One-year effectiveness of long-term exercise therapy in people with axial spondyloarthritis and severe functional limitations

Maria A T van Wissen; Cornelia H M van den Ende; Maaike G J Gademan; Max M H Teuwen; Wilfred F Peter; Elien A M Mahler; Dirkjan van Schaardenburg; Floris A van Gaalen; Anneke Spoorenberg; Wilbert B van den Hout; Astrid M van Tubergen; Theodora P M Vliet Vlieland; Salima F E van Weely

doi:10.1093/rheumatology/keae323

One-year effectiveness of long-term exercise therapy in people with axial spondyloarthritis and severe functional limitations

Rheumatology (Oxford). 2025 Apr 1;64(4):1817-1825. doi: 10.1093/rheumatology/keae323.

Authors

Maria A T van Wissen¹, Cornelia H M van den Ende^{2

3}, Maaike G J Gademan^{1

4}, Max M H Teuwen¹, Wilfred F Peter^{1

5}, Elien A M Mahler⁶, Dirkjan van Schaardenburg⁵, Floris A van Gaalen⁷, Anneke Spoorenberg⁸, Wilbert B van den Hout⁹, Astrid M van Tubergen^{10

11}, Theodora P M Vliet Vlieland¹, Salima F E van Weely^{1

12}

Affiliations

¹ Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.
² Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
³ Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
⁴ Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
⁵ Center for Rehabilitation and Rheumatology, Reade, Amsterdam, The Netherlands.
⁶ Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
⁷ Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Department of Rheumatology, University Medical Center Groningen, Groningen, The Netherlands.
⁹ Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
¹⁰ Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
¹¹ Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
¹² Institute of Allied Health Professions, HU University of Applied Sciences, Utrecht, The Netherlands.

Abstract

Objective: To evaluate the effectiveness of long-term, personalized, supervised exercise therapy on functional ability compared with usual care in people with axial spondyloarthritis (axSpA) and severe functional limitations.

Methods: Participants were randomly 1:1 assigned to the intervention [maximal 64 sessions, with 14 additional optional sessions of supervised active exercise therapy (e.g. aerobic and muscle strengthening) with individualized goal-setting, education and self-management regarding physical activity] or usual care (care determined by clinician(s) and participants themselves). Primary endpoint was the change in the Patient-Specific Complaints activity ranked 1 [PSC1 (0-10)] at 52 weeks. Secondary endpoints were the PSC activities ranked 2 and 3, the Bath Ankylosing Spondylitis Functional Index, 6-min walk test, Patient Reported Outcome Measurement Information System-Physical Function-10 and the Short Form-36 Physical and Mental Component Summary Score (SF-36 PCS and MCS). Statistical comparisons comprised independent student t-tests and linear mixed models, based on intention-to-treat.

Results: 214 participants [49% female, age 52 (s.d. 12) years], were randomized to the intervention (n = 110) or usual care (n = 104) group. In the intervention group 93% started treatment, using on average 40.5 sessions (s.d. 15.1). At 52 weeks, the difference in change in PSC1 between groups favoured the intervention group [mean difference (95% CI); -1.8 (-2.4 to -1.2)]. Additionally, all secondary outcomes, except the SF-36 MSC, showed significantly greater improvements in the intervention group with effect sizes ranging from 0.4 to 0.7.

Conclusion: Long-term, supervised exercise therapy proved more effective than usual care in improving functional disability and physical quality of life in people with axSpA and severe functional limitations.

Trial registration: Netherlands Trial Register NL8238, included in the International Clinical Trial Registry Platform (ICTRP) (https://trialsearch.who.int/Trial2.aspx?TrialID=NL8238).

Keywords: exercise; physical function; physical therapy; randomized trial; spondyloarthritis.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Axial Spondyloarthritis* / physiopathology
Axial Spondyloarthritis* / rehabilitation
Axial Spondyloarthritis* / therapy
Exercise Therapy* / methods
Female
Humans
Male
Middle Aged
Patient Reported Outcome Measures
Quality of Life
Severity of Illness Index
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding