Exercise as it relates to Disease/Exercise on Ankylosing spondylitis

Background to Ankylosing Spondylitis Ankylosing Spondylitis (AS) is an inflammatory disease primarily affecting the axial skeleton and sacroiliac joints.Braun J, Sieper J. Ankylosing Sponylitis. Lancet. 2007; 369: 1379-1390 Ankylosing Spondylitis is a rheumatic disease with no known cause but is genetically linked to the HLA-B27 gene.Calin A. Ankylosing Spondylitis. Spondyloarthropathies. 2006; 34(10): 396-400 AS affects men more than women (2:1) and commonly presents in patients aged 20 to 30 years old. Ankylosing Spondylitis is typically characterised by back pain and reduced spinal mobility.Halvorsen S, Vollestad NK, Fongen C, et al. Physical Fitness in Patients with Ankylosing: Comparison with population controls. Physical Therapy. 2012; 92:298-309 The back pain originates from the inflammation of and potential fusing of the joints. In an attempt to heal, the body forms new bone on the sites of inflammation, fusing sections of the spine.Spondylitis Association of America (US). Ankylosing Spondylitis[internet]. Sherman Oakes (CA): Spondylities Association of America; 2014 [cited 2014 Sept 20]. Management of Ankylosing Spondylitis Management of AS is aimed at controlling disease activity (flare-ups) as there is no known cure for the condition.Braun J, van den Berg R, Baraliakos X, et al. 2010 update of the ASAS/EULAR recommendations for the management of Ankylosing Sponylitis. Ann Rhuem Dis. 2011; 70:896-904 Physical therapy is highly recommended along with medication for the treatment of Ankylosing Spondylitis. Exercise for the treatment of Ankylosing Spondylitis largely focuses around controlling disease activity and improvement and maintenance of mobility. There is also focus on strengthening postural and breathing muscles,Dagfinrud H, Halvorsen S, Vollestad NK, et al. Exercise programs in trials for patients with Ankylosing Sponylitis: do they really have the potential for effectiveness? Arthritis Care Res (Hoboken). 2011; 63:597-603. especially back, hip neck and shoulder extensors.Ince G, Sarpel, T, Durgun B, et al. Effects of a Multimodal Exercise Program for People with Ankylosing Spondylitis. Physical Therapy.2006;86: 924-935 The vertebral fusion and subsequent loss of lumbar spinal curve causes a spinal kyphosishttp://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/basics/definition/con-20019766 [cited 2014 Sept 20] and additionally there is a growing body of evidence that that patients with inflammatory rheumatic diseases are at increased risk of cardiovascular disease and Metabolic Syndrome (MetS).Malesci D, Niglio A, Mennillo GA, et al. High Prevalence of metabolic syndrome in patients with ankylosing spondylitis. Clin Rheumatol. 2007;26:710-714 Exercise has been strongly linked to the reduction in inflammation markers (including IL-6 and C-reactive protein),Ford ES. Does exercise reduce inflammation: physical activity and C-reactive protein among US adults. Epidemiology. 2002; 13:561-568Troseid M, Lappegard KT, Claudi T, et al. Exercise reduces plasma levels of the chemokines MCP-1 and IL-8 in subjects with metabolic syndrome. Eur Heart J. 2004; 25:349-355Fischer CP, Berntsen A, Perstrup LB, et al. Plasma levels of interleukin-6 and C-reactive protein are associated with physical activity independent of obesity. Scan J Med Sci Sports. 2007; 17:580-587. therefore aerobic exercise in the disease management of patients with AS should be included. Exercise Management of Ankylosing Spondylitis= As with any exercise prescription, the two main considerations are adherence and maximising benefits. For patients with AS this should also result in maintained function and quality of life.Masiero S, Poli P, Bonaldo L, et al. Supervised training and home-based rehabilitation in patients with stabilized ankylosing spondylitis on TNF inhibitor treatment: a controlled clinical trial with a 12-month follow-up. Clinical Rehabilitation. 2014;28: 562-572 A Cochrane reviewDagfinrud H, Kvien TK and Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev. 2008; 1:CD002822. suggested that much better spinal mobility, pain reduction, and fatigue is achieved with supervised sessions. Group physical therapy such as Pilates, Yoga and Physiocise twice a week for up to 60 minute duration, displayed a significant improvement in long term outcomes when compared to home-based programs. Conversely, with aerobic exercise for patients with Ankylosing Spondylitis, the type of exercise appears not to matter.Falkenback A, Neger J, Tripathi R, et al. Recreational exercises and mobility in young patients with ankylosing spondylitis (AS). Sports Medicine, Training and Rehabilitation. 1999;9: 101-106. Regular aerobic exercise is recommended for lowering the risk of CVDHaskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39: 1423-1434http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#apaadult (viewed September 2014) and most likely to succeed for AS patients is therefore choosing something they can fit into their daily lives. Daily aerobic exercise of 30 minute duration is recommended to reduce the risk of both CVD and MetS and daily exercise yields the greatest disease management for AS patients. Exercise Program Summary Twice weekly participation in supervised exercise program with specific exercises for AS strengthening postural and breathing muscles strengthening back and hip extensors strengthening neck and shoulder extensors 30 minutes minimum daily cardiorespiratory fitness training Any activity that is aerobic in nature, walking, cycling, running, swimming, team sports. Adherence to exercise programs will result in reducing flare ups which will result in reduced pain and inflammation and an improvement in function and quality of life. Management of weight and cardiorespiratory fitness will assist patients with AS in reducing their risks of CVD and MetS. Resources http://www.nass.co.uk/exercise/ http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2014/AnkylosingSpondylitis.dpf http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#apaadult http://www.health.gov/paguidelines/guidelines/#pag References