Skip to main content

High disease activity is related to low levels of physical activity in patients with ankylosing spondylitis

Abstract

This study aims to compare physical activity (PA) level and exercise habits in patients with ankylosing spondylitis (AS) who have high disease activity with those who have low disease activity and, further, to compare both groups with population controls. Cross-sectional study design was used. The participants include 149 patients (mean age 49.3 (SD 11.1), 61 % men, 54 % high disease activity) and 133 controls (mean age 52.7 (SD11.3), 58 % men). PA was reported with the International PA Questionnaire-Long and results were presented as weekly energy expenditure (metabolic equivalent, MET) in different intensities, domains, and proportion reaching health enhancing physical activity (HEPA). Types of PA were registered in a structured interview. The AS Disease Activity Score was used to assess patients’ disease activity. Patients with high disease activity reported significantly lower total weekly energy expenditure (MET) than patients with low disease activity and controls (p = 0.02, p = 0.01, respectively) and lower amounts of walking (p < 0.01, p = 0.02, respectively) and vigorous activity (p = 0.06, p = 0.06, respectively). Only 41 % of the patients with high disease activity reached HEPA compared to 61 % of the patients with low disease activity (p = 0.02). Patients in general participated less in leisure PA performed outdoor and with higher intensities (MET ≥ 6) than controls.

AS patients with high disease activity had lower weekly energy expenditure in PA than patients with low disease activity and controls, and were less likely to reach HEPA than patients with low disease activity. For optimal management, health professionals should focus on physical activity in their consultations with AS patients, especially those with high disease activity.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J (2003) Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 23:61–66

    PubMed  Google Scholar 

  2. 2.

    Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390

    PubMed  Article  Google Scholar 

  3. 3.

    Dagfinrud H, Mengshoel AM, Hagen KB, Loge JH, Kvien TK (2004) Health status in patients with ankylosing spondylitis: a comparison with the general population. Ann Rheum Dis 63:1605–1610

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Dagfinrud H, Kjeken I, Mowinckel P, Hagen KB, Kvien TK (2005) Impact of functional impairment in ankylosing spondylitis: impairment, activity limitation, and participation restrictions. J Rheumatol 32:516–523

    PubMed  Google Scholar 

  5. 5.

    Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D (2011) 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 70:896–904

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Dagfinrud H, Halvorsen S, Vollestad NK, Niedermann K, Kvien TK, Hagen KB (2010) Exercise programs in trials for patients with ankylosing spondylitis: do they really have the potential for effectiveness? Arthritis Care Res (Hoboken) 63(4):597–603

    Article  Google Scholar 

  7. 7.

    Mathieu S, Gossec L, Dougados M, Soubrier M (2011) Cardiovascular profile in ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 63(4):557–563

    Article  Google Scholar 

  8. 8.

    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A (2007) 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 39:1423–1434

    PubMed  Article  Google Scholar 

  9. 9.

    Sundstrom B, Ekergard H, Sundelin G (2002) Exercise habits among patients with ankylosing spondylitis. A questionnaire based survey in the County of Vasterbotten, Sweden. Scand J Rheumatol 31:163–167

    PubMed  Google Scholar 

  10. 10.

    Santos H, Brophy S, Calin A (1998) Exercise in ankylosing spondylitis: how much is optimum? J Rheumatol 25:2156–2160

    PubMed  CAS  Google Scholar 

  11. 11.

    Passalent LA, Soever LJ, O’Shea FD, Inman RD (2010) Exercise in ankylosing spondylitis: discrepancies between recommendations and reality. J Rheumatol 37:835–841

    PubMed  Article  Google Scholar 

  12. 12.

    Uhrin Z, Kuzis S, Ward MM (2000) Exercise and changes in health status in patients with ankylosing spondylitis. Arch Intern Med 160:2969–2975

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Ainsworth BE (2009) How do I measure physical activity in my patients? Questionnaires and objective methods. Br J Sports Med 43:6–9

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Spoorenberg A, van Tubergen A, Landewe R, Dougados M, van der Linden S, Mielants H, van de Tempel H, van der Heijde D (2005) Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology (Oxford) 44:789–795

    Article  CAS  Google Scholar 

  15. 15.

    Gran JT, Skomsvoll JF (1997) The outcome of ankylosing spondylitis: a study of 100 patients. Br J Rheumatol 36:766–771

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Bakland G, Gran JT, Nossent JC (2011) Increased mortality in ankylosing spondylitis is related to disease activity. Ann Rheum Dis 70:1921–1925

    PubMed  Article  Google Scholar 

  17. 17.

