Assessing Physical Activity Levels in Patients with Axial Spondyloarthritis

High levels of sedentary activity and low levels of physical activity found in patients with axSpA

Pain from spinal stiffness is common among patients with axial spondyloarthritis (axSpA). Physical activity (PA) and exercise offer many benefits, however, studies have shown that patients with axSpA tend to partake in less PA compared with the general population in a multi-ethnic Asian country.

A team led by Jie Kie Phang, Department of Rheumatology and Immunology, Singapore General Hospital, conducted a study to examine PA in patients with axSpA and explore the patterns.

The Study

Investigators performed a cross-sectional study conducted between May 2016 and January 2017. At the largest tertiary hospital in Singapore, consecutive patients with axSpA were recruited from the outpatient rheumatology clinic at Singapore General Hospital.

The study included 74 patients with axSpA and the investigators used the Global Physical Activity Questionnaire (GPAQ) to assess PA.

Also included were 2679 control participants, chosen based on a previous cross-sectional study from Singapore Health 2012. Households were selected randomly from the Database of Dwellings, which consists of all residential dwelling units in Singapore.

Socio-Demographics of the Participants

When comparing the group of patients with axSpA alongside the control group, patients with axSpA were younger (median age [IQR], 37.0 [26.3] years) than the control group (median age [IQR], 51.0 [23.0] years) (P < 0.001). There was very little difference in BMI between the groups (axSpA: median BMI [IQR], 24.1 [5.1]; control: median BMI [IQR], 23.6 [5.5]; P = 0.290).

Most of the control group participants did not smoke (70.7%), but all of the patients with axSpA either smoked, or had previously smoked (100%) (P < 0.001). Participants in the control group did not have axSpA, however, 58.8% self-reported a history of either osteoarthritis of the hip or knee, or rheumatoid arthritis or gout.

Why We Need Interventions

The results show that despite the many benefits of PA, patients with axSpA still tend to partake in it less often than the general population. Patients with axSpA that met the World Health Organization (WHO) recommendations for PA were in the lower proportion (axSpA = 77.0%, controls = 89.7%, P < 0.001).

Not only do patients with axSpA engage in less PA but they engage in more sedentary activity when compared with the general population (axSpA = 56.8%, controls = 36.1%, P < 0.001). This is concerning because sedentary activity has been linked to increased cardiovascular risk and death.

No significant difference was found in the levels of PA between patients with active axSpA and patients with inactive axSpA.

Patients with axSpA spent more time on recreational-related physical activity per day (median [IQR], 13.9 [51.4] minutes vs 0 [17.1] minutes, P = 0.01), but the median total amount of time spent on PA per day didn’t differ between the groups (P = 0.07).

Although this study did not determine the cause for the lower levels of PA among patients with axSpA, it does indicate there’s more to be understood about this condition and the need for successful interventions.

“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,” the authors wrote. “This highlights the need for interventions to promote PA among patients with axSpA.”

The study, “Physical activity in patients with axial spondyloarthritis in a multi-ethnic south-east Asian country” was published in BMC Rheumatology.