Exercise Therapy in Patients With Axial Spondyloarthritis

Fasting blood concentration.

Expression of receptors associated with inflammatory activity and stimulated cell inflammatory cytokine release. This will be analysed via flow cytometry.

Using the validated Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The BASDAI consists of a 0-10 score (0 being no problem and 10 being the worst problem) which is used to answer 6 questions on fatigue, spinal pain, joint pain, tenderness, morning stiffness duration, and morning stiffness severity. To give each symptom equal weighting, the mean (average) of the two scores relating to stiffness is taken. The resulting 0 to 50 score is divided by 5 to give a final 0 - 10 BASDAI score. The higher the score, the higher the activity of disease.

Using the validated Bath Ankylosing Spondylitis Functional Index (BASFI). The index assesses the functional limitation in patients with anykylosing spondylitis by asking the patient about symptom burden. The index consists of 10 questions evaluating how hard the patient finds situations i.e 'how difficult is it to put on your socks?' A score of 0 represents easy, and a score of 10 represents impossible. The mean (average) of the 10 questions is used to assign a symptom burden score of 0-10. The higher the score, the higher the symptom burden caused by ankylosing spondylitis.

Using the validated visual analogue scale for spinal pain. The scale consists of a straight line with the end points defining extreme limits 'no spinal pain' and 'spinal pain as bad as it could be'. The line is 10cm in length (0cm point representing no pain, 10cm point representing pain as bad as it could be). A score of 0-10 is given depending on where the patient marks the line (5cm representing a score of 5). The higher the score, the worse the spinal pain.

Using the validated Assessment of SpondyloArthritis Health Index (ASAS-HI). The health index assesses health in patients with spondyloarthritis. The questionnaire asks 17 questions to assess health, with a dichotomous response option: 'I agree' and 'I do not agree'. A score of 1 is given for each 'I agree' response, and a score of 0 is given for each 'I do not agree' response. The lower the total score, the better the overall health status.

Using the validated work productivity and activity impairment questionnaire (WPAI:GH). The questionnaire asks about the effect of health problems on the ability to work and perform regular activities. The questionnaire outcome is expressed as an impairment percentage, with higher numbers indicating greater impairment and less productivity.

All participants will wear an Actigraph activity monitor on their non-dominant wrist to record physical activity for approximately 7 days (+/- 3 days) in the two weeks before the baseline assessment visit to characterise physical activity levels.

The Freedson (1998) activity monitor counts per minute cut points will be used to quantify minutes per day spent sedentary.

All participants will wear an Actigraph activity monitor on their non-dominant wrist to record physical activity for approximately 7 days (+/- 3 days) in the two weeks before the baseline assessment visit to characterise physical activity levels.

The Freedson (1998) activity monitor counts per minute cut points will be used to quantify minutes per day spent in light activity.

All participants will wear an Actigraph activity monitor on their non-dominant wrist to record physical activity for approximately 7 days (+/- 3 days) in the two weeks before the baseline assessment visit to characterise physical activity levels.

The Freedson (1998) activity monitor counts per minute cut points will be used to quantify minutes per day spent in moderate to vigorous physical activity.

Measured from the international physical activity questionnaire (IPAQ). The IPAQ asks 27 questions on physical activity (PA).

Those who score 'high' engage in: 1) vigorous activity on at least 3 days achieving a total PA of at least 1500 metabolic equivalent of task (MET) minutes a week - OR - 2) 7 or more days of any combination of walking, moderate intensity or vigorous intensity activities achieving a minimum total PA of at least 3000 MET minutes per week.

Those who score 'moderate' engage in: 1) 3 or more days of vigorous intensity activity and/or walking of at least 30 minutes per day - OR - 2) 5 or more days of moderate intensity activity and/or walking of at least 30 minutes per day - OR - 3) 5 or more days of any combination of walking, moderate intensity, or vigorous intensity activities achieving a minimum total PA of at least 600 MET minutes per week.

Those who score 'low' do not fit the criteria of either the moderate or high levels of PA.

The participant will walk for 30 minutes on a motorised treadmill at a 1% gradient and at a speed that will elicit a perceived exertion of somewhat hard. The validated rating of perceiving exertion (RPE) scale will be used to quantify RPE. For the 30 minute duration, a combination of heart rate and rating of perceived exertion will be used to quantify exercise tolerance. A rating of perceived exertion of 6 represents no exertion, and a score of 20 represents maximal exertion. The score will be used to assess changes in exercise tolerance during (week 12) and after (week 20) the 12-week home based exercise intervention.

Sit to stand-5 test.

Sit to stand-60 test.

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Kilograms

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Centimetres

mmHg.

mmHg.

Via tanita body composition scales (bio electrical impedance analysis).