Physical activity linked to better health, quality of life in axSpA
Dutch study found minority of patients met exercise recommendations
Higher levels of physical activity are linked to better disease outcomes and quality of life in people with axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS), according to a recent study.
“Patients with axSpA should be especially encouraged to exercise, as it is particularly beneficial for disease-related outcomes,” researchers wrote.
The study, which analyzed data from two separate groups in different regions of the Netherlands, found consistent results, suggesting the positive impact of physical activity applies across diverse populations. However, researchers noted that about one-third of patients met the World Health Organization (WHO) recommendations for physical activity, with fewer meeting the muscle-strengthening component of these recommendations than the aerobic one.
The study, “Physical activity in relation to health status, quality of life and compliance with World Health Organization recommendations in patients with axial spondyloarthritis,” was published in Arthritis Research & Therapy.
Study measures how many axSpA patients follow exercise guidelines
In axSpA, inflammation affects the spine and the sacroiliac joints, the areas where the spine connects to the pelvis. This inflammation can cause chronic back pain and other related symptoms. AS is a specific form of axSpA that is defined by clear inflammation in the sacroiliac joints.
Physical activity is known to improve overall health and can help reduce symptoms in people with axSpA, such as pain, stiffness, and reduced mobility. Physical activity includes all kinds of body movements that use energy, from daily tasks to structured exercise.
The WHO and the European Alliance of Associations for Rheumatology recommend that people with axSpA follow these general physical activity guidelines: at least 2.5 to 5 hours of moderate aerobic activity per week, or 1.25 to 2.5 hours of vigorous activity, plus muscle-strengthening exercises twice a week. Physical activity can come from many sources, including walking or biking to work, household chores, recreational sports, or exercise routines.
Regular movement, especially when tailored to an individual’s ability, is important for managing axSpA and improving quality of life. For example, a 2024 study showed functional improvements in spinal mobility after a two-week physical therapy program.
In this study, the researchers examined how many people with axial axSpA met physical activity guidelines and how this related to their disease outcomes. The analysis included 341 participants from two different studies: the ongoing Groningen Leeuwarden Axial Spondyloarthritis (GLAS) study in the northern Netherlands, and a second group from a medical center in the southwestern region, known as the LUMC group.
Participants in the GLAS group were seen during follow-up visits, while those in the LUMC group were assessed during outpatient clinic visits. Both groups completed the Assessment of Spondyloarthritis International Society Health Index (ASAS-HI) to measure disease-related health, though only a subset of GLAS participants had available ASAS-HI data.
Participants in the LUMC group were older on average compared to those in the GLAS group (mean age 55.7 years vs. 48.5 years) and had been diagnosed with axSpA for a longer time (median 23 years vs. 11 years). They were also more likely to be male and more frequently used non-steroidal anti-inflammatory drugs.
More subjects met aerobic recommendations
A minority of participants met the WHO physical activity guidelines: 37% in the GLAS group and 34% in the LUMC group. The researchers noted that many more patients met the aerobic exercise recommendations compared to the muscle-strengthening ones, with about three-quarters of each group completing the aerobic component.
The types of planned exercises performed by people with axSpA were similar to those of the general Dutch population, with walking and cycling being the most common activities in both groups.
Higher levels of physical activity were significantly associated with better disease-related health status, shown by lower ASAS-HI scores, in both groups. This relationship remained significant even after adjusting for age and sex. A similar positive association was seen with quality of life scores in the GLAS group, while quality of life data were not available for the LUMC group.
In daily clinical practice, greater awareness and focus on moderate-to-vigorous intensity and muscle strengthening activity is beneficial for axSpA patients.
Associations between physical activity and health status or quality of life don’t indicate a causal relationship, the team noted.
“We do not know whether being more active results in a better outcome, or patients who already have a better health status and [quality of life] are able to do more [physical activity],” they wrote.
The rural region where GLAS was based tends to have lower socioeconomic indications than the urban area where the LUMC group received care. As socioeconomic status may affect physical activity and disease-related outcomes, this could have complicated the analysis. However, similar effects in the two different study populations demonstrate the robustness of the results, according to the researchers.
These results support data from previous studies that indicates physical activity may be helpful for people with axSpA, the team said.
“In daily clinical practice, greater awareness and focus on moderate-to-vigorous intensity and muscle strengthening activity is beneficial for axSpA patients,” the researchers concluded.
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