Adherency to exercise and axspa
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Adherence to Exercise in Axial Spondyloarthritis (axSpA)
Introduction to Axial Spondyloarthritis and Exercise
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the axial skeleton, leading to symptoms such as back pain, stiffness, and reduced spinal mobility. Regular exercise is a cornerstone of axSpA management, offering benefits such as reduced disease activity, improved physical function, and enhanced cardiovascular health . However, adherence to exercise recommendations among axSpA patients remains a significant challenge.
Barriers to Exercise Adherence in axSpA Patients
Physical and Psychological Barriers
Several studies have identified common barriers to exercise among axSpA patients. Physical barriers include pain, fatigue, and stiffness, which can discourage patients from engaging in regular physical activity . Psychological barriers such as lack of motivation and fear of exacerbating symptoms also play a crucial role . Additionally, environmental factors like limited access to exercise facilities and lack of family support further hinder adherence.
Social and Environmental Barriers
Social factors, including the perception of being judged while exercising and insufficient encouragement from family members, significantly impact exercise adherence. A study involving 153 axSpA patients highlighted that concerns about appearance in exercise clothes and lack of exercise venues were major deterrents. These findings underscore the need for supportive environments and social encouragement to enhance exercise participation.
Facilitators of Exercise Adherence
Intrinsic Motivation and Symptom Improvement
Intrinsic factors such as personal motivation and the perceived benefits of exercise, including symptom relief and overall health improvement, are strong facilitators of exercise adherence. Patients who recognize the positive impact of exercise on their physical and mental well-being are more likely to maintain regular physical activity routines.
Structured and Supervised Exercise Programs
Structured exercise programs, particularly those supervised by physiotherapists, have shown to significantly improve adherence and outcomes in axSpA patients. A multicenter randomized trial demonstrated that high-intensity exercise programs led to reduced disease activity, improved physical function, and better cardiovascular health . Supervised programs provide the necessary guidance and support, making it easier for patients to adhere to exercise regimens.
Impact of Exercise on Disease Activity and Health Outcomes
High-Intensity Exercise Benefits
High-intensity exercise has been proven to reduce disease activity and inflammation in axSpA patients. Studies have shown significant improvements in disease activity scores (ASDAS and BASDAI), physical function, and cardiovascular health following high-intensity exercise interventions . These findings challenge the misconception that high-intensity exercise might worsen disease symptoms, highlighting its potential as a therapeutic strategy.
Wearable Technology and Exercise Monitoring
The use of wearable devices to monitor physical activity offers an objective measure of adherence and can support the development of personalized exercise interventions. In the SELECT-AXIS 2 trial, wearable devices provided valuable data on physical activity patterns, revealing that lower activity levels were associated with higher disability scores and poorer health status. This technology can help tailor exercise programs to individual needs, enhancing adherence and outcomes.
Conclusion
Adherence to exercise in axSpA patients is influenced by a complex interplay of physical, psychological, social, and environmental factors. Addressing these barriers through intrinsic motivation, supportive environments, and structured exercise programs can significantly improve adherence and health outcomes. High-intensity exercise, in particular, offers substantial benefits in reducing disease activity and improving overall health, making it a crucial component of axSpA management. Future research should continue to explore innovative strategies, including wearable technology, to support and monitor exercise adherence in this patient population.
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