Effects of Land- and Water-Based Exercise in Axial Spondyloarthritis
Comparison of the Effects of Land- and Water-Based Exercise on Symptoms and Inflammatory Gene Expression in Individuals With Axial Spondyloarthritis
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease characterized by pain, morning stiffness, restricted spinal mobility, and systemic manifestations. Exercise is an important component of axSpA management and has beneficial effects on pain, disease activity, quality of life, posture, and pulmonary function. Exercise may also modulate inflammatory responses by altering the expression of genes involved in pro- and anti-inflammatory pathways. However, evidence regarding the effects of different exercise environments on inflammatory gene expression in individuals with axSpA remains limited.
Both land-based and aquatic exercise programs are commonly used in the management of axSpA. Aquatic exercise may provide additional advantages through buoyancy and hydrostatic pressure, which reduce joint loading and facilitate exercise performance. Nevertheless, the comparative effects of land-based and aquatic combined exercise programs, particularly on inflammatory biomarkers and gene expression, have not been sufficiently investigated.
The aim of this randomized controlled trial is to compare the effects of land-based and aquatic combined exercise programs on postural control, disease-related outcomes, inflammatory biomarkers and gene expression, disease activity, quality of life, and pulmonary function in individuals with axSpA. Participants will be randomly allocated to a land-based exercise group, an aquatic exercise group, or a control group. Both exercise groups will complete a 45-minute combined program including aerobic, strengthening, and flexibility exercises twice weekly for 8 weeks. The control group will not participate in a structured exercise program and will receive educational videos. Outcomes will be assessed at baseline, immediately after the 8-week intervention, and at the 3-month follow-up.
Studieoversigt
Status
Undersøgelsestype
Tilmelding (Anslået)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
- Navn: Barış Gürpınar, Assoc. Prof
- Telefonnummer: 00902322792525
- E-mail: baris.gurpinar@izmirekonomi.edu.tr
Studiesteder
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-
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Izmir, Tyrkiet (Türkiye)
- Izmir University of Economics
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Kontakt:
- Barış Gürpınar
- Telefonnummer: 00902322792525
- E-mail: baris.gurpinar@izmirekonomi.edu.tr
-
-
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria
- Diagnosis of axial spondyloarthritis (axSpA) according to the Assessment of SpondyloArthritis International Society (ASAS) classification criteria
- Willingness to participate in the study
- BASDAI score between 3 and 4
- Age between 18 and 70 years
- No change in tumor necrosis factor (TNF) inhibitor treatment within the previous 3 months
- No regular cardiorespiratory or strengthening exercise (>1 session/week) during the previous 6 months.
Exclusion Criteria
- Regular exercise participation within the previous 6 months
- Missing 4 consecutive exercise sessions
- Any condition requiring a change in medical treatment
- Presence or identification of other comorbidities that may limit exercise capacity.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Dobbelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
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Eksperimentel: Land-Based Exercise Group
Participants will receive a supervised, land-based combined exercise program twice weekly for 8 weeks. Each session will include warm-up, high-intensity interval aerobic exercise, breathing combined with mobility exercises, strengthening exercises targeting major muscle groups, and cool-down. Exercise intensity will be monitored using heart rate. |
Participants will perform supervised group exercise sessions (3-4 participants per group) twice weekly for 8 weeks. The program will include warm-up, high-intensity interval aerobic exercise, breathing combined with mobility exercises, strengthening exercises, and cool-down. Aerobic training will consist of running in place, with a 5-minute warm-up at 70% intensity, followed by four 4-minute intervals at 90-95% intensity, with 3 minutes of active recovery at 70% intensity between intervals, and a 3-minute cool-down at 70% intensity. Exercise intensity will be monitored using a Polar heart rate monitor, and target heart rate will be calculated using the Karvonen method. Strengthening will include six individually adapted exercises targeting the major muscle groups using elastic bands and/or free weights. Participants will perform 2-3 sets of 8-10 repetitions, with progressive resistance as tolerated. |
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Eksperimentel: Aquatic Exercise Group
