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CAMBRIDGE, MASS. – , according to Angelo Papachristos, an advanced physiotherapist at St. Michaels Hospital in Toronto.
Speaking in an education session at the annual meeting of the Spondyloarthritis Research and Treatment Network (SPARTAN), Mr. Papachristos said that therapy should be introduced at diagnosis, individualized, and constantly reevaluated.
“There is no one recommendation,” he said. “Therapy should be monitored and adjusted over time depending on how the patient responds.”
Mr. Papachristos drew attention to two portions of recommendations from the American College of Sports Medicine (ACSM).
First, that scientific evidence demonstrates that the beneficial effects of exercise are indisputable and that the benefits far outweigh the risks.
Second, that a program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor aspects to improve and maintain fitness and health is essential for most adults.
How much exercise to prescribe and when to introduce exercise remains a question.
The ACSM recommends moderate-intensity cardiovascular exercise for 30 minutes or more each day or 150 minutes per week, resistance training, neuromotor exercise, and flexibility training at least twice each week.
In a 2011 literature review published in Arthritis Care & Research, researchers analyzed 12 studies (826 total patients) to find out if exercise had actual potential for patients with ankylosing spondylitis. They used three criteria: whether the programs were designed using ACSM recommendations, if/how physiological responses were measured, and whether adherence to programs was monitored.
Of the 12 trials, 5 included cardiovascular exercise, 5 included strength training, 11 included flexibility, and 4 reported program adherence.
Only one trial met ACSM recommendations for intensity, duration, frequency, and length of exercise period. That trial showed the greatest improvement in aerobic capacity (Arthritis Car Res. 2011 Apr;63[4]:597-603).
“The literature isn’t impressive,” said Mr. Papachristos. “But, that’s because it isn’t uniform. No specific protocol is being followed.”
He compared what he believes is happening with what he believes to be a better alternative.
What he calls the hit-them-with-everything approach includes diagnosis, NSAIDs, biologics, smoking cessation at the same time as exercise that includes posture, swimming, strength, and aerobic conditioning. According to Mr. Papachristos, this approach can lead to patient burnout.
Indeed, research from 2010 published in the Journal of Rheumatology showed that 40% of patients with ankylosing spondylitis said that exercise takes too much time, 60% said that exercise is hard work, 60% reported being fatigued by exercise, and 20% said that their family members did not encourage exercise (J Rheumatol. 2010 Mar 1. doi: 10.3899/jrheum.090655).
To combat burnout and improve patient outcomes, Mr. Papachristos suggested an alternative approach whereby patients would begin with diagnosis and medication, but disease education and a baseline fitness assessment would also be a priority. The first 6-9 months following diagnosis would then be used to evaluate a patient’s home and work/school ergonomic situation to assess needs. During this time, the patient would be introduced to basic exercises for range of motion and flexibility. Throughout this approach, the patient would be consistently reevaluated and, if appropriate, would slowly ramp up exercise efforts. At 12 months, the patients could graduate to core cervical and lumbar strength before reaching cardiovascular and sports recreation at 12-18 months following diagnosis.
Mr. Papachristos concluded that the coordination between physical therapist, primary care provider, and rheumatologist is of the utmost importance.
“It’s just like anything else – if we’re all on the same page, it’s better for the patient,” he said. “Patients should be encouraged on lifestyle and wellness management with the goal of lifelong regular exercise.”
Mr. Papachristos reported having no disclosures.
CAMBRIDGE, MASS. – , according to Angelo Papachristos, an advanced physiotherapist at St. Michaels Hospital in Toronto.
Speaking in an education session at the annual meeting of the Spondyloarthritis Research and Treatment Network (SPARTAN), Mr. Papachristos said that therapy should be introduced at diagnosis, individualized, and constantly reevaluated.
“There is no one recommendation,” he said. “Therapy should be monitored and adjusted over time depending on how the patient responds.”
Mr. Papachristos drew attention to two portions of recommendations from the American College of Sports Medicine (ACSM).
First, that scientific evidence demonstrates that the beneficial effects of exercise are indisputable and that the benefits far outweigh the risks.
Second, that a program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor aspects to improve and maintain fitness and health is essential for most adults.
How much exercise to prescribe and when to introduce exercise remains a question.
The ACSM recommends moderate-intensity cardiovascular exercise for 30 minutes or more each day or 150 minutes per week, resistance training, neuromotor exercise, and flexibility training at least twice each week.
In a 2011 literature review published in Arthritis Care & Research, researchers analyzed 12 studies (826 total patients) to find out if exercise had actual potential for patients with ankylosing spondylitis. They used three criteria: whether the programs were designed using ACSM recommendations, if/how physiological responses were measured, and whether adherence to programs was monitored.
Of the 12 trials, 5 included cardiovascular exercise, 5 included strength training, 11 included flexibility, and 4 reported program adherence.
Only one trial met ACSM recommendations for intensity, duration, frequency, and length of exercise period. That trial showed the greatest improvement in aerobic capacity (Arthritis Car Res. 2011 Apr;63[4]:597-603).
“The literature isn’t impressive,” said Mr. Papachristos. “But, that’s because it isn’t uniform. No specific protocol is being followed.”
