Background In ankylosing spondylitis (AS) the chronic inflammatory process mainly affects the axial skeleton with ensuing pain and limitation of thoracic and spinal mobility. Most of the AS patients have the complaint of reduced exercise capacity. Pulmonary function impairment, chest wall restriction, weak respiratory muscle performance, peripheral muscle weakness and deconditioning have been reported as the hypotheses for reduced exercise capacity.
Objectives The aim of this study was to evaluate the effects of inspiratory muscle training on aerobic capacity, pulmonary function and functional status in patients with AS.
Methods A total of 32 patients (18 female, 16 male; mean age: 37.3±10.4 years) were included in this study. The patients were randomized as two groups; Group I consisted of 16 patients, received inspiratory muscle training (IMT) in addition to conventional exercise (CE), Group II consisted of 16 patients, received only CE. All assessments were done before and after the training (8 weeks) for every patient. Standard pulmonary function tests were applied for pulmonary volumes. Maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) were also measured as respiratory muscle strength. Six-minute walk test (6MWT) was used for the assessment of aerobic capacity. For the evaluation of functional status, the Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI) were used. CE training program consisted of 20 exercises: motion and flexibility exercises of the cervical, thoracic, and lumbar spine; stretching of the hamstring muscles, erector spine muscle, and shoulder muscles. IMT training load was based on 50% of the patient's sustained maximum inspiratory pressure. The patients started by performing ten loaded inspiration with a 60 second rest period between each inspiration for three sets in each session. Four sessions of IMT was applied in a day. The exercises were performed as home program for five days per week, 40 minutes per session. Wilcoxan test was used to compare groups.
Results After eight weeks follow-up, patients in Group I had a significant increase in PImax (p=0,000), PEmax (p=0,05), and 6MWT (p=0,041) compared with Group II (p=0,134, p=0,020, p=0,281, respectively). There were no significant differences of spirometric measurements. Comparison of the groups showed significantly superior results for group I in BASDAI (p=0,049).
Conclusions Ankylosing spondylitis patients who performed eight weeks of inspiratory muscle training in addition to conventional exercise training, had an increased respiratory muscle strength, a better aerobic capacity, and disease activity than those who performed conventional exercise only. Inspiratory muscle training should be disseminated with these patients due to advantages.
Dragoi GR, Amaricai E, Dragoi M, Popoviciu H, Avram C. Inspiratory muscle training improves aerobic capacity and pulmonary function in patients with ankylosing spondylitis: A randomized controlled study. 2015 Clinical Rehabilitation, doi: 10.1177/0269215515578292.
Acknowledgements Inspiratory muscle training should be disseminated with these patients due to advantages.
Disclosure of Interest None declared