Participants will receive a supervised, aquatic combined exercise program twice weekly for 8 weeks in a thermoneutral pool. Each session will include warm-up, high-intensity interval aerobic exercise, breathing combined with mobility exercises, water-resisted strengthening exercises targeting major muscle groups, and cool-down. Exercise intensity will be monitored using heart rate adjusted for water immersion. |
Participants will perform supervised group exercise sessions (3-4 participants per group) twice weekly for 8 weeks in a 120-cm-deep thermoneutral pool. The program will include warm-up, high-intensity interval aerobic exercise, breathing combined with mobility exercises, water-resisted strengthening exercises, and cool-down. Aerobic training will consist of running in place, with a 5-minute warm-up at 70% intensity, followed by four 4-minute intervals at 90-95% intensity, with 3 minutes of active recovery at 70% intensity between intervals, and a 3-minute cool-down at 70% intensity. Exercise intensity will be monitored using a Polar heart rate monitor. Target heart rate will be calculated using the Karvonen method and adjusted for the heart rate response to water immersion. Strengthening exercises will target the major muscle groups using aquatic resistance equipment. Participants will perform 2-3 sets of 8-10 repetitions, with progression achieved by increasing movement speed. |
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Aktiv komparator: Control Group
Participants will receive education on the effects of physical activity and exercise videos based on home exercise recommendations from the National Axial Spondyloarthritis Society (NASS). The materials will be provided online and in MP4 format, and participants will receive monthly text-message reminders encouraging them to continue the recommended exercises. |
Participants will receive education about the effects of physical activity and exercise videos based on home exercise recommendations from the National Axial Spondyloarthritis Society (NASS). Materials will be provided online and in MP4 format. Participants will receive monthly text-message reminders encouraging adherence to the recommended exercises. |
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Disease Activity
Tidsramme: Baseline
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Disease activity will be assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). This index is used to assess disease activity and monitor disease progression and prognosis. The mean of the last two questions is calculated first, and this value is then used together with the scores of the first four questions to calculate the overall mean BASDAI score. The total BASDAI score ranges from 0 to 10, with higher scores indicating greater disease activity and therefore a worse outcome. |
Baseline
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Disease Activity
Tidsramme: at the end of the 8-week intervention
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Disease activity will be assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). This index is used to assess disease activity and monitor disease progression and prognosis. The mean of the last two questions is calculated first, and this value is then used together with the scores of the first four questions to calculate the overall mean BASDAI score. The total BASDAI score ranges from 0 to 10, with higher scores indicating greater disease activity and therefore a worse outcome. |
at the end of the 8-week intervention
|
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Disease Activity
Tidsramme: at 3-month follow-up after completion of the intervention
|
Disease activity will be assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). This index is used to assess disease activity and monitor disease progression and prognosis. The mean of the last two questions is calculated first, and this value is then used together with the scores of the first four questions to calculate the overall mean BASDAI score. The total BASDAI score ranges from 0 to 10, with higher scores indicating greater disease activity and therefore a worse outcome. |
at 3-month follow-up after completion of the intervention
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Inflammatory Cytokine Levels
Tidsramme: Baseline
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Serum levels of IL-6, IL-17, IL-23, IL-10, and TNF-α will be quantitatively measured using enzyme-linked immunosorbent assay (ELISA) and expressed as pg/mL. |
Baseline
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Inflammatory Cytokine Levels
Tidsramme: at the end of the 8-week intervention
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Serum levels of IL-6, IL-17, IL-23, IL-10, and TNF-α will be quantitatively measured using enzyme-linked immunosorbent assay (ELISA) and expressed as pg/mL. |
at the end of the 8-week intervention
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Inflammatory Cytokine Levels
Tidsramme: at 3-month follow-up after completion of the intervention
|
Serum levels of IL-6, IL-17, IL-23, IL-10, and TNF-α will be quantitatively measured using enzyme-linked immunosorbent assay (ELISA) and expressed as pg/mL. |
