title: Long term high intensity exercise and damage of small joints in rheumatoid arthritis. Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study. Efficacy of High Intensity Exercise on Disease Activity and Cardiovascular Risk in Active Axial Spondyloarthritis: A Randomized Controlled Pilot Study The effect of 30 min cycle ergometry on ankylosing spondylitis. ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis Effects of Aerobic Training in Patients with Ankylosing Spondylitis Effect of a high-intensity weight-bearing exercise program on radiologic damage progression of the large joints in subgroups of patients with rheumatoid arthritis.
abstract: OBJECTIVE To investigate the effect of long term high intensity weightbearing exercises on radiological damage of the joints of the h and s and feet in patients with rheumatoid arthritis ( RA ) . METHODS Data of the 281 completers of a 2 year r and omised controlled trial comparing the effects of usual care physical therapy ( UC ) with high intensity weightbearing exercises  were analysed for the rate of radiological joint damage ( Larsen score ) of the h and s and feet . Potential determinants of outcome were defined : disease activity , use of drugs , change in physical capacity and in bone mineral density , and attendance rate at exercise sessions . RESULTS After 2 years , the 136 participants in high intensity weightbearing exercises  developed significantly less radiological damage than the 145 participants in UC . The mean ( SD ) increase in damage was 3.5 ( 7.9 ) in the exercise group and 5.7 ( 10.2 ) in the UC group , p = 0.045 . Separate analysis of the damage to the h and s and feet suggests that this difference in rate of increase of damage is more pronounced in the joints of the feet than in the h and s. The rate of damage was independently associated with less disease activity , less frequent use of glucocorticoids , and with an improvement in aerobic fitness . CONCLUSION The progression of radiological joint damage of the h and s and feet in patients with RA is not increased by long term high intensity weightbearing exercises . These exercises may have a protective effect on the joints of the feet AIM The aim of the study was to compare the effects of conventional exercise ( CE ) , swimming and walking on the pulmonary functions , aerobic capacity , quality of life , Bath indexes and psychological symptoms in patients with ankylosing spondylitis ( AS ) . METHODS Forty-five patients were r and omised into either swimming ( group 1 ) , walking ( group 2 ) , CE group ( group 3 ) . Patients in Group 1 performed CE and swimming , patients in Group 2 performed CE and walking and patients in Group 3 performed CE only . Exercise sessions were performed three times a week for a period of six weeks . Patients were assessed before and after the rehabilitation program , with respect to , pulmonary function test ( forced vital capacity [ FVC , mL ] , forced expiration volume in one second [ FEV1 , mL ] , FEV1/FVC ( % ) and vital capacity [ VC , mL ] ) , maximal oxygen uptake ( pV.O2 ) , 6-minute walking test ( 6MWT ) , Bath Ankylosing Spondylitis Functional Index , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Metrology Index , Nottingham Health Profile and Beck Depression Inventory . RESULTS There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 ( P<0.05 ) . FeV1 , FVC and VC improved significantly with treatment in all three groups ( P<0.05 ) . A statistically significant improvement was observed in energy , emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program ( P<0.05 ) . CONCLUSIONS Swimming , walking and CE had beneficial effects on the quality of life and pulmonary functions . Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients Background Physical therapy is recommended for the management of axial spondyloarthritis ( axSpA ) and flexibility exercises have traditionally been the main focus . Cardiovascular ( CV ) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases . Therefore , the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA. Methods In a single blinded r and omized controlled pilot study the exercise group ( EG ) performed 12 weeks of endurance and strength exercise while the control group ( CG ) received treatment as usual . The primary outcome was the Ankylosing Spondylitis ( AS ) Disease Activity Score ( ASDAS ) . Secondary outcomes included patient reported disease activity ( Bath AS Disease Activity Index [ BASDAI ] ) , physical function ( Bath AS Functional Index [ BASFI ] ) , and CV risk factors measured by arterial stiffness ( Augmentation Index [ Alx ] ) and Pulse Wave Velocity [ PWV ] ) , cardiorespiratory fitness ( VO2 peak ) and body composition . ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences , and Mann Whitney U-test was used for outcomes with skewed residuals . Results Twenty-eight patients were included and 24 ( EG , n = 10 , CG , n = 14 ) completed the study . A mean treatment effect of −0.7 ( 95%CI : −1.4 , 0.1 ) was seen in ASDAS score . Treatment effects were also observed in secondary outcomes ( mean group difference [ 95%CI ] ) : BASDAI : −2.0 ( −3.6 , −0.4 ) , BASFI : −1.4 ( −2.6 , −0.3 ) , arterial stiffness ( estimated median group differences [ 95 % CI ] ) : AIx ( % ) : −5.3 ( −11.0 , −0.5 ) , and for PVW ( m/s ) : −0.3 ( −0.7 , 0.0 ) , VO2 peak ( ml/kg/min ) ( mean group difference [ 95%CI ] : 3.7 ( 2.1 , 5.2 ) and trunk fat ( % ) : −1.8 ( −3.0 , −0.6 ) . No adverse events occurred . Conclusion High intensity exercise  improved disease activity and reduced CV risk factors in patients with active axSpA. These effects will be further explored in a larger trial . Trial Registration Clinical Trials.gov The effect of 30 min cycle ergometry at approximately 100 W ( mean 98.8 W ; range 34 - 151 W ) in 11 male patients who had no hip involvement were studied . In most patients , exercise produced immediate increases in spinal flexibility and bilateral cervical tilt , and a reduction in pain . However , these improvements steadily waned and all had disappeared by 3 - 5 h. Exercise induced marked changes in the numbers of circulating leucocytes and platelets , and in the distribution of lymphocytes subsets , similar to those previously reported to occur in individuals without the disease . In a majority of patients there were positive associations ( Kendall 's tau test ) between Schober 's index and the platelet count , and negative associations between Schober 's index and the percentage of CD4-positive cells over a 5 h period on the exercise day , whereas there were negative associations between the pain score and the leucocyte and neutrophil counts over a comparable period on a control day without exercise . We conclude that exercising those regions of the body unaffected by disease can elicit short-term beneficial effects by a systemically mediated mechanism(s ) Objectives : To evaluate various validity aspects of four disease activity scores ( ASDAS ) for ankylosing spondylitis ( AS ) in comparison with the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , its individual components and physician and patient global assessment of disease activity . Methods : The analyses were performed in two cohorts of patients with AS : ( 1 ) the NOR-DMARD data base which includes patients starting on a disease-modifying antirheumatic drug or tumour necrosis factor ( TNF ) blocker and ( 2 ) patients participating in double-blind placebo controlled r and omised clinical trials with TNF blockers in four centres . Discrimination between patients with low versus high disease activity according to various definitions and between various levels of change were analysed as the st and ardised mean difference ( difference in the group means divided by the pooled SD of the group means ) and t score . Results : The four ASDAS versions were highly discriminatory in differentiating patients with different levels of disease activity and patients with different levels of change . The ASDAS scores outperformed the BASDAI and its single components in all setting s : patient- or physician-based , reflecting status or change , with normal or raised C-reactive protein ( CRP ) , in the presence or absence of peripheral arthritis . There were no major differences between the four ASDAS scores . Based on feasibility , the ASAS membership selected the ASDAS version which included back pain , duration of morning stiffness , patient global assessment , peripheral joint complaints and CRP as the preferred version . Conclusions : The ASDAS is a vali date d , highly discriminatory instrument for assessing disease activity in AS , including patient-reported outcomes and CRP levels Objective . To evaluate the effects of aerobic exercise in patients with ankylosing spondylitis ( AS ) . Methods . Seventy patients classified with AS by the modified New York criteria were included . The patients were r and omly assigned into 2 groups . The intervention group ( IG ) performed 50 min of walking followed by stretching exercises 3 times a week for 12 weeks . The control group ( CG ) performed only stretching exercises . The outcome measurements were the Bath indexes [ Bath AS Functional Index ( BASFI ) , Bath AS Disease Activity Index ( BASDAI ) , and Bath AS Metrology Index ( BASMI ) ] , Health Assessment Question naire for the Spondyloarthropathies ( HAQ-S ) , AS Disease Activity Score ( ASDAS ) , the 6-min walk test ( 6MWT ) , chest expansion , and the Medical Outcomes Study Short Form-36 . Aerobic capacity was assessed by ergospirometry on a treadmill . Routine laboratory techniques were used in determining lipid levels . Assessment s were performed immediately before r and omization and after 6 , 12 , and 24 weeks . Results . Thirty-five patients were r and omized to the IG and 35 to the CG . There was significant improvement in the BASFI , HAQ-S , BASMI , BASDAI , and ASDAS in both groups ( p < 0.05 ) , but did not differ between groups . There was a significant increase in the walking distance in the 6MWT in the IG compared with CG ( p < 0.001 ) . The IG showed significant improvement in cardiopulmonary capacity compared with CG . Cholesterol and triglyceride levels did not change in either group . Conclusion . In patients with AS , aerobic training improved walking distance and aerobic capacity . Aerobic training did not provide additional benefits in functional capacity , mobility , disease activity , quality of life , and lipid levels when compared with stretching exercises alone OBJECTIVE To investigate whether a high-intensity exercise program accelerates the rate of radiologic damage of the large joints in predefined subgroups of patients with rheumatoid arthritis . METHODS The data of 277 participants in a 2-year r and omized controlled trial , comparing the effects of high-intensity exercises with usual care  , were used . Linear regression analysis was used to test which predefined variables at baseline ( age , disease duration , disease activity , physical capacity , functional ability , joint damage ) modified the effect of high-intensity exercise on the progression of radiologic damage of the large joints over 24 months . RESULTS Baseline radiologic joint damage was the only variable associated with the effect of high-intensity exercise on joint damage progression in large joints . In a subgroup of 218 patients with no or little joint damage ( defined as Larsen score < or = 5 ; 80 % of our study population ) the proportions of patients with an increase in joint damage were similar for the exercise and usual-care group ( 35 % versus 36 % , risk ratio [ RR ] 1.0 [ 0.7 - 1.4 ] ; P = not significant ) , whereas , in a subgroup of 59 patients who already had extensive damage of large joints ( defined as Larsen score > 5 ) the proportion was significantly higher in the exercise group ( 85 % versus 48 % , RR 1.8 [ 1.2 - 2.6 ] ; P < 0.05 ) . CONCLUSION High-intensity weight-bearing exercises appear to accelerate joint damage progression in patients with preexisting extensive damage . Patients with extensive large joint damage should , therefore , be advised to refrain from activities excessively loading the damaged joints
target: Aerobic exercise did not improve BASFI , CRP or ESR .
  CONCLUSION Aerobic exercise did not provide beneficial effects either on disease activity or on physical function and biological parameters when compared to a control group in axial spondyloarthritis
background: AIM To evaluate the impact of an aerobic fitness program on disease activity , defined by the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) and on C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR ) and the Bath Ankylosing Spondylitis Functional Index ( BASFI ) in case of axial spondyloarthritis .