    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368

    PubMed  Article  Google Scholar 

  18. 18.

    van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, Braun J, Landewe R (2009) ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 68:1811–1818

    PubMed  Article  Google Scholar 

  19. 19.

    Machado P, Landewe R, Lie E, Kvien TK, Braun J, Baker D, van der Heijde D (2010) Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. doi:10.1136/ard.2010.138594

    Google Scholar 

  20. 20.

    Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285

    PubMed  CAS  Google Scholar 

  21. 21.

    Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 21:1694–1698

    PubMed  CAS  Google Scholar 

  22. 22.

    Jones SD, Porter J, Garrett SL, Kennedy LG, Whitelock H, Calin A (1995) A new scoring system for the Bath Ankylosing Spondylitis Metrology Index (BASMI). J Rheumatol 22:1609

    PubMed  CAS  Google Scholar 

  23. 23.

    Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395

    PubMed  Article  Google Scholar 

  24. 24.

    Graff-Iversen S, Anderssen SA, Holme IM, Jenum AK, Raastad T (2007) An adapted version of the long International Physical Activity Questionnaire (IPAQ-L): construct validity in a low-income, multiethnic population study from Oslo, Norway. Int J Behav Nutr Phys Act 4:13

    PubMed  Article  Google Scholar 

  25. 25.

    American College of Sports Medicine (2006) ACSM’s guidelines for exercise testing and prescription. Lippincott Williams and Wilkins, New York

    Google Scholar 

  26. 26.

    Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS (2011) 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43:1575–1581

    PubMed  Article  Google Scholar 

  27. 27.

    Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, McInnes IB, Haentzschel H, Gonzalez-Gay MA, Provan S, Semb A, Sidiropoulos P, Kitas G, Smulders YM, Soubrier M, Szekanecz Z, Sattar N, Nurmohamed MT (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Hakkinen A, Sokka T, Kotaniemi A, Hannonen P (2001) A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis Rheum 44:515–522

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Troseid M, Lappegard KT, Claudi T, Damas JK, Morkrid L, Brendberg R, Mollnes TE (2004) Exercise reduces plasma levels of the chemokines MCP-1 and IL-8 in subjects with the metabolic syndrome. Eur Heart J 25:349–355

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Ploeger HE, Takken T, de Greef MH, Timmons BW (2009) The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. Exerc Immunol Rev 15:6–41

    PubMed  Google Scholar 

  31. 31.

    Elliott CG, Hill TR, Adams TE, Crapo RO, Nietrzeba RM, Gardner RM (1985) Exercise performance of subjects with ankylosing spondylitis and limited chest expansion. Bull Eur Physiopathol Respir 21:363–368

    PubMed  CAS  Google Scholar 

  32. 32.

    Carter R, Riantawan P, Banham SW, Sturrock RD (1999) An investigation of factors limiting aerobic capacity in patients with ankylosing spondylitis. Respir Med 93:700–708

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    YrO O, Inanici F, Hascelik Z (2011) Reduced vital capacity leads to exercise intolerance in patients with ankylosing spondylitis. Eur J Phys Rehabil Med 47(3):391–397

    Google Scholar 

  34. 34.

    Halvorsen S, Vollestad NK, Fongen C, Provan SA, Semb AG, Hagen KB, Dagfinrud H (2011) Physical fitness in patients with ankylosing spondylitis: a comparison with population controls. Phys Ther 92(2):298–309

    PubMed  Article  Google Scholar 

  35. 35.

    Rehn TA, Winett RA, Wisloff U, Rognmo O (2013) Increasing physical activity of high intensity to reduce the prevalence of chronic diseases and improve public health. Open Cardiovasc Med J 7:1–8

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

Financial support was received from the Norwegian Foundation for Postgraduate Physiotherapists and Norwegian Rheumatism Association.

Disclosures

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Camilla Fongen.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fongen, C., Halvorsen, S. & Dagfinrud, H. High disease activity is related to low levels of physical activity in patients with ankylosing spondylitis. Clin Rheumatol 32, 1719–1725 (2013). https://doi.org/10.1007/s10067-013-2320-5

Download citation

Keywords

  • Ankylosing spondylitis
  • Disease activity
  • Energy expenditure
  • Habits
  • Physical activity