at 3-month follow-up after completion of the intervention
|
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Inflammation-Related Gene Expression in PBMCs
Tidsramme: Baseline
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Expression levels of 13 inflammation-related genes in peripheral blood mononuclear cells (PBMCs) will be assessed using RT-qPCR. Relative gene expression will be normalized to housekeeping genes and calculated using the 2^-ΔΔCt method, with results expressed as fold change |
Baseline
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Inflammation-Related Gene Expression in PBMCs
Tidsramme: at the end of the 8-week intervention
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Expression levels of 13 inflammation-related genes in peripheral blood mononuclear cells (PBMCs) will be assessed using RT-qPCR. Relative gene expression will be normalized to housekeeping genes and calculated using the 2^-ΔΔCt method, with results expressed as fold change |
at the end of the 8-week intervention
|
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Inflammation-Related Gene Expression in PBMCs
Tidsramme: at 3-month follow-up after completion of the intervention
|
Expression levels of 13 inflammation-related genes in peripheral blood mononuclear cells (PBMCs) will be assessed using RT-qPCR. Relative gene expression will be normalized to housekeeping genes and calculated using the 2^-ΔΔCt method, with results expressed as fold change |
at 3-month follow-up after completion of the intervention
|
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BASFI - Functional Status
Tidsramme: Baseline
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Functional status will be assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), a 10-item questionnaire assessing physical function and the ability to cope with activities of daily living. Each item is scored from 0 (easy) to 10 (impossible), with higher scores indicating greater functional impairment. |
Baseline
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BASFI - Functional Status
Tidsramme: at the end of the 8-week intervention
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Functional status will be assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), a 10-item questionnaire assessing physical function and the ability to cope with activities of daily living. Each item is scored from 0 (easy) to 10 (impossible), with higher scores indicating greater functional impairment. |
at the end of the 8-week intervention
|
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BASFI - Functional Status
Tidsramme: at 3-month follow-up after completion of the intervention
|
Functional status will be assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), a 10-item questionnaire assessing physical function and the ability to cope with activities of daily living. Each item is scored from 0 (easy) to 10 (impossible), with higher scores indicating greater functional impairment. |
at 3-month follow-up after completion of the intervention
|
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BASMI - Spinal Mobility
Tidsramme: Baseline
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Spinal mobility will be assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI), which includes cervical rotation, tragus-to-wall distance, lateral lumbar flexion, anterior lumbar flexion, and intermalleolar distance. Lower scores indicate better spinal mobility. |
Baseline
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BASMI - Spinal Mobility
Tidsramme: at the end of the 8-week intervention
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Spinal mobility will be assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI), which includes cervical rotation, tragus-to-wall distance, lateral lumbar flexion, anterior lumbar flexion, and intermalleolar distance. Lower scores indicate better spinal mobility. |
at the end of the 8-week intervention
|
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BASMI - Spinal Mobility
Tidsramme: at 3-month follow-up after completion of the intervention
|
Spinal mobility will be assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI), which includes cervical rotation, tragus-to-wall distance, lateral lumbar flexion, anterior lumbar flexion, and intermalleolar distance. Lower scores indicate better spinal mobility. |
at 3-month follow-up after completion of the intervention
|
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Static Postural Balance
Tidsramme: Baseline
|
Static postural balance will be assessed using KINVENT force plates. Participants will stand as still and upright as possible for 10 seconds with eyes open and feet in a comfortable position. The test will be repeated three times, and the trial with the best postural sway performance will be used. Mean center of pressure (CoP) velocity will be recorded. |
Baseline
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Static Postural Balance
Tidsramme: at the end of the 8-week intervention
