High-Intensity Exercise Improves Fatigue, Sleep, and Mood in Patients With Axial Spondyloarthritis: Secondary Analysis of a Randomized Controlled Trial

Silje Halvorsen Sveaas, Hanne Dagfinrud, Inger Jorid Berg, Sella Arrestad Provan, Melissa Woll Johansen, Elisabeth Pedersen, Annelie Bilberg, Silje Halvorsen Sveaas, Hanne Dagfinrud, Inger Jorid Berg, Sella Arrestad Provan, Melissa Woll Johansen, Elisabeth Pedersen, Annelie Bilberg

Abstract

Objective: Although exercise is recommended in the treatment of axial spondyloarthritis (axSpa), the focus has been on flexibility, and the effect of high-intensity exercises is unknown. The purpose of this study was to investigate the effect of high-intensity exercises on fatigue, sleep, and mood in patients with axSpA.

Methods: In this secondary analysis of a randomized controlled trial, participants were recruited from outpatient clinics at 4 hospitals in Scandinavia. A total of 100 patients with axSpA were randomized to either an exercise group (n = 50) or a control group (n = 50). High-intensity exercise was provided 3 times per week for 3 months and supervised by a physical therapist. The controls received no intervention. Measurements were self-reported at baseline, 3 months, and 12 months: fatigue, using the Fatigue Severity Scale (range = 0-7, 7 = worst, ≥5 = severe); vitality, using the RAND 36-item short-form health survey (SF-36, range = 0-100, 100 = best); sleep, using the Pittsburgh Sleep Quality Index (range = 0-21, 21 = worst, >5 = poor quality); mood, using the General Health Questionnaire 12 (range = 0-36, 36 = worst); and general health, using the EUROQoL (range = 0-100, 100 = best).

Results: A total of 38 participants (76%) in the exercise group followed ≥80% of the exercise protocol. At 3 months, there was a significant beneficial effect on fatigue (mean group differences = -0.4, 95% CI = -0.7 to -0.1), vitality (5.0, 95% CI = 1.1 to 10.5), mood (-2, 95% CI = -3.7 to -0.04), and general health (9.0, 95% CI = 3.3 to 14.7) but no effect on sleep (-1.1, 95% CI = -2.1 to 0.2). Compared with the control group, the exercise group had a reduced rate of severe fatigue and poor sleep. No differences were seen between the groups at 12 months.

Conclusions: A 3-month exercise program had a beneficial effect on fatigue, sleep, mood, and general health in patients with axSpA at the end of the intervention; however, no long-term effects were seen.

Impact: High-intensity cardiorespiratory and strength exercises should be considered as important in exercise programs for patients with axSpA.

Trial registration: ClinicalTrials.gov NCT02356874.

© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association.

Figures

Figure 1
Figure 1
Flow of study participants.
Figure 2
Figure 2
Forest plot of the effect of exercise on fatigue, vitality, mood, sleep quality, and perceived general health at 3- and 12-month follow-up. Data are shown as standardized mean difference (SMD, effect sizes) with 95% CI. SMDs between 0.2 and 0.4 are considered a small effect size, from 0.5 to 0.7 a medium effect size, and ≥0.8 a large effect size.

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