It’s well known that patients with axSpA are at higher risk of developing cardiovascular events. “Of course we recommend behavioral changes, such as smoking cessation, but physical activity is also crucial,” Ms. Passalent said. The World Health Organization recommends 150 minutes of moderate-intensity aerobic activity per week, or at least 75 minutes of high-intensity aerobic activity per week, or a combination of the above, plus muscle strengthening activities at least twice per week.6
Although exercise can produce positive effects on a number of different outcomes in patients with axSpA, other factors must be considered when prescribing exercise for those individuals. For example, it’s important to understand the radiographic status of a patient before prescribing exercise. “If your patient has involvement only in the sacroiliac joints, I think on the whole you could probably be a little more liberal in terms of your exercise prescription,” Ms. Passalent said.
“However,” she warned, “if your patient has axial involvement, I think that’s where we become a little more conservative in terms of our exercise prescription.” Axial involvement, particularly if the patient has significant syndesmophytes or bamboo spine, will change the individual’s biomechanics, alter their center of mass and potentially create balance deficits. “We need to be aware of that because these patients are also at higher risk of vertebral fracture,” she said.
Although Dr. Dubreuil and Ms. Passalent recommend exercise for axSpA patients, they do so with caution because evidence is limited. “In most cases, we’re dealing with small sample sizes and variant patient populations,” Ms. Passalent said.
Mike Fillon is a healthcare writer living in the Atlanta area.
References
- Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the ACR/SAA/SPARTAN recommendations for the treatment of ankylosing spondylitis and nonradiogrpahic axial spondyloarthritis. Arthritis Care Res (Hoboken). 2019 Oct;71(10):1599–1613.
- van der Heijde D, Ramiro S, Landewé R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017 Jun;76(6):978–991.
- Lomas-Vega R, Garrido-Jaut MV, Rus A. Effectiveness of global postural re-education for treatment of spinal disorders: A meta-analysis. Am J Phys Med Rehabil. 2017 Feb;96(2):124–130.
- Ewing Garber C, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc. 2011 Jul;43(7):1334–1359.
- Sveaas SH, Bilberg A, Berg IJ, et al. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): A multicentre randomised trial of 100 patients. Br J Sports Med. 2020 Mar;54(5):292–297.
- Global strategy on diet, physical activity and health: Physical activity and adults. World Health Organization. (n.d.)
