Exercise Adherence in Patients With Ankylosing Spondylitis: Difference between revisions
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== Introduction == | == Introduction == | ||
Ankylosing spondylitis (also called Bechterew's disease or Marie-Strumpell disease) is a seronegative spondyloarthritis of the spine and pelvis. It is a chronic inflammatory rheumatic disease with unknown aetiology. AS causes inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. AS is also called "Bamboo Spine" due to bony formation at the level of the joint capsule and cartilage. Hence, affected joints progressively become stiff and sensitive. The treatment for AS mainly consists of drug therapy (usually nonsteroidal anti-inflammatory drugs), and regular performance of an exercise regimen designed by physiotherapists to improve or maintain mobility and posture <ref>Barlow, J.H., Macey, S.J., Struthers, G., 1992. Psychosocial factors and self-help in ankylosing spondylitis patients. Clin Rheumatol 11, 220–225. <nowiki>https://doi.org/10.1007/BF02207961</nowiki></ref>. Exercise therapy has been consistently supported by current evidence to be a beneficial treatment for patients with AS <ref>Millner, J.R., Barron, J.S., Beinke, K.M., Butterworth, R.H., Chasle, B.E., Dutton, L.J., Lewington, M.A., Lim, E.GS., Morley, T.B., O’Reilly, J.E., Pickering, K.A., Winzenberg, T., Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Seminars in Arthritis and Rheumatism 45, 411–427. <nowiki>https://doi.org/10.1016/j.semarthrit.2015.08.003</nowiki></ref> and it is recommended by the NHS guideline as a vital component in | Ankylosing spondylitis (also called Bechterew's disease or Marie-Strumpell disease) is a seronegative spondyloarthritis of the spine and pelvis. It is a chronic inflammatory rheumatic disease with unknown aetiology. AS causes inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. AS is also called "Bamboo Spine" due to bony formation at the level of the joint capsule and cartilage. Hence, affected joints progressively become stiff and sensitive. The treatment for AS mainly consists of drug therapy (usually nonsteroidal anti-inflammatory drugs), and regular performance of an exercise regimen designed by physiotherapists to improve or maintain mobility and posture <ref>Barlow, J.H., Macey, S.J., Struthers, G., 1992. Psychosocial factors and self-help in ankylosing spondylitis patients. Clin Rheumatol 11, 220–225. <nowiki>https://doi.org/10.1007/BF02207961</nowiki></ref>. Exercise therapy has been consistently supported by current evidence to be a beneficial ameliorative, instead of curative, treatment for patients with AS <ref>Millner, J.R., Barron, J.S., Beinke, K.M., Butterworth, R.H., Chasle, B.E., Dutton, L.J., Lewington, M.A., Lim, E.GS., Morley, T.B., O’Reilly, J.E., Pickering, K.A., Winzenberg, T., Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Seminars in Arthritis and Rheumatism 45, 411–427. <nowiki>https://doi.org/10.1016/j.semarthrit.2015.08.003</nowiki></ref> and it is recommended by the NHS guideline as a vital component in the management of patients with AS. According to the NHS UK, there is no known cure for AS at the moment <ref>NHS UK, 2019. Ankylosing spondylitis - Treatment. nhs.uk. URL <nowiki>https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/</nowiki> (accessed 5.24.20).</ref>. As a result, exercise treatment has to be maintained for the remainder of the patient's life and long term exercise adherence is crucial. | ||
== Quality of life in patients with AS == | == Quality of life in patients with AS == | ||
Exercise and quality of life are closely linked together. Studies have shown that exercise therapy is able to improve the quality of life in patients with long term illness <ref>Hacker, E., 2009. Exercise and Quality of Life: Strengthening the Connections. Clin J Oncol Nurs 13, 31–39. <nowiki>https://doi.org/10.1188/09.CJON.31-39</nowiki></ref>. Therefore, | Exercise and quality of life are closely linked together. Studies have shown that exercise therapy is able to improve the quality of life in patients with long term illness <ref>Hacker, E., 2009. Exercise and Quality of Life: Strengthening the Connections. Clin J Oncol Nurs 13, 31–39. <nowiki>https://doi.org/10.1188/09.CJON.31-39</nowiki></ref>. Moreover, another study has shown that monitoring adherence and tailored exercise regimen to induce changes in cardiovascular fitness and body composition can improve the quality of life and self-efficacy <ref>Imayama, I., Alfano, C.M., Mason, C.E., Wang, C., Xiao, L., Duggan, C., Campbell, K.L., Foster-Schubert, K.E., McTiernan, A., 2013. Exercise adherence, cardiopulmonary fitness and anthropometric changes improve exercise self-efficacy and health-related quality of life. J Phys Act Health 10, 676–689.</ref>. Therefore, exercise adherence and quality of life in patients with AS are closely linked and should be explored. | ||
