S. De Mits, PT, PhD, Department of Rheumatology, and Smart Space, Ghent University Hospital, Ghent;
T.M. Willems, PT, PhD, P. Calders, PhD, L. Danneels, PT, PhD, Department of Rehabilitation Sciences, Ghent University, Ghent.
J Rheumatol. 2024 Jun 1;51(6):596-602. doi: 10.3899/jrheum.2023-1046.
Although exercise therapy is safe, effective, and recommended as a nonpharmacological treatment for axial spondyloarthritis (axSpA), there is a lack of guidelines regarding type and dosage. Insufficient knowledge about physical and physiological variables makes designing effective exercise programs challenging. Therefore, the goal of this study was to simultaneously assess trunk strength, spinal mobility, and the cardiorespiratory fitness of patients with axSpA.
In a cross-sectional study, 58 patients with axSpA (mean age 40.8 yrs, 50% male, mean symptom duration 10.3 yrs) performed maximal cervical and trunk mobility and isometric strength tests in all planes (using David Back Concept devices) and a maximal cardiopulmonary bicycle exercise test (n = 25). Mobility and strength data were compared to healthy reference data. Cut-off values for clinical cardiopulmonary exercise testing interpretation were used to judge normality. Patients were compared based on radiographic involvement and symptom duration.
Both strength ( ≤ 0.02) and mobility ( ≤ 0.001) were significantly lower for the patients with axSpA compared to the reference. Strength deficits were comparable between the radiographic and nonradiographic groups ( > 0.05, except trunk extension [ = 0.03]), whereas mobility showed higher deficits in the radiographic group (cervical extension [ = 0.02] and rotation [ = 0.01], and trunk extension [ = 0.03] and rotation [ = 0.03]), regardless of symptom duration. Similarly, symptom duration positively affected oxygen pulse ( = 0.03), relative anaerobic threshold ( = 0.02), and aerobic capacity ( = 0.02).
In patients with axSpA, strength is more affected than mobility when compared to healthy controls. Likewise, mainly the metabolic component of aerobic capacity is impaired, affecting cardiopulmonary fitness. These findings indicate that future personalized exercise programs in patients with axSpA should incorporate exercises for cardiopulmonary fitness next to strength and mobility training.
尽管运动疗法安全、有效，并且被推荐作为治疗中轴型脊柱关节炎（axSpA）的非药物治疗方法，但目前缺乏关于运动类型和剂量的指南。由于对身体和生理变量的了解不足，设计有效的运动方案具有挑战性。因此，本研究的目的是同时评估 axSpA 患者的躯干力量、脊柱活动度和心肺功能。
在一项横断面研究中，58 例 axSpA 患者（平均年龄 40.8 岁，50%为男性，平均症状持续时间 10.3 年）在所有平面（使用 David Back Concept 设备）进行最大颈椎和躯干活动度以及等长力量测试，以及最大心肺自行车运动测试（n=25）。将活动度和力量数据与健康参考数据进行比较。使用临床心肺运动测试解释的截断值来判断正常与否。根据放射学受累和症状持续时间对患者进行比较。
axSpA 患者的力量（≤0.02）和活动度（≤0.001）均明显低于参考值。在放射学和非放射学组之间，力量缺陷具有可比性（>0.05，除了躯干伸展[=0.03]），而在放射学组中，活动度缺陷更高（颈椎伸展[=0.02]和旋转[=0.01]，以及躯干伸展[=0.03]和旋转[=0.03]），无论症状持续时间如何。同样，症状持续时间对氧脉搏（=0.03）、相对无氧阈值（=0.02）和有氧能力（=0.02）有积极影响。
与健康对照组相比，axSpA 患者的力量受影响比活动度更大。同样，主要是有氧能力的代谢成分受损，影响心肺功能。这些发现表明，未来 axSpA 患者的个性化运动方案应将心肺功能训练纳入力量和活动度训练之外。