He compared what he believes is happening with what he believes to be a better alternative.
What he calls the hit-them-with-everything approach includes diagnosis, NSAIDs, biologics, smoking cessation at the same time as exercise that includes posture, swimming, strength, and aerobic conditioning. According to Mr. Papachristos, this approach can lead to patient burnout.
Indeed, research from 2010 published in the Journal of Rheumatology showed that 40% of patients with ankylosing spondylitis said that exercise takes too much time, 60% said that exercise is hard work, 60% reported being fatigued by exercise, and 20% said that their family members did not encourage exercise (J Rheumatol. 2010 Mar 1. doi: 10.3899/jrheum.090655).
To combat burnout and improve patient outcomes, Mr. Papachristos suggested an alternative approach whereby patients would begin with diagnosis and medication, but disease education and a baseline fitness assessment would also be a priority. The first 6-9 months following diagnosis would then be used to evaluate a patient’s home and work/school ergonomic situation to assess needs. During this time, the patient would be introduced to basic exercises for range of motion and flexibility. Throughout this approach, the patient would be consistently reevaluated and, if appropriate, would slowly ramp up exercise efforts. At 12 months, the patients could graduate to core cervical and lumbar strength before reaching cardiovascular and sports recreation at 12-18 months following diagnosis.
Mr. Papachristos concluded that the coordination between physical therapist, primary care provider, and rheumatologist is of the utmost importance.
“It’s just like anything else – if we’re all on the same page, it’s better for the patient,” he said. “Patients should be encouraged on lifestyle and wellness management with the goal of lifelong regular exercise.”
Mr. Papachristos reported having no disclosures.
CAMBRIDGE, MASS. – , according to Angelo Papachristos, an advanced physiotherapist at St. Michaels Hospital in Toronto.
Speaking in an education session at the annual meeting of the Spondyloarthritis Research and Treatment Network (SPARTAN), Mr. Papachristos said that therapy should be introduced at diagnosis, individualized, and constantly reevaluated.
“There is no one recommendation,” he said. “Therapy should be monitored and adjusted over time depending on how the patient responds.”
Mr. Papachristos drew attention to two portions of recommendations from the American College of Sports Medicine (ACSM).
First, that scientific evidence demonstrates that the beneficial effects of exercise are indisputable and that the benefits far outweigh the risks.
Second, that a program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor aspects to improve and maintain fitness and health is essential for most adults.
How much exercise to prescribe and when to introduce exercise remains a question.
The ACSM recommends moderate-intensity cardiovascular exercise for 30 minutes or more each day or 150 minutes per week, resistance training, neuromotor exercise, and flexibility training at least twice each week.
In a 2011 literature review published in Arthritis Care & Research, researchers analyzed 12 studies (826 total patients) to find out if exercise had actual potential for patients with ankylosing spondylitis. They used three criteria: whether the programs were designed using ACSM recommendations, if/how physiological responses were measured, and whether adherence to programs was monitored.
Of the 12 trials, 5 included cardiovascular exercise, 5 included strength training, 11 included flexibility, and 4 reported program adherence.
Only one trial met ACSM recommendations for intensity, duration, frequency, and length of exercise period. That trial showed the greatest improvement in aerobic capacity (Arthritis Car Res. 2011 Apr;63[4]:597-603).
“The literature isn’t impressive,” said Mr. Papachristos. “But, that’s because it isn’t uniform. No specific protocol is being followed.”
He compared what he believes is happening with what he believes to be a better alternative.
What he calls the hit-them-with-everything approach includes diagnosis, NSAIDs, biologics, smoking cessation at the same time as exercise that includes posture, swimming, strength, and aerobic conditioning. According to Mr. Papachristos, this approach can lead to patient burnout.
Indeed, research from 2010 published in the Journal of Rheumatology showed that 40% of patients with ankylosing spondylitis said that exercise takes too much time, 60% said that exercise is hard work, 60% reported being fatigued by exercise, and 20% said that their family members did not encourage exercise (J Rheumatol. 2010 Mar 1. doi: 10.3899/jrheum.090655).
To combat burnout and improve patient outcomes, Mr. Papachristos suggested an alternative approach whereby patients would begin with diagnosis and medication, but disease education and a baseline fitness assessment would also be a priority. The first 6-9 months following diagnosis would then be used to evaluate a patient’s home and work/school ergonomic situation to assess needs. During this time, the patient would be introduced to basic exercises for range of motion and flexibility. Throughout this approach, the patient would be consistently reevaluated and, if appropriate, would slowly ramp up exercise efforts. At 12 months, the patients could graduate to core cervical and lumbar strength before reaching cardiovascular and sports recreation at 12-18 months following diagnosis.
Mr. Papachristos concluded that the coordination between physical therapist, primary care provider, and rheumatologist is of the utmost importance.
“It’s just like anything else – if we’re all on the same page, it’s better for the patient,” he said. “Patients should be encouraged on lifestyle and wellness management with the goal of lifelong regular exercise.”
Mr. Papachristos reported having no disclosures.
REPORTING FROM SPARTAN