A recent US-based survey (AS Life Impact survey) on the quality of life in patients with AS was published in 2019 <ref>Rosenbaum, J.T., Pisenti, L., Park, Y., Howard, R.A., 2019. Insight into the Quality of Life of Patients with Ankylosing Spondylitis: Real-World Data from a US-Based Life Impact Survey. Rheumatol Ther 6, 353–367. <nowiki>https://doi.org/10.1007/s40744-019-0160-8</nowiki></ref>. | A recent US-based survey (AS Life Impact survey) on the quality of life in patients with AS was published in 2019 <ref>Rosenbaum, J.T., Pisenti, L., Park, Y., Howard, R.A., 2019. Insight into the Quality of Life of Patients with Ankylosing Spondylitis: Real-World Data from a US-Based Life Impact Survey. Rheumatol Ther 6, 353–367. <nowiki>https://doi.org/10.1007/s40744-019-0160-8</nowiki></ref>. | ||
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* Female patients are more likely to report a high impact of AS than male in all the domains (physical, emotional, social and discomfort domains) of the questionnaire. (p< 0.05) | * Female patients are more likely to report a high impact of AS than male in all the domains (physical, emotional, social and discomfort domains) of the questionnaire. (p< 0.05) | ||
** Various aspects of daily living being affected include: | ** Various aspects of daily living being affected include: | ||
*** Lifting a child or heavy object (P<0.0001) | *** '''Lifting a child or heavy object (P<0.0001)''' | ||
*** Standing for 30 mins (P=0.0128) | *** Standing for 30 mins (P=0.0128) | ||
*** Feeling tired or lacking in energy (P=0.0004) | *** Feeling tired or lacking in energy (P=0.0004) | ||
*** Interference with sleep (P=0.0081) | *** Interference with sleep (P=0.0081) | ||
*** Worried about the future (P<0.0001) | *** '''Worried about the future (P<0.0001)''' | ||
*** Lacked drive or motivation (P=0.0364) | *** Lacked drive or motivation (P=0.0364) | ||
*** The ability to concentrate (P=0.0057) | *** The ability to concentrate (P=0.0057) | ||
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*** Interference with work (P=0.0268) | *** Interference with work (P=0.0268) | ||
* The authors concluded | * The authors concluded there is a need to identify and ameliorate the impaired QoL aspects to improve outcomes of AS. | ||
Ankylosing Spondylitis can have a considerable impact on the patient's quality of life. Exercise therapy is shown to be a beneficial treatment and the adherence to a tailored exercise program can potentially improve the patient's qualify of life. Hence, the barriers and facilitators to exercise adherence will be explored. | |||
== Exercise Adherence in patients with AS == | == Exercise Adherence in patients with AS == | ||
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- It is not possible to quantify whether benefits from supervised exercise are due to the change in setting or environment, or the consequential support for motivation, supervised exercise therapy has a moderate level of evidence of increasing physical activity level (PAL), which indicates to increase in exercise adherence.<ref name=":0">Millner, J., Barron, J., Beinke, K., Butterworth, R., Chasle, B., Dutton, L., Lewington, M., Lim, E., Morley, T., O’Reilly, J., Pickering, K., Winzenberg, T. and Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. ''Seminars in Arthritis and Rheumatism'', 45(4), pp.411-427.</ref> | - It is not possible to quantify whether benefits from supervised exercise are due to the change in setting or environment, or the consequential support for motivation, supervised exercise therapy has a moderate level of evidence of increasing physical activity level (PAL), which indicates to increase in exercise adherence.<ref name=":0">Millner, J., Barron, J., Beinke, K., Butterworth, R., Chasle, B., Dutton, L., Lewington, M., Lim, E., Morley, T., O’Reilly, J., Pickering, K., Winzenberg, T. and Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. ''Seminars in Arthritis and Rheumatism'', 45(4), pp.411-427.</ref> | ||
- Patients under supervised exercise therapy also | - Patients under supervised exercise therapy also spend significantly longer on their home exercise program compare to those who do not undertake supervised exercise therapy.<ref name=":1">McDonald, M., Siebert, S., Coulter, E., McDonald, D. and Paul, L., 2019. Level of adherence to prescribed exercise in spondyloarthritis and factors affecting this adherence: a systematic review. ''Rheumatology International'', 39(2), pp.187-201.</ref> | ||
==== Home Exercise Program (HEP) ==== | ==== Home Exercise Program (HEP) ==== | ||
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==== Patient education: Exercise following an educational program ==== | ==== Patient education: Exercise following an educational program ==== | ||
- Study found that exercise following with patient education can lead to an increase in the number of patients completing exercises and frequency of HEP. However, the number and frequency of exercises significantly decreased in a rather short period (at 6 | - Study found that exercise following with patient education can lead to an increase in the number of patients completing exercises and frequency of HEP. However, the number and frequency of exercises significantly decreased in a rather short period (at 6 months).<ref name=":1" /> | ||
