Exercise in Ankylosing Spondylitis

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Exercise in Ankylosing Spondylitis

• Prof. Pál Géher MD

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Ankylosing Spondylitis

• Prevalence 0.1 to 1.4.
• Significant burden of disease, similar to RA.
• HLA B27 association.
• Diagnosed late.
• Underdiagnosed.
• Unsatisfactory treatment.

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Milestones of AS therapy

• 1921. X-ray treatment.
• 1949. Phenylbutazon.
• 1965. Indometacinum.
• ? Exercise
• 2000. Biologics.

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Studies on exercise in AS

• Individual conducted- exercise.
• Group - conducted exercise.
• Individual exercise.
• No accepted protocol!
• 4. Underwater exercise no study available.

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ASessment in Ankylosing Spondylitis
1995.
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ASAS 50 response criteria
At least ? 50 or in absolute value ? 10 mm (VAS
0-100 mm) improvement ? 3 domains

• Patients opinion
• Pain
• Function BASFI
• Inflammation BASDAI 5. 6.questions

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Outcomes in exercise in AS

• Function.
• Pain.
• Spinal mobility.
• Stiffness.
• Patients opinion.

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Individual- conducted - exercise

• 4 months, randomized, one center.
• 26 treated, 27 controll.
• Function - 23 improvement.
• Pain ?
• Spinal mobility - 42 improvement (finger-floor
  distance).
• Stiffness ?
• Patients opinion ?

Kraag G et al J Rheumatol 1994 21 261-3.
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Group - conducted exercise

• 9 months, randomized, one center.
• 6 weeks, individual-conducted- exercise, 68
  patients individual exercise at home, once weekly
  group exercise,76 patients individual exercise at
  home.
• Function - 32 difference (4 improvement).
• Pain ?
• Spinal mobility - 7 improvement (Schöber).
• Stiffness ?
• Patients opinion - 28 improvement.

Hidding A et al Arthritis Care Res 1994 790-6.
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Evidence based studies

• 3 trials, 241 patients.
• Supervised vs. Individualised supervised 50
  better (pain, stiffness)
• Individual vs. None individual better.

Dagfinrud H et al The Cochrane Library, 2003.
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ASAS/EULAR recommandations
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ASAS/EULAR recommandations

• 10 recommandations.
• 3 general.
• 5 pharma-therapy.
• 1 surgery.
• 1 non-pharmacological.

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Non-pharmacological recommandation

• Should include education, regular exercise and
  individual and group physical therapy.(level C)
• C directly based on category III evidence or
  extrapolated recommendation from category I or II
  evidence.

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Thank you for your attention.