Fitness level low in axial spondyloarthritis patients

Patients with axial spondyloarthritis (AxSpA) have decreased exercise capacity, with low heart rate recovery tied to elevated 10-year risk of cardiovascular (CV) events, as reported in a study.

The study looked at the CV risk profile data and physical activity levels of 38 AxSpA patients and 38 age-gender matched controls. All patients underwent a maximal treadmill exercise test by Bruce protocol, and the 10-year CV event risk, assessed using the Framingham model, and Ankylosing Spondylitis Disease Activity Score–C-reactive protein were documented.

Compared with controls, patients had much lower exercise capacity (mean difference, 2.2; metabolic equivalents, 0.91–3.49; p=0.001), with the difference remaining significant following adjustments (p=0.001). Also, nonradiographic AxSpA patients had higher high-density lipoprotein cholesterol levels (p=0.026) and lower body mass index (BMI; p=0.03).

Exercise capacity showed significant correlations with age, 10-year CV event risk, body mass index (BMI), and waist circumference among both patients and controls (p<0.001 and p<0.05, respectively). Among patients, specifically, exercise capacity was associated with total cholesterol (p=0.04), triglycerides (p<0.001), and heart rate recovery (p=0.006).

Significant predictors of exercise capacity in the AxSpa group included age (β = −0.105, p=0.003) and triglyceride levels (β = −0.016, p=0.003).

Along with anti-inflammatory medications, physical therapy with supervised exercise is a mainstay in the management of axSpA. Including exercise in the treatment repertoire is supported by the evidence of increased risk of CV diseases in these patients. There are no specific guidelines regarding the type of exercise and intensity, but traditionally flexibility exercises at a low intensity level have been recommended. [PLoS One 2014;9:e108688]