Working Out for Your Arthritic Spine

Ankylosing spondylitis patients with low disease activity were more physically active

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) If you were diagnosed with ankylosing spondylitis, your doctor may have recommended that you watch your posture and exercise regularly. But have you followed these instructions in the same way you would your prescribed medication? Well, new findings may convince you to workout more.

Ankylosing spondylitis is a type of arthritis in which the joints in the spine (vertebrae) become inflamed, though other joints can be involved. The most common symptoms include pain and stiffness in the lower back and hips.

After examining the physical activity levels of ankylosing spondylitis patients with symptoms ranging from mild to severe, researchers found that patients with mild symptoms were engaged in more physical activities than patients with severe symptoms.

Furthermore, it was found that the majority of ankylosing spondylitis patients didn’t get involved in vigorous activities or aerobic exercises. Patients with ankylosing spondylitis focused more on back exercises to maintain their flexibility.

While it is important that patients with ankylosing spondylitis perform stretching exercises to relieve symptoms, aerobic exercise can be beneficial as well.

"Follow an exercise program designed by you and your doctor."

This study to examine the physical activity of ankylosing spondylitis patients was conducted by Hanne Dagfinrud, PhD, and colleagues from the National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital in Norway.

This study used data from 149 participants who had been diagnosed with ankylosing spondylitis (AS) and 133 participants without the disease.  The participants were adults, around 50 years of age.

The objective of this study was to investigate whether or not there was an association between the level of disease activity (low or high) and the physical activity and exercise habits of the participants.

The researchers measured patients' AS disease activity according to the symptoms. Patients were classified as having either high (severe symptoms) or low (mild symptoms) disease activity.

For classification purposes, the researchers used a standard test called the Ankylosing Spondylitis Disease Activity Score (ASDAS).

ASDAS gives a score based on the amount of back pain, duration of morning stiffness, patient global assessment, peripheral joint complaints and blood markers for inflammation.

In this study, low disease activity was defined as an ASDAS score of less than 2.1, and high disease activity was defined as an ASDAS score equal to or greater than 2.1.

The study found that patients with high disease activity had poorer physical function and less flexibility than patients with low disease activity.

The researchers also estimated the amount of energy that was used to perform different type of physical activities. Energy used was measured in metabolic equivalent units (MET).

For example, a person at rest will spend one MET of energy per minute, slow walking will use 2.2 METS per minute and fast walking will use 5 METS per minute.  In this study, MET was measured for all the activities that participants engaged in for more than 10 minutes. The researchers also calculated the amount of energy a participant expended in a week.

Results showed that AS patients with high disease activity expended less energy per week (about 3,073 METs per week) compared to patients with low disease activity, who spent about 4,290 METS per week, and participants without AS who spent 4,300 METs per week.

Additionally, they looked at the type of exercises the participants usually performed and the intensity level (vigorous or less vigorous) of those exercises. They found that the most common exercises that participants engaged in, from vigorous to less vigorous, were bicycling, cross country skiing, hiking, strength exercise, swimming, back exercise and walking.

Fewer patients with high disease activity engaged in cycling, cross-country skiing, hiking and strength exercise activities when compared to patients with low disease activity or participants without AS.

However, patients with high disease activity reported swimming more than patients with low disease activity or participants without AS.

Participation among the control group (those without AS) was higher in all the activities, except for the back exercises. It was reported that 33 percent of patients with low disease activity and 22 percent of patients with high disease activity performed back exercises. Only 3 percent of people without AS did back exercises as part of their routines.

Exercising promotes health when done with the adequate intensity, duration, frequency and continuity. This study showed that most patients with severe AS symptoms were not engaged in the physical activity necessary to enhance health and lower the risks for cardiovascular disease.

The study aimed to only show the association between physical fitness and disease level activity, but more work is needed to address whether exercise may reduce symptoms for ankylosing spondylitis patients.  Some studies already exist showing that exercise reduces level of inflammation in patients with rheumatoid arthritis, metabolic syndrome, chronic heart failure and diabetes mellitus.

Not surprisingly, it is also suggested that the reason patients with high disease activity were less likely to work out was because of their disease symptoms. That is, people with high disease may be less likely to exercise because they could be in severe pain.

Silje Halvorsen and Camilla Fongen, Physiotherapists from the Diakonhjemmet Hospital in Oslo and co-authors of this paper further explained to dailyRx News. Dr Halvorsen said,“Terrible pain was not addressed in this study, we cannot state that patients with a high physical activity level decreases their disease activity due to the physical activity. It could in fact be the other way around that patients with a high disease activity not are physically active due to their disease activity. Cause and effects cannot be addressed.”  

Dr Fongen added, "Some patients will prefer/ need activities with less impact, so a good way to start might be fast walking uphill on a trail/ treadmill, bicycling, elliptical crosstrainer or swimming."

The authors of this study recommended that physicians closely monitor the physical activity of their patients as an important part of their treatment for ankylosing spondylitis.

This study was published on July 31 in the Journal of Clinical Rheumatology. The authors had no disclosures to make.

Review Date: 
August 26, 2013
Last Updated:
December 30, 2013