- However, educational support patients have been shown to have an increase in adherence with medicines.<ref>Shillington, A., Ganjuli, A. and Clewell, J., 2016. The impact of patient support programs on adherence, clinical, humanistic, and economic patient outcomes: a targeted systematic review. ''Patient Preference and Adherence'', p.711.</ref> | |||
- | |||
=== Measurement of Adherence === | === Measurement of Adherence === | ||
Revision as of 08:16, 25 May 2020
Introduction[edit | edit source]
Ankylosing spondylitis (also called Bechterew's disease or Marie-Strumpell disease) is a seronegative spondyloarthritis of the spine and pelvis. It is a chronic inflammatory rheumatic disease with unknown aetiology. AS causes inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. AS is also called "Bamboo Spine" due to bony formation at the level of the joint capsule and cartilage. Hence, affected joints progressively become stiff and sensitive. The treatment for AS mainly consists of drug therapy (usually nonsteroidal anti-inflammatory drugs), and regular performance of an exercise regimen designed by physiotherapists to improve or maintain mobility and posture [1]. Exercise therapy has been consistently supported by current evidence to be a beneficial ameliorative, instead of curative, treatment for patients with AS [2] and it is recommended by the NHS guideline as a vital component in the management of patients with AS. According to the NHS UK, there is no known cure for AS at the moment [3]. As a result, exercise treatment has to be maintained for the remainder of the patient's life and long term exercise adherence is crucial.
Quality of life in patients with AS[edit | edit source]
Exercise and quality of life are closely linked together. Studies have shown that exercise therapy is able to improve the quality of life in patients with long term illness [4]. Moreover, another study has shown that monitoring adherence and tailored exercise regimen to induce changes in cardiovascular fitness and body composition can improve the quality of life and self-efficacy [5]. Therefore, exercise adherence and quality of life in patients with AS are closely linked and should be explored.
A recent US-based survey (AS Life Impact survey) on the quality of life in patients with AS was published in 2019 [6].
- The overall mean score for the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) questionnaire is 28.9 (medium impact).
- Female patients are more likely to report a high impact of AS than male in all the domains (physical, emotional, social and discomfort domains) of the questionnaire. (p< 0.05)
- Various aspects of daily living being affected include:
- Lifting a child or heavy object (P<0.0001)
- Standing for 30 mins (P=0.0128)
- Feeling tired or lacking in energy (P=0.0004)
- Interference with sleep (P=0.0081)
- Worried about the future (P<0.0001)
- Lacked drive or motivation (P=0.0364)
- The ability to concentrate (P=0.0057)
- Prevented them from being physically active (P=0.0092)
- Travel by car or public transport (P=0.0019)
- Interference with work (P=0.0268)
- Various aspects of daily living being affected include:
- The authors concluded there is a need to identify and ameliorate the impaired QoL aspects to improve outcomes of AS.
Ankylosing Spondylitis can have a considerable impact on the patient's quality of life. Exercise therapy is shown to be a beneficial treatment and the adherence to a tailored exercise program can potentially improve the patient's qualify of life. Hence, the barriers and facilitators to exercise adherence will be explored.
Exercise Adherence in patients with AS[edit | edit source]
Factors Affecting Adherence[edit | edit source]
Strategies to Increase Adherence[edit | edit source]
Supervised exercise[edit | edit source]
- Supervised exercise therapy is suggested to have clinically relevant benefits compared with non‐supervised regimens by previous study.[7]
- It is not possible to quantify whether benefits from supervised exercise are due to the change in setting or environment, or the consequential support for motivation, supervised exercise therapy has a moderate level of evidence of increasing physical activity level (PAL), which indicates to increase in exercise adherence.[8]
- Patients under supervised exercise therapy also spend significantly longer on their home exercise program compare to those who do not undertake supervised exercise therapy.[9]
Home Exercise Program (HEP)[edit | edit source]
- HEP is efficient in improving the functional capacity, mobility, pain and reduction in fatigue. Because of these advantages, HEP is generally advised for the management program in AS in addition to medical treatments.[10]
- HEP is reported to have high exercise adherence. Two studies measured adherence to AS patients with HEP only. Fernandez-de-las-Penas et al.[11] reported 95% adherence (sessions completed) to a once-weekly HEP for 1 year and Chimenti et al.[12] reported an overall 76% adherence to sessions and exercises prescribed during a 12 week, twice-weekly HEP.
