May 16, 2018

Experts Agree – Exercise Remains Critical Component for Managing Ankylosing Spondylitis

By Editor

Report from the 16th 2018 Spondyloarthritis Research and Treatment Network (SPARTAN) Annual Meeting

Spine Community News: SPARTAN is a research and treatment network organization that includes expert clinicians and researchers who care for patients with spondyloarthritis.  At this 16th Annual meeting research was presented that increases our understanding of these disorders that affect the spine.

At the first session of the meeting, a question was asked – “is Physical Therapy Intervention in the Biologic Era Still Relevant?”    Angelo Papachristos, a physical therapis, reviewed the benefits of various forms of physical interventions for spondyloarthritis.  Biologic therapies have made an important impact on the clinical symptoms of ankylosing spondylitis.  However, without movement, can patients get the full benefit of treatment?  Guidelines from European League against rheumatism and the American College of Rheumatology both promote the use of exercise and physical therapy as important interventions for AS patients.  These recommendations include physical therapy and unsupervised back exercises, but do not support spinal manipulation by chiropractors on evidence of potential harm.  Among the benefits of exercise include the following: increased cardiovascular endurance, reduce blood pressure, increased HDL, maintenance of muscle mass, maintaining bone density , control of weight, improved psyche, decreased fatigue, and pain modification.

The American College of Sports Medicine has published a guideline for prescribing exercise.    The recommendation includes moderate intensity for 30 minutes a day. Components of exercise should include muscle resistance, balance, and stretching exercises.  These recommendations need to be transposed into suggestions that are appropriate for AS patients.  Exercise in AS patients needs to be recommended taking into account the limitations of the patient and their disease.  For example, for reasons of safety and to limit the risk of fracture, exercises should avoid the end of ranges of mobility and excessive trunk rotation.  Exercise is easier when inflammatory disease is controlled with drug therapy.  The frequency, intensity, duration, and type must be tailored to the individual and the extent of their disease.  In certain circumstances, pool therapy may be the most appropriate form.  Group settings may increase overall adherence to exercise regimens.

The answer is that even in the era of biologic therapy for AS, exercise remains a key part of therapy to maximize the overall general health of patients with inflammatory spine disease.

David Borenstein, MD
Executive Editor TheSpineCommunity.com

References:

Parachristos A. Session on Is Physical Therapy Intervention in the Biologic Era Still Relevent? Current Evidence and Practice Trends.  Proceedings from the 2018 Annual Spartan meeting

Zochling J et al. ASA/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2006;65:442-452

Ward MW et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol 2016;68:282-298

Garber CE, et al. Quantity and Quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exer. 2011;43:1334-1359

Millner JR et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin Arthritis Rheum 2016;54:411-427

Tags: Ankylosing Spondylitis, biologic therapy, exercise, News Tips and Features, SPARTAN, Uncategorized

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