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Static postural balance will be assessed using KINVENT force plates. Participants will stand as still and upright as possible for 10 seconds with eyes open and feet in a comfortable position. The test will be repeated three times, and the trial with the best postural sway performance will be used. Mean center of pressure (CoP) velocity will be recorded. |
at the end of the 8-week intervention
|
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Static Postural Balance
Tidsramme: at 3-month follow-up after completion of the intervention
|
Static postural balance will be assessed using KINVENT force plates. Participants will stand as still and upright as possible for 10 seconds with eyes open and feet in a comfortable position. The test will be repeated three times, and the trial with the best postural sway performance will be used. Mean center of pressure (CoP) velocity will be recorded. |
at 3-month follow-up after completion of the intervention
|
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Pulmonary Function-FEV1
Tidsramme: Baseline
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEV1 will be recorded as applicable in absolute values and/or percentage of predicted values |
Baseline
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Pulmonary Function-FEV1
Tidsramme: at the end of the 8-week intervention
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Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEV1 will be recorded as applicable in absolute values and/or percentage of predicted values |
at the end of the 8-week intervention
|
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Pulmonary Function-FVC
Tidsramme: baseline
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Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FVC will be recorded as applicable in absolute values and/or percentage of predicted values |
baseline
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Leg Muscle Strength
Tidsramme: Baseline
|
Leg muscle strength will be assessed using a back-leg dynamometer. Participants will perform a maximal leg extension effort with the knees positioned at approximately 130-140° of flexion. Three measurements will be performed, and the mean value will be recorded in kilograms (kg). |
Baseline
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Leg Muscle Strength
Tidsramme: at the end of the 8-week intervention
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Leg muscle strength will be assessed using a back-leg dynamometer. Participants will perform a maximal leg extension effort with the knees positioned at approximately 130-140° of flexion. Three measurements will be performed, and the mean value will be recorded in kilograms (kg). |
at the end of the 8-week intervention
|
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Leg Muscle Strength
Tidsramme: at 3-month follow-up after completion of the intervention
|
Leg muscle strength will be assessed using a back-leg dynamometer. Participants will perform a maximal leg extension effort with the knees positioned at approximately 130-140° of flexion. Three measurements will be performed, and the mean value will be recorded in kilograms (kg). |
at 3-month follow-up after completion of the intervention
|
|
Back Muscle Strength
Tidsramme: Baseline
|
Back muscle strength will be assessed using a back-leg dynamometer. Participants will perform a maximal strength effort according to the standardized dynamometer testing procedure. Three measurements will be performed, and the mean value will be recorded in kilograms (kg). |
Baseline
|
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Back Muscle Strength
Tidsramme: at the end of the 8-week intervention
|
Back muscle strength will be assessed using a back-leg dynamometer. Participants will perform a maximal strength effort according to the standardized dynamometer testing procedure. Three measurements will be performed, and the mean value will be recorded in kilograms (kg). |
at the end of the 8-week intervention
|
|
Back Muscle Strength
Tidsramme: at 3-month follow-up after completion of the intervention
|
Back muscle strength will be assessed using a back-leg dynamometer. Participants will perform a maximal strength effort according to the standardized dynamometer testing procedure. Three measurements will be performed, and the mean value will be recorded in kilograms (kg). |
at 3-month follow-up after completion of the intervention
|
|
ASQoL - Quality of Life
Tidsramme: Baseline
|
Quality of life will be assessed using the 18-item Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Each item is answered "yes" (1 point) or "no" (0 points), yielding a total score ranging from 0 to 18. Higher scores indicate poorer quality of life. |
Baseline
|
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ASQoL - Quality of Life
Tidsramme: at the end of the 8-week intervention
|
Quality of life will be assessed using the 18-item Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Each item is answered "yes" (1 point) or "no" (0 points), yielding a total score ranging from 0 to 18. Higher scores indicate poorer quality of life. |
