December AxSpA Research Highlights – Focus on Physical Activity

Hi everyone, I hope you are all having a good week! This is the first research highlights post of the New Year, so Happy New Year to you all.For December’s research highlights (although by now, December feels very long ago!), we have chosen to do a 2-part series: with this first post presenting some of the recent research regarding axial spondyloarthritis (axSpA) and physical activity.I am sure we are all aware of the benefits of physical activity in axSpA (especially if you have read our previous blog posts or have attended one of the 2-week rehabilitation courses at the Royal National Hospital for Rheumatic Diseases [RNHRD])… However, if you still need some more convincing, here is some of the latest evidence!

New Insights in Physical Therapy and Rehabilitation in Axial Spondyloarthritis: A Review. Rheumatology and Therapy, December, Perrotta and colleagues.
The following comprehensive review outlines the current literature in the field of physical therapy and rehabilitation in axSpA, covering:

- Assessments used to better understand axSpA and evaluate the effectiveness of physical therapy interventions, both in research studies and clinical practice, for example Bath Ankylosing Spondylitis Metrology Index (BASMI) that measures the mobility of the spine and AS quality of life (ASQoL), which you may recognise from appointments at the RNHRD
- An outline of the current evidence to support physiotherapy and exercise in axSpA, and in which settings it tends to be most successful in (a supervised group)
- Aims of the activities: such as reducing pain, stiffness and improving function
- Highlights regarding both established and early stages of AS and non-radiographic axSpA – whereby, Levitova et al. recently showed that exercise therapy is beneficial for both radiographic and non-radiographic subgroups of axSpA, using a combination of different methods (strengthening and spinal traction, spinal exercises, posture correction, elements derived from Pilates, muscle stretching, and home-based exercise). Disease activity and mobility also improved after an intensive exercise program. Furthermore, a decrease in blood serum calprotectin (a protein released during inflammation and implicated in radiographic spinal progression) was found in both axSpA subgroups
- Mentioning of important factors to consider, such as pain and potentially inhibited mobility, which should be carefully considered when developing or partaking in an exercise program
- Potential benefits of combined pharmacological and physical rehabilitation interventions
- Cardiorespiratory exercise – including report of a recent study suggesting a significant beneficial effect of a cardiorespiratory high-intensity interval exercise intervention on fatigue, emotional distress, and ability to carry out daily activities.

Regular exercise is considered to be a key component in the management of axSpA and has been shown to reduce disease activity, pain, and stiffness and improve physical functioning, chest expansion, spinal mobility, and cardiorespiratory function, while also in some cases reducing depressive symptoms. As mentioned above, in some research studies, supervised group exercise has shown a greater improvement in quality of life, spinal mobility, and global condition assessment than unsupervised, individual exercise programs – a good reason to sign up to a local NASS group! Find your local axSpA services and hydrotherapy groups here:

A combined exercise program (range of motion, strengthening, and aerobic exercises) seems to be more beneficial than range of motion exercises alone. Furthermore, it is essential to invest in correctly learning how to perform such exercises. A really good source of information are the videos on the NASS website, reflecting ways to easily integrate exercises into your daily routine, in addition to showing how to properly perform these exercises (, or the Back to Action program

However, there is very limited evidence regarding the effectiveness of rehabilitation programs and physiotherapy in the early stages of axSpA due to the limited number of studies performed in this group of people and potentially different approaches used for physical therapy. Excitingly, in collaboration with the University of Bath (and with support/funding from NASS) we have recently conducted some analyses exploring the impact of the 2-week rehabilitation course in Bath on changes in factors such as spinal mobility, disease activity and quality of life over time. Over 30 years of medical records have been analysed, for those individuals who have consented for their medical records to be used for research. If you are one of those people then thank you so much for your support! Results from this study will be released later in the year and will of course be posted on the blog.

Physical activity and sedentary behaviour and their associations with clinical measures in axial spondyloarthritis. Rheumatology International, December 17th. Coulter and colleagues.

The aim of this study was to explore the associations between objectively measured physical activity and sedentary behaviour with clinical measures in people with established axSpA. Fifty participants were recruited from rheumatology services in Glasgow. Clinical measures collected included; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQOL) and the Six Minute Walk Test (6MWT). Accelerometers were then used to measure activity levels.Physical activity was found to be associated with better function, exercise capacity and spinal mobility, while sedentary behaviour was associated with lower exercise capacity and poor quality of life. Yet again, these findings support the promotion of physical activity and reduction of sedentary behaviour in axSpA.

Assessing Physical Activity and Sleep in Axial Spondyloarthritis: Measuring the Gap. Rheumatology and Therapy. December. Deodhar and colleagues.

Despite the reported benefits of physical activity in axSpA, the nature of the condition and often associated pain, stiffness, fatigue, and sleep problems, may lead to impaired physical activity for some people. In order for healthcare professionals to provide appropriate support, we need to better understand the long-term effects of this reduced physical activity and disturbed sleep. One way to do this is to measure physical activity and sleep, and in the following article, Deodhar and colleagues look at the ways we can measure both of these in people with axSpA. This includes the use of tools such as questionnaires and wearable technology or devices – with a particular focus in the article on wearable devices. At present, the majority of measures for sleep and physical activity used in axSpA are subjective and limited by recall, and are often over relatively short study intervals. Actigraphy, which measures light exposure, sleep, activity, and the sleep-wake cycle, will enable unintrusive, accurate monitoring of sleep and physical activity in people with axSpA over longer periods of time; similar to a FitBit or other wearable activity tracker. Since 2012, a variety of wearable activity trackers have been introduced, and are being used increasingly by the general population to promote health – even being used in our Project Nightingale study! Their use and availability appear to be ever increasing, as more devices with various designs and functions are being introduced.Importantly, actigraphy may be used to evaluate the impact of treatment interventions on physical activity and sleep, allowing for identification of appropriate management strategies in people with axSpA. Enhanced insight into sleep disturbance and impaired physical activity, and association with treatment changes in the long term, will enable healthcare providers to better understand variability between people and identify potential opportunities to address axSpA-related drivers of sleep disturbance and physical inactivity – again, as we are trying to do with Project Nightingale.

How to optimize exercise behavior in axial spondyloarthritis? Results of an intervention mapping study. Patient Education & Counselling, December 31st. Hilberdink and colleagues.
As you may be aware, for many of us it is hard to engage in adequate/recommended exercise – despite its proven health benefits. This study by Hilberdink and colleagues aimed to identify components needed to optimise exercise behaviour in people with axSpA.The first three steps of the Intervention Mapping protocol used: 1) needs assessment; 2) identification of axSpA-specific exercise barriers and facilitators; 3) selection of effective intervention components addressing potentially modifiable barriers/facilitators. All three steps included reviews of the literature and semi-structured interviews with both people with axSpA and physical therapists.

Results showed that only a reported one third of people with axSpA currently exercise regularly, demonstrating especially a lack of strengthening and cardiorespiratory exercises. Several intervention components were then selected: education, motivational interviewing, goal setting, action planning, monitoring, feedback, tailoring, guided practice, therapists’ training and group exercise encouragement. Research such as this will hopefully provide a foundation for the development of more axSpA-specific exercise interventions, similar to the 2-week rehabilitation course in Bath. There is such a buzz in this area at the moment, especially regarding the development of digitally delivered programs.

If you made it to the end of the post then thank you for reading! Have a great week. Our second December research highlights post will also follow shortly! Have you read any interesting articles last month that we have missed, and you think should be included here? If so, please get in touch at and we can add them to our page.