No Link Between High Intensity Exercise and Increasing Inflammation in Psoriatic Arthritis

Mari Hoff, MD

Credit: Norwegian University of Science and Technology

A study examining the effects of high-intensity interval training in people with psoriatic arthritis has returned results that could surprise many.

Results of the study, which included 67 patients with psoriatic arthritis, suggest there was no clear evidence of objectively measured increases in inflammation after high-intensity interval training when assessed using ultrasound and MRI.¹

“This supports that [high-intensity interval training] is safe in PsA without increasing disease activity, at least in patients with a low to moderate disease activity,” wrote investigators.¹

For patient populations with psoriatic arthritis, there has been debate surrounding the impact of high-intensity training and exercise on changes in inflammatory markers, with some data suggesting this type of activity could increase the risk of adverse changes in inflammatory markers. The current study was an analysis of a randomized controlled trial designed to assess the effects of high-intensity interval training on disease activity in patients with psoriatic arthritis.¹

In the original trial, 67 patients with psoriatic arthritis were randomized in a 1:1 ratio to an intervention group or a control group. Those randomized to the intervention group performed structured high-intensity interval training for 11 weeks and those in the control group were instructed not to change exercise habits.

The original trial’s primary outcomes of interest were differences in patient's global assessment, fatigue, and pain scores measured on a 100-mm visual analog scale, and the composite Disease Activity Score in 44 joints at 3 and 9 months. Results indicated there was no evidence of long-term effects of high-intensity interval training on outcomes measured at 9 months, but those in the exercise group reported less fatigue after the intervention period.²

In the current study, a team of investigators sought to better understand this relationship through further analysis of data from this trial. With this in mind, investigators designed the study to assess changes of inflammation in patients with psoriatic arthritis from within the trial using ultrasound and MRI imaging. All 67 patients had ultrasound measurements available for analysis and a subgroup of 41 patients had MRI data available.¹

The primary outcomes of interest for the analyses were the proportions with an increased ultrasound bright-mode score and power-doppler (PD) signal of joints and entheses and Spondyloarthritis-Research-Consortium-of-Canada (SPARCC)-BME score of the sacroiliac joint and spine for both groups.¹

Upon analysis, results indicated the proportions of patients with an increased ultrasound bright-mode score were 32% and 28% among the exercise and control groups, respectively. Assessments of PD scores revealed increases in PD scores of the joints occurred among 7% and 10% of the exercise and control groups, respectively, while increases in PD scores of entheses occurred among 32% and 315 of the exercise and control groups, respectively. MRI analysis indicated BME score of the sacroiliac joint increased in 6% of the exercise group and 10% of the control group. For MRI BME of the spine, increases were observed in 6% of the exercise group and 5% of the control group.¹

“In this [randomized controlled trial], there was no clear evidence of an increased risk of inflammation after three months of [high-intensity interval training], evaluated by objective measures such as [ultrasound] of the peripheral joints and entheses, as well as by MRI [bone marrow edema] of the sacroiliac joint and spine, comparing the [high-intensity interval training] group with controls,” investigators wrote.¹

References:

1. Thomsen RS, Nilsen TIL, Haugeberg G, et al. Changes of inflammation in patients with psoriatic arthritis after high intensity interval training assessed by ultrasound and MRI, a randomized controlled trial. BMC Musculoskelet Disord. 2023;24(1):743. Published 2023 Sep 19. doi:10.1186/s12891-023-06871-3
2. Thomsen RS, Nilsen TIL, Haugeberg G, Bye A, Kavanaugh A, Hoff M. Impact of High-Intensity Interval Training on Disease Activity and Disease in Patients With Psoriatic Arthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2019;71(4):530-537. doi:10.1002/acr.23614