at the end of the 8-week intervention
|
|
ASQoL - Quality of Life
Tidsramme: at 3-month follow-up after completion of the intervention
|
Quality of life will be assessed using the 18-item Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Each item is answered "yes" (1 point) or "no" (0 points), yielding a total score ranging from 0 to 18. Higher scores indicate poorer quality of life. |
at 3-month follow-up after completion of the intervention
|
|
Pulmonary Function-FEV1
Tidsramme: at 3-month follow-up after completion of the intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEV1 will be recorded as applicable in absolute values and/or percentage of predicted values |
at 3-month follow-up after completion of the intervention
|
|
Pulmonary Function-FVC
Tidsramme: at the end of the 8-week intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FVC will be recorded as applicable in absolute values and/or percentage of predicted values |
at the end of the 8-week intervention
|
|
Pulmonary Function-FVC
Tidsramme: at 3-month follow-up after completion of the intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FVC will be recorded as applicable in absolute values and/or percentage of predicted values |
at 3-month follow-up after completion of the intervention
|
|
Pulmonary Function-FEV1/FVC
Tidsramme: Baseline
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEV1/FVC will be recorded as applicable in absolute values and/or percentage of predicted values |
Baseline
|
|
Pulmonary Function-FEV1/FVC
Tidsramme: at the end of the 8-week intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEV1/FVC will be recorded as applicable in absolute values and/or percentage of predicted values |
at the end of the 8-week intervention
|
|
Pulmonary Function-FEV1/FVC
Tidsramme: at 3-month follow-up after completion of the intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEV1/FVC will be recorded as applicable in absolute values and/or percentage of predicted values |
at 3-month follow-up after completion of the intervention
|
|
Pulmonary Function-PEF
Tidsramme: Baseline
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. PEF will be recorded as applicable in absolute values and/or percentage of predicted values |
Baseline
|
|
Pulmonary Function-PEF
Tidsramme: at the end of the 8-week intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. PEF will be recorded as applicable in absolute values and/or percentage of predicted values |
at the end of the 8-week intervention
|
|
Pulmonary Function-PEF
Tidsramme: at 3-month follow-up after completion of the intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. PEF will be recorded as applicable in absolute values and/or percentage of predicted values |
at 3-month follow-up after completion of the intervention
|
|
Pulmonary Function-FEF25-75%
Tidsramme: Baseline
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEF25-75% will be recorded as applicable in absolute values and/or percentage of predicted values |
Baseline
|
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Pulmonary Function-FEF25-75%
Tidsramme: at the end of the 8-week intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEF25-75% will be recorded as applicable in absolute values and/or percentage of predicted values |
at the end of the 8-week intervention
|
|
Pulmonary Function-FEF25-75%
Tidsramme: at 3-month follow-up after completion of the intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. FEF25-75% will be recorded as applicable in absolute values and/or percentage of predicted values |
at 3-month follow-up after completion of the intervention
|
|
Pulmonary Function-vital capacity (VC)
Tidsramme: Baseline
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. Vital capacity (VC) will be recorded as applicable in absolute values and/or percentage of predicted values |
Baseline
|
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Pulmonary Function-vital capacity (VC)
Tidsramme: at the end of the 8-week intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. Vital capacity (VC) will be recorded as applicable in absolute values and/or percentage of predicted values |
at the end of the 8-week intervention
|
|
Pulmonary Function-vital capacity (VC)
Tidsramme: at 3-month follow-up after completion of the intervention
|
Pulmonary function will be assessed using a portable spirometer (MIR Spirobank II) according to ATS/ERS criteria. Vital capacity (VC) will be recorded as applicable in absolute values and/or percentage of predicted values |
at 3-month follow-up after completion of the intervention
|
Samarbejdspartnere og efterforskere
Sponsor
Samarbejdspartnere
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Primær færdiggørelse (Anslået)
Studieafslutning (Anslået)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- İEU_SYY_7
Plan for individuelle deltagerdata (IPD)
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IPD-planbeskrivelse
IPD will not be shared due to ethical and participant confidentiality considerations.
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