Introduction: Knee pain increases the risk of developing chronic widespread pain (CWP) and knee osteoarthritis (KOA). The prevalence of CWP and KOA has increased, and there is a need for early prevention. Therefore, the aim was to examine the associations of health-related quality of life (HRQoL) and lifestyle habits with chronic pain at a two-year follow-up in individuals with knee pain. Methods: A two-year longitudinal cohort study including 251 individuals aged 30–60 years reporting knee pain at baseline. HRQoL was measured via the Short-Form General Health Survey (SF-36), and lifestyle habits included questions on overweight, physical activity, diet, alcohol and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time in groups with unchanged no chronic pain (NCP), transitioned to less and more pain, and unchanged CWP were analysed using Wilcoxon’s, McNemar’s and Friedman’s tests. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up. Results: Reporting better HRQoL across various SF-36 concepts and normal weight at baseline was associated with reporting NCP after two years. A few changes were made regarding HRQoL and lifestyle habits over the course of two years, but an increase in general health was associated with transitioning to less pain. Conclusions: During primary care visits for knee pain with a combination of overweight or lower HRQoL, individuals should receive comprehensive attention to prevent the development of CWP. Future studies should investigate the associations further. © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

The aim of this study was to investigate how physical fitness performance, which is related to the strength and power of the lower extremities and core, as well as lateral agility, changes across 20 weeks of in-season training in youth female and male padel players. This study was conducted using a prospective cohort design on 16 Swedish high school padel players aged between 15 and 18 years old. The players were assessed at baseline with five tests of their physical fitness and followed prospectively, with the registration of their training load for 20 weeks, and then assessed at a follow-up, approximately five months later. The players increased their performance in all tests (p ≤ 0.02). The mean improvement in their Isometric squat test performance was 20% for peak force, 18% for relative strength value and 69% for average rate of force development. Their improvement in the squat jump test performance was 9%, whereas the improvement in their countermovement jump test was 6%. For the 30 second sit-up test, an improvement of 14% was observed. Improvements were also noted for the 30 second side hop test performance on both the right (9%) and left leg (11%). The effect size ranged from 0.31 to 1, respectively, for the tests, representing a small to large effect. The data from this study suggest that an improvement in physical fitness performance can be obtained during 20 weeks of padel training. © 2024 by the authors.

Objectives: The aim was to study the development of radiographic knee osteoarthritis (RKOA) in individuals with knee pain over 2 years, and the associations between radiographic changes and baseline variables.

Design: Longitudinal cohort study.

Participants and setting: This study is part of the Halland Osteoarthritis cohort. The included 178 individuals, aged 30-67, had knee pain, without cruciate ligament injury or radiographic findings and 67% were women. The presence of RKOA was defined as Ahlbäck score of ≥1 in ≥1 knee. (Ahlbäck grade 1: joint space narrowing in the tibiofemoral joint <3 mm). Diagnosis of clinical KOA was based on the clinical guideline from the National Institute for Health and Care Excellence (NICE). Knee injury and Osteoarthritis Outcome Score (KOOS), pain intensity, physical function, body mass index (BMI) and visceral fat area (VFA) were measured. Associations to RKOA were analysed with logistic regression (OR).

Results: In all, 13.8% (n=24) developed RKOA in 2 years whereof all had clinical KOA at baseline, as defined by NICE. Deterioration to RKOA was significantly associated with higher BMI, OR 1.119 (95% CI 1.024 to 1.223; p=0.013), and VFA, 1.008 (95% CI 1.000 to 1.016; p=0.049), worse knee pain intensity, 1.238 (95% CI 1.028 to 1.490; p=0.024), worse scores for KOOS Pain, 0.964 (95% CI 0.937 to 0.992; p=0.013) and KOOS Symptoms, 0.967 (95% CI 0.939 to 0.996; p=0.027), KOOS Activities of daily living 0.965 (95% CI 0.935 to 0.996; p=0.026) and KOOS Quality of Life 0.973 (95% CI 0.947 to 0.999; p=0.044), at baseline.

Conclusions: One out of seven individuals with clinical KOA developed RKOA in only 2 years. Baseline variables associated with RKOA after 2 years may possibly be detected early by using the NICE guideline, assessment of obesity and self-reported data of symptoms to support first-line treatment: education, exercise and weight control. © Author(s) (or their employer(s)) 2024.

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: Low health literacy is associated with worse pain and poorer self-management. This study (1) examined the level of health literacy and associations with lifestyle habits, health status, chronic pain, and radiographic knee osteoarthritis; and (2) explored experiences illuminating health literacy among individuals with knee pain.

METHODS: A convergent parallel mixed-methods design was used, including 221 individuals. Health literacy was assessed by HLS-EU-Q16 and eHEALS. The questionnaire included questions on lifestyle habits, health status, and pain distribution. Radiographic knee osteoarthritis was assessed with x-rays. Associations were analysed using logistic regression analyses. Individual semi-structured interviews were conducted (n = 19) and analysed with qualitative content analysis.

RESULTS: The result showed that 71% reported sufficient health literacy. Higher education, healthy lifestyle habits, better general health, and absence of widespread pain were associated with sufficient health literacy. Experiences regarding health literacy influencing the decision-making process toward a decision on action comprised: (1) searching for information actively or passively; (2) processing of the information included being informed, critical, and interpretive; and (3) taking a stand on the information based on trustfulness and motivation.

CONCLUSION: Seven out of 10 reported sufficient health literacy. Despite this, unhealthy lifestyles were common, suggesting that having sufficient HL is not enough for a behavioural change and the decision-making process, including different phases such as searching, processing, and taking a stand on health information is important to consider. More research on health literacy is needed to gain knowledge of how best to develop health promotion in individuals with knee pain. © 2023, BioMed Central Ltd., part of Springer Nature.

Background: There is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA).

Methods: A population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as “healthy” or “unhealthy”, summarized for each patient and stratified into four groups (0–3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis.

Results: Out of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors—more frequently patients with PsA (48%) than AS (39%) or USpA (38%)—and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes.

Conclusion: Reporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health. © 2022, The Author(s).

Physical exercise is a potentially effective treatment for adolescents with mild to moderate depression. However, there is a lack of long-term follow-ups to reveal adolescents’ experiences of exercise as a treatment for depression. The salutogenic concept of sense of coherence (SOC), comprising the domains manageability, comprehensibility, and meaningfulness is important to understand behaviour change. This study aimed to describe adolescents’ long-term experiences of manageability, comprehensibility, and meaningfulness of a group-based exercise intervention for depression. Fourteen adolescents with persistent depression were recruited from a psychiatric outpatient clinic and interviewed one year after participating in a 14-week moderate to vigorous exercise intervention for depression. An abductive qualitative content analysis was conducted, based on the three SOC domains manageability, comprehensibility, and meaningfulness. The results revealed that participation in the intervention was made manageable by a supportive environment, including: the intervention design, togetherness with peer group, and encouragement from adults. The comprehensibility of the intervention emerged through the insights regarding health benefits of exercise and the aim of the intervention. Meaningfulness was achieved through improved health behaviour, well-being and self-esteem, along with strengthened belief in the future and increased commitment to everyday life. The group-based exercise intervention was experienced as manageable, comprehensible, and meaningful. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.