Background: Patients with arthritis are less likely to adhere to physical activity recommendations than are individuals in the general population. In contrast to rheumatoid arthritis (RA), which affects predominantly peripheral joints, axial spondyloarthritis (axSpA) affects predominantly the axial skeleton and may result in restricted spinal mobility. Both RA and axSpA are associated with an increased risk of cardiovascular disease, the development of physical disability, and decreased levels of physical activity. However, the extent to which the distinct joint distributions in these forms of inflammatory arthritis might differentially affect physical activity behaviors is not known. Several studies have addressed the relationship between “physical activity behavior” and “disease-specific outcomes” among patients with RA, but information about this among patients with axSpA is more limited.
Objectives: To review systematically and synthesize qualitatively the literature about perceived facilitators and barriers to physical activity in patients with axSpA and identify the types of physical activity preferred by these patients.
Methods: PubMed and Scopus and reference lists were searched for quantitative and qualitative studies reporting on beliefs towards exercise in patients with axSpA. Searches were limited to studies published from 2000 through 2018. The PRISMA guidelines were followed. Systematic searches identified 125 publications which underwent a title, abstract, or full-text review. Studies were excluded if articles were not in English or did not include original data. We summarized the methodologic quality using modified criteria for quantitative and qualitative studies.
Results: Eight quantitative and three qualitative studies met eligibility criteria, with variable study quality. Based on self-reported data, 50% to 68% met established physical activity recommendations with walking, swimming/pool exercise, and cycling the most common forms reported. Intrinsic factors such as motivation and improvement in symptoms and health were commonly reported as facilitators associated with physical activity/exercise. Barriers included lack of time, fatigue, and symptoms such as pain.
Conclusion: Up to half of patients with axSpA do not meet established physical activity recommendations. Given the potential for regular physical activity to reduce symptom burden in this patient population and the recent 2018 EULAR recommendations for regular physical activity as part of the management of these patients, more rigorous studies of physical activity behaviors and attitudes will be useful to inform interventions and promote exercise among individuals with axSpA.
References  Ehrlich-Jones L, Lee J, Semanik P, Cox C, Dunlop D, Chang RW. Relationship between beliefs, motivation, and worries about physical activity and physical activity participation in persons with rheumatoid arthritis. Arthritis Care Res 2011;63:1700–1705.
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 Rausch Osthoff A-K, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018:annrheumdis-2018-213585. Available at: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2018-213585.
Acknowledgement: This work was supported by a generous donation from Timothy S. and Elaine L. Peterson.
Disclosure of Interests: Stephen Morais: None declared, Shao-Hsien Liu Grant/research support from: Novartis, Kate Lapane Grant/research support from: Novartis, Merck, Pfizer, Janssen, Consultant for: Pfizer, Jonathan Kay Grant/research support from: Gilead Sciences, Pfizer, UCB Pharma, Consultant for: AbbVie, Boehringer Ingelheim GmbH, Celltrion Healthcare, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals, Pfizer, Samsung Bioepis, Sandoz, UCB Pharma
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