Background: Physical exercise is an important treatment for individuals with axial spondyloarthritis (axSpA). Although high-intensity training (HIT) has been shown to reduce disease symptoms and risk of comorbidity without exacerbating disease activity (1), compliance tends to decrease over time. Increased knowledge is needed on how to optimize and tailor individual exercise programs for continued regular exercising and improved health.

Objective: To study the effects of HIT on aerobic capacity, body composition, disease activity, physical function, health status and fatigue in individuals with axSpA after a 12-week intervention supported by digital coaching.

Methods: Twenty-two individuals (women, n=12), recruited from two rheumatology clinics in southern Sweden, were randomized to a HIT intervention group (HG; n=11) or a control group (CG; n=11). The HG completed three HIT sessions/week, including two interval training sessions (4x4 min), in self-selected activities for 12 weeks. The individuals in the HG were individually coached and had regular support from a physical therapist primarily by digital coaching. The CG continued exercising as usual. Assessment of aerobic capacity (VO2max), body composition (BMI and visceral fat area [cm2]), disease activity (CRP [µg/ml], BASDAI, 0-10 best-worst), physical function (BASFI, 0-10 best-worst), health status (EQ5D, 0-1 worst-best, ASAS health index [ASAS-HI], 0-17 best-worst), and fatigue (fatigue severity scale [FFS], 0-7 best-worst) were sampled at baseline and after 12 weeks. Mean and standard deviation (SD) were used for descriptive statistics. Repeated measures analysis of variance (ANOVA) was used to investigate effect of group (HG*CG) and time (PRE*POST), with a post-hoc analysis using t-tests when ANOVA indicated a significant difference in main effects or interactions. A significance level of p≤0.05 was used. Fisher´s exact test was used to study the effects over time for CRP (as dichotomized variable, > or < 4 µg/ml).

Results: Results presented are part of an ongoing RCT based on 19 individuals (women n=11) that have completed the 12-week follow-up analyses. The participants mean (SD) age was 48 (10) years, BMI 25 (4), VO2max 37 (6) mlO2/kg/min, and BASDAI 2.6 (0.3). No differences were present between the HG (n=9) and the CG group (n=10) at baseline for the studied variables. After 12 weeks of HIT an ANOVA interaction (p<0.05 showed that HG increased their VO2max (6.4 [3.6] mlO2/kg/min; p<0.001) but CG did not. For BMI, visceral fat area, disease activity (BASDAI), physical function (BASFI), fatigue (FFS) no differences in main effects or interactions were found (p>0.05). Health status (EQ5D) showed an ANOVA time main effect (p=0.007) where the HG increased their health status (0.10 [0.06] units; p=0.02) after 12-weeks, but CG did not. For health status measured with ASAS-HI no differences between groups were found. For dichotomized CRP-values no differences were found in either of the group’s pre-post. 

Conclusions: This pilot RCT shows that after 12 weeks of digital-based HIT intervention, the HG increased their aerobic capacity and EQ5D health status compared to CG, while body composition, disease activity, physical function, and fatigue did not show any significant differences between the groups. 

References

(1) Sveaas SH, Bilberg a, Berg IJ, Provan SA, Rollefstad S, Semb AG, et al. high intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. Br J Sports med. 2019

Background: Physical exercise is included in the recommended treatment for individuals with axSpA, and different forms of aerobic training are known to improve health and cardiorespiratory function. However, little is known about the experiences of digital-based HIIT in individuals with axSpA.

Objective: To describe experiences of a digital-based HIIT intervention in individuals with axSpA.

Method: The participants completed a standardized training protocol, including three sessions/week (two HIIT sessions) in self-selected activities for 12 weeks. They used a fitness watch and were individually coached by a physical therapist primarily by telephone. Individual interviews were conducted with 12 participants (table 1). Open-ended questions were used such as; “How have you experienced the HIIT intervention?”, and “How has the HIIT intervention affected you?”. Data were analyzed by qualitative content analysis.

Results: The analysis resulted in four categories constituted of 12 subcategories (table 2) describing participation in a digital-based HIIT intervention as: 1) The intervention design creates opportunities for exercise through easy accessibility, time efficiency, and increased selfawareness.

Conclusion: Individuals with axSpA found that the intervention provided exercise opportunities. Encouragement and positive well-being effects was highlighted, but the need to overcome difficulties was also emphasized. These findings are key for implementing sustainable, individualized HIIT-based rehabilitation.

Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the axial skeleton causing pain, inflammation, and stiffness. Individuals with axSpA are at greater risk of developing cardiovascular disease, which can be counteracted by physical activity. High-intensity interval training (HIIT) has been shown to improve cardiovascular health, but the effect on disease activity and the level of inflammation in axSpA has been less studied. With the aim of investigating how levels of inflammatory cytokines, myokines, and protein markers for bone metabolism are acutely affected by one bout of HIIT, we studied serum from individuals with axSpA and healthy controls (HC).

Methods: Ten participants with axSpA and 11 age- and sex-matched HC performed a single HIIT bout on a cycle ergometer: 4x4 minutes intervals with three minutes active rest in between. Blood samples were taken before and one hour after the HIIT bout. Serum proteins (IL-6, IL-17, IL-18, TNFa, CXCL-10, VEGF-A, BDNF, DKK-1, osteoprotegerin, osteocalcin, osteopontin, BMP-7, CRP) were analyzed with a Luminex system or ELISA. Descriptive data are presented as mean with standard deviation. A two-way ANOVA was used for comparisons.

Results: A main effect from baseline to one hour post HIIT showed that both groups had a significant increase in serum levels (pg/ml) of IL-6: axSpA 2.2 (3.0) to 3.2 (1.8) and HC 0.4 (0.4) to 1.9 (2.0), p=0.03. VEGF-A (pg/ml) was significantly lower in the axSpA group: 159 (138) vs. HC 326 (184), p=0.03, but was not affected by the HIIT bout. BMP-7 (ng/ml) increased in both groups after the HIIT: axSpA 61.6 (13.1) to 75.2 (20.0) and HC 64.6 (20.8 to 75.0 (17.8), p<0.001. For the other proteins analyzed, there were no significant differences in serum concentrations between individuals with axSpA and HC, or within the two groups before and after one bout of HIIT.

Conclusions: One acute bout of HIIT significantly increases the serum concentrations of IL-6 and BMP-7 after 1 hour in both individuals with axSpA and HC.

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