- There is strong level of evidence that show HEP with proper self-monitoring such as interventions including practices such as keeping an activity diary, tracking activity in a calendar, or recording activity on a website etc. can enhance the PAL of AS patients.[8]
Patient education: Exercise following an educational program[edit | edit source]
- Study found that exercise following with patient education can lead to an increase in the number of patients completing exercises and frequency of HEP. However, the number and frequency of exercises significantly decreased in a rather short period (at 6 months).[9]
- However, educational support patients have been shown to have an increase in adherence with medicines.[13]
Measurement of Adherence[edit | edit source]
Barriers to exercise adherence[edit | edit source]
Facilitators to exercise adherence[edit | edit source]
Group therapy[edit | edit source]
Clinical bottom line[edit | edit source]
Conclusion[edit | edit source]
The most recent systematic review on the exercise adherence on AS patients has found limited information on the level and factors influencing adherence in SpA. Adherence was poorly reported within included studies; however, findings suggest patients do not fully adhere.
- ↑ Barlow, J.H., Macey, S.J., Struthers, G., 1992. Psychosocial factors and self-help in ankylosing spondylitis patients. Clin Rheumatol 11, 220–225. https://doi.org/10.1007/BF02207961
- ↑ Millner, J.R., Barron, J.S., Beinke, K.M., Butterworth, R.H., Chasle, B.E., Dutton, L.J., Lewington, M.A., Lim, E.GS., Morley, T.B., O’Reilly, J.E., Pickering, K.A., Winzenberg, T., Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Seminars in Arthritis and Rheumatism 45, 411–427. https://doi.org/10.1016/j.semarthrit.2015.08.003
- ↑ NHS UK, 2019. Ankylosing spondylitis - Treatment. nhs.uk. URL https://www.nhs.uk/conditions/ankylosing-spondylitis/treatment/ (accessed 5.24.20).
- ↑ Hacker, E., 2009. Exercise and Quality of Life: Strengthening the Connections. Clin J Oncol Nurs 13, 31–39. https://doi.org/10.1188/09.CJON.31-39
- ↑ Imayama, I., Alfano, C.M., Mason, C.E., Wang, C., Xiao, L., Duggan, C., Campbell, K.L., Foster-Schubert, K.E., McTiernan, A., 2013. Exercise adherence, cardiopulmonary fitness and anthropometric changes improve exercise self-efficacy and health-related quality of life. J Phys Act Health 10, 676–689.
- ↑ Rosenbaum, J.T., Pisenti, L., Park, Y., Howard, R.A., 2019. Insight into the Quality of Life of Patients with Ankylosing Spondylitis: Real-World Data from a US-Based Life Impact Survey. Rheumatol Ther 6, 353–367. https://doi.org/10.1007/s40744-019-0160-8
- ↑ Fokkenrood, H., Bendermacher, B., Lauret, G., Willigendael, E., Prins, M. and Teijink, J., 2013. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database of Systematic Reviews,.
- ↑ 8.0 8.1 Millner, J., Barron, J., Beinke, K., Butterworth, R., Chasle, B., Dutton, L., Lewington, M., Lim, E., Morley, T., O’Reilly, J., Pickering, K., Winzenberg, T. and Zochling, J., 2016. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Seminars in Arthritis and Rheumatism, 45(4), pp.411-427.
- ↑ 9.0 9.1 McDonald, M., Siebert, S., Coulter, E., McDonald, D. and Paul, L., 2019. Level of adherence to prescribed exercise in spondyloarthritis and factors affecting this adherence: a systematic review. Rheumatology International, 39(2), pp.187-201.
- ↑ Durmus, D., Alayli, G., Cil, E. and Canturk, F., 2008. Effects of a home-based exercise program on quality of life, fatigue, and depression in patients with ankylosing spondylitis. Rheumatology International, 29(6), pp.673-677.
- ↑ Fernandez-de-Las-Penas C, Alonso-Blanco C, Alguacil-Diego IM, Miangolarra-Page JC. One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil. 2006;85:559–567. doi: 10.1097/01.phm.0000223358.25983.df.
- ↑ Chimenti MS, Triggianese P, Conigliaro P, Santoro M, Lucchetti R, Perricone R. Self-reported adherence to a home-based exercise program among patients affected by psoriatic arthritis with minimal disease activity. Drug Dev Res. 2014;75:S57S59.
- ↑ Shillington, A., Ganjuli, A. and Clewell, J., 2016. The impact of patient support programs on adherence, clinical, humanistic, and economic patient outcomes: a targeted systematic review. Patient Preference and Adherence, p.711.
