Exercise in Exercise in Ankylosing Ankylosing SpondylitisSpondylitis

Prof. Pál Prof. Pál Géher MDGéher MD

Ankylosing SpondylitisAnkylosing Spondylitis Prevalence: 0.1% to Prevalence: 0.1% to

1.4%1.4%.. Significant burden of Significant burden of

disease, similar to RAdisease, similar to RA.. HLA B27 associationHLA B27 association.. Diagnosed lateDiagnosed late.. UnderdiagnosedUnderdiagnosed.. Unsatisfactory Unsatisfactory

treatmenttreatment..

Milestones of AS therapyMilestones of AS therapy

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

Studies on exercise in ASStudies on exercise in AS

1.1. Individual – Individual – conducted- exercise.conducted- exercise.

2.2. Group - conducted – Group - conducted – exercise.exercise.

3.3. Individual exercise.Individual exercise.

No accepted protocol!No accepted protocol!

4. Underwater exercise 4. Underwater exercise – no study available.– no study available.

ASessment in Ankylosing ASessment in Ankylosing SpondylitisSpondylitis

1995.

ASAS 50 % response criteriaASAS 50 % response criteria

1.1. Patient’s opinionPatient’s opinion

2.2. PainPain

3.3. Function = BASFIFunction = BASFI

4.4. Inflammation = BASDAI 5.& Inflammation = BASDAI 5.& 6.questions6.questions

At least 50% or in absolute value 10 mm (VAS 0-100 mm) improvement 3 domains:

Outcomes in exercise in ASOutcomes in exercise in AS

Function.Function. Pain.Pain. Spinal mobility.Spinal mobility. Stiffness.Stiffness. Patient’s opinionPatient’s opinion..

Individual- conducted - exerciseIndividual- conducted - exercise

4 months, randomized, one center.4 months, randomized, one center. 26 treated, 27 controll.26 treated, 27 controll.

Function Function - - 23 % improvement.23 % improvement. Pain ?Pain ? Spinal mobility Spinal mobility - 42 % improvement (finger-- 42 % improvement (finger-

floor distance).floor distance). Stiffness ?Stiffness ? Patient’s opinion ?Patient’s opinion ?

Kraag G et al: J Rheumatol 1994; 21: 261-3.

Group - conducted – Group - conducted – exerciseexercise

9 months, randomized, one center.9 months, randomized, one center. 6 weeks, individual-conducted- exercise, 6 weeks, individual-conducted- exercise,

68 patients individual exercise at home, 68 patients individual exercise at home, once weekly group exercise,76 patients once weekly group exercise,76 patients individual exercise at home.individual exercise at home.

Function Function - 32 % difference (4% improvement).- 32 % difference (4% improvement). Pain ?Pain ? Spinal mobility Spinal mobility - 7 % improvement (Schöber).- 7 % improvement (Schöber). Stiffness ?Stiffness ? Patient’s opinion Patient’s opinion - 28 % improvement.- 28 % improvement.

Hidding A et al: Arthritis Care Res 1994; 7:90-6.

Evidence based studiesEvidence based studies

3 trials, 241 3 trials, 241 patients.patients.

Supervised vs. Supervised vs. Individualised= Individualised= supervised 50 % supervised 50 % better (pain, better (pain, stiffness)stiffness)

Individual vs. None Individual vs. None individual better.individual better.

Dagfinrud H et al: The Cochrane Library, 2003.

ASAS/EULAR ASAS/EULAR recommandationsrecommandations

ASAS/EULAR ASAS/EULAR recommandationsrecommandations

10 10 recommandations.recommandations.

3 general.3 general. 5 pharma-therapy.5 pharma-therapy. 1 surgery.1 surgery. 1 non-1 non-

pharmacological.pharmacological.

Non-pharmacological Non-pharmacological recommandationrecommandation

Should include education, regular Should include education, regular exercise and individual and group exercise and individual and group physical therapy….(level C)physical therapy….(level C)

C= directly based on category III C= directly based on category III evidence or extrapolated evidence or extrapolated recommendation from category I or II recommendation from category I or II evidence.evidence.

Thank you for your attention.Thank you for your attention.