Patients With Axial Spondyloarthritis Less Likely to Engage in Physical Activity

Patients with both active and inactive axial spondyloarthritis (axSpA) were more likely to have higher levels of sedentary activity and lower quality of life (QOL) when compared with the general population, thus emphasizing the need for interventions to promote physical activity (PA) in this patient population, according to a study published in BMC.¹

“Patients with axSpA have predominantly inflammatory back pain, and their axial skeleton and sacroiliac joints are often affected. This leads to reduced spinal mobility and function, which may result in reduced physical functioning and QOL,” investigators stated. “PA and exercise have been shown to improve general well-being and reduce cardiovascular disease (CVD) risk in the general population. Despite these recommendations, studies show that levels of PA are reduced among patients with axSpA.”

This cross-sectional study included patients with axSpA recruited at an outpatient clinic in Singapore General Hospital between May 2016 and January 2017. Patients were at least 21 years old and fulfilled axSpA classification criteria. PA levels were determined using the Global Physical Activity Questionnaire (GPAQ). Age, gender, race, smoking and alcohol status, education level, income, comorbidities, and body mass index (BMI) were recorded.

The Ankylosing Spondylitis Disease Activity Score with C-Reactive Protein (ASDAS-CRP) measured back pain, swelling, morning stiffness, a patient global assessment, and the C-reactive protein. The Bath Ankylosing Spondylitis Functional Index (BASFI) self-assessment analyzed functional limitation. The median number of minutes spend working, commuting, and engaging in recreation-related PA was recorded, including those who achieved 150 minutes of moderate-intensity physical activity, 75 minutes of vigorous physical activity, or a combination of the 2 culminating in 600 minutes per week.

A total of 74 patients with axSpA were compared with 2679 controls. The majority of patients in the axSpA cohort were male (75.7%) and BMI was similar in both groups.

A lower proportion of patients in the axSpA group met World Health Organization (WHO) recommendations for PA (77% vs 89.7% p < 0.001). However, disease activity level did not impact PA in this patient population. A larger amount of patients with axSpA had higher levels of sedentary behavior when compared with the control group (56.8% vs 36.1% respectively, p < 0.001).

The demographics and comorbidities of patients with inactive and active disease were not significantly different. While higher levels of PA were seen in patients with inactive disease (51.9% vs 38.3%), investigators did not deem this as statistically significant. When compared with controls, patients with axSpA had more recreational-related physical activity (0 [17.1] minutes vs 13.9 [51.4] minutes p = 0.01).

The small sample size hindered analysis among other ethnic groups and the cross-sectional study design prevented analysis of PA levels before the onset of axSpA. Additionally, as the GPAQ was self-reported, it may have led to an overestimation of PA.

“Although levels of PA did not differ between patients with active and inactive axSpA disease, patients with axSpA were less likely to meet the WHO recommendations for PA compared to the general population and had higher levels of sedentary activity compared to the general population,” investigators concluded. “This highlights the need for interventions to promote PA among patients with axSpA.”

Reference:

Phang JK, Khor AYK, Kwan YH, Ng CT, Fong W. Physical activity in patients with axial spondyloarthritis in a multi-ethnic south-east Asian country. BMC Rheumatol. 2021;5(1):38. Published 2021 Aug 31. doi:10.1186/s41927-021-00211-5