiovascular disease (CVD) is common in immune-mediated inflammatory diseases (IMIDs) and it is predominately attributed to the interplay between chronic inflammation and traditional CVD risk factors. CVD has significant impact on the survival of patients with IMIDs as it is associated with increased morbidity and mortality. Despite recommendations for monitoring and managing CVD in patients with IMIDs, the individual CVD risk assessment remains problematic as CVD risk calculators for the general population consistently underestimate the risk in patients with IMIDs. Application of new technologies utilizing artificial intelligence techniques have shown promising potential for tailoring predictive medicine to the individual patient, but further validation of their role in clinical decision-making is warranted. In the meantime, individuals with IMIDs should be encouraged to adopt behavioral interventions targeting at modifiable lifestyle CVD risk factors, whereas rheumatologists need to be well aware of the unfavorable effects of antirheumatic medication on various CVD risk factors and outcomes. In the current paper, we aim to provide an overview of current and emerging strategies for mitigating CVD risk in patients with IMIDs, based on a practical approach.
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Affiliation(s)
- Panagiota Anyfanti
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasia Dara
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elena Angeloudi
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Bekiari
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George D Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Swärdh E, Opava C, Brodin N. Physical activity in patients with rheumatoid arthritis - an agile lifelong behaviour: a qualitative meta-synthesis. RMD Open 2021; 7:rmdopen-2021-001635. [PMID: 33963063 PMCID: PMC8108693 DOI: 10.1136/rmdopen-2021-001635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 11/06/2022] Open
Abstract
Background Physical activity (PA) in rheumatoid arthritis (RA) is considered a cornerstone in the treatment. To highlight aspects involved in supporting a positive PA behaviour, it is important to understand the patients’ perceptions of the phenomenon. Objective The aim of this qualitative meta-synthesis was to explore and synthesise patient perceptions of PA in RA. Methods A purposeful search was conducted across three online databases (PubMed, CINAHL and Web of Science). The methodological quality of the included studies was appraised, and data were extracted and analysed using an interpretive inductive thematic synthesis. Results Fifteen studies met the inclusion criteria and were included. PA was identified as an agile lifelong behaviour, with one main theme: The disease as a persistent catalyst for or against PA illustrating how the constant presence of the disease itself underlies the entire process of a life with or without regular PA. Seven subthemes: ‘considering aggravated symptoms’, ‘acknowledging the impact on health’, ‘becoming empowered and taking action’, ‘keeping informed to increase awareness’, ‘creating body awareness’, ‘dealing with social support’ and ‘feeling satisfied with circumstances and achievements’ were interpreted as facilitators and/or challenges. Conclusion This synthesis has identified PA as an agile lifelong behaviour in which the disease pervades all aspects of an individuals’ perception of PA. Placed in a theoretical context, our findings outline a model for tailoring PA support to the drivers and determinants of a certain individual, which will improve clinical practice for the benefit of both health professionals and patients with RA.
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Affiliation(s)
- Emma Swärdh
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Christina Opava
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Nina Brodin
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Department of Orthopaedics, Division of Physiotherapy, Danderyds Sjukhus AB, Stockholm, Sweden
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Chatzidionysiou K. Mediterranean Journal of Rheumatology March 2020 Highlights. Mediterr J Rheumatol 2020; 31:1-2. [PMID: 32411926 PMCID: PMC7219646 DOI: 10.31138/mjr.31.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Katerina Chatzidionysiou
- Department of Propaedeutic and Internal Medicine, “Laikon” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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