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Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea, Department of Rehabilitation Medicine1, Hospital Medicine Center, Seoul National University Bundang Hospital, Department of Internal Medicine2, Yonsei University College of Medicine, Seoul, South Korea, Division of Rheumatology, Department of Internal Medicine3 |
1. Introduction
Ankylosing spondylitis (AS) is a chronic inflammatory disease involving axial skeletal system, peripheral joints, and non-articular structures. Unlike stretching exercise, the effect of aerobic exercise in patients with AS is not well known, and there is a lack of detailed protocols of aerobic exercise. We aimed to identify the additional benefits of aerobic exercise for stretching exercise in patients with AS.
2. Methods
1) Patients
This prospective study recruited 34 patients classified as AS according to the 1984 modified NY criteria or the ASAS classification criteria between the age of 20 and 60 years. 16 patients were allocated for stretching and aerobic exercise (Group A), and 18 patients for stretching only (Group B).
2) Exercise Education
To educate precisely, we developed an exercise protocol of written instruction with photographic guides. The AS school was held twice inviting each group in different day. After informing the general disease concepts by a rheumatologist, the instruction of the exercise prescription was done by a physiatrist and a physical therapist. The precise exercise protocol is described in Table 1.
3) Functional Outcome
As functional outcomes, 11 scales are surveyed or examined before and after 12 weeks of home exercise; total and nocturnal pain with Visual Analogue Scale (VAStotal and VASnocturnal), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Routine Assessment of Patient Index Data (RAPID3), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL), Fatigue Severity Scale (FSS), Jenkins Sleep Evaluation Questionnaire (JSEQ), and The Brief Illness Perception Questionnaire (BIPQ). Bath Ankylosing Spondylitis Metrology index (BASMI) was examined before (0), and 30 minutes and 3 months after exercise.
4) Statistical Analysis
Basic characteristics were analyzed using T test or Fisher’s exact test. The changes in functional scales at 12 weeks compared to initial point were analyzed by T test and repeated-measures ANOVA.
3. Results
Basic characteristics showed no significant differences between two groups (Table 2). The changes of all 11 scales at 12th weeks did not show significant difference between the groups; ΔVAStotal (P=0.59), ΔVASnocturnal (P=0.95), ΔASDAS (P=0.86), ΔBASDAI (P=0.84), ΔRAPID3 (P=0.61), ΔBASFI (P=0.49), ΔASQoL (P=0.82), ΔFSS (P=0.17), ΔJSEQ (P=0.86), ΔBIPQ (P=0.50), ΔBASMI (P=0.19). However, ΔBASMI and sub-scores of lateral lumbar flexion (P<0.01), tragus-to-wall distance (P=0.02), modified Schober test (P=0.03) had significant cumulative exercise effects (Table 3).
4. Conclusion
Aerobic exercise in patients with AS did not show a significant add-on effect to stretching alone. However, with limitations of small sample size and not considering the cardiopulmonary effects, further study with larger data would be required.
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