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IRD AS – Improves fatigue

Evidence Summary (Updated 2022)

Fatigue is a frequent symptom in patients with ankylosing spondylitis(1) and can be particularly challenging to manage. There is a strong evidence base that physical activity and exercise interventions can help improve fatigue levels and disease activity scores (2-6). Meta-analyses and systematic reviews consistently show a small to modest improvement in disease activity scores regardless of the physical activity prescription/specific exercise intervention (3-6). Pécourneau et al meta-analysis reported a weighted mean difference (interval) was -0.90 for the BASDAI and -0.72 for the functions score in favour of exercise programs[3].

In psoriatic arthritis (PsA), a recent systematic review conducted by Kessler et al (7) with 13 studies found significant improvements in fatigue. However due to the fact that only aerobic exercise on a bicycle and resistance training were evaluated prospectively, these results could not be generalised to all types of physical activity. In AxSpA the data is more conflicting. Regnaux et al (8) in their systematic review found very low‐quality evidence that showed no important clinically meaningful reduction in fatigue with exercise (MD ‐1.4, 95% CI ‐2.7 to ‐0.1; 2 studies, 72 participants; absolute reduction 14%, 95% CI 27% to 1%). However, a more recent randomised controlled trial published after this SR by Sveaas and colleagues (9) found that in their cohort of patients undertaking high intensity interval training (HIIT), disease symptoms one of which being fatigue was significantly reduced in their treatment group after 3 months. However, caution must be taken with their findings as these HIIT sessions were goal-orientated and specifically guided for patients with axSpA by specialist physiotherapists .

Quality of evidence:
Grade B – Moderate quality evidence in AxSpA and PsA.

Strength of recommendation
Grade 1 – Strong Recommendation for PsA
Grade 2 – Weak Recommendation for AxSpA

Conclusion:

Fatigue is a challenging symptom and there is evidence to suggest for those with psoriatic arthritis, physical activity and exercise interventions can help with these symptoms. Although the recommendation for this is not as strong in AxSpA, high intensity interval training has shown to be promising with short term benefits of improvement in fatigue.

References:

  1. Missaoui B, Revel M. Fatigue in ankylosing spondylitis. Ann Readapt Med Phys. 2006;49(6):305-308, 389-391.
  2. Millner JR, Barron JS, Beinke KM, et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin Arthritis Rheum. 2016;45(4):411-427.
  3. Pécourneau V, Degboé Y, Barnetche T, Cantagrel A, Constantin A, Ruyssen-Witrand A. Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2017.
  4. Saracoglu I, Kurt G, Okur EO, et al. The effectiveness of specific exercise types on cardiopulmonary functions in patients with ankylosing spondylitis: a systematic review. Rheumatol Int. 2017;37(3):409-421.
  5. Martins NA, Furtado GE, Campos MJ, Leitão JC, Filaire E, Ferreira JP. Exercise and ankylosing spondylitis with New York modified criteria: a systematic review of controlled trials with meta-analysis. Acta Reumatol Port. 2014;39(4):298-308.
  6. Sveaas SH, Smedslund G, Hagen KB, Dagfinrud H. Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis. Br J Sports Med. 2017;51(14):1065-1072.
  7. Kessler, J., Chouk, M., Ruban, T. et al. Psoriatic arthritis and physical activity: a systematic review. Clin Rheumatol 40, 4379–4389 (2021). https://doi.org/10.1007/s10067-021-05739-y
  8. Regnaux JP, Davergne T, Palazzo C, Roren A, Rannou F, Boutron I, Lefevre-Colau MM. Exercise programmes for ankylosing spondylitis. Cochrane Database Syst Rev. 2019 Oct 2;10(10):CD011321. doi: 10.1002/14651858.CD011321.pub2. Epub ahead of print. PMID: 31578051; PMCID: PMC6774752.
  9. Sveaas SH, Bilberg A, Berg IJ, et al. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. British Journal of Sports Medicine 2020;54:292-297.