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High-intensity exercise improves fatigue, sleep, and mood in patients with axial spondyloarthritis: secondary analysis of a randomized controlled trial
Sveaas SH, Dagfinrud H, Berg IJ, Provan SA, Johansen MW, Pedersen E, Bilberg A
Physical Therapy 2020 Aug;100(8):1323-1332
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: Although exercise is recommended in the treatment of axial spondyloarthritis (axSpa), the focus has been on flexibility, and the effect of high-intensity exercises is unknown. The purpose of this study was to investigate the effect of high-intensity exercises on fatigue, sleep, and mood in patients with axSpA. METHODS: In this secondary analysis of a randomized controlled trial, participants were recruited from outpatient clinics at 4 hospitals in Scandinavia. One hundred patients with axSpA were randomized to either an exercise group (n = 50) or a control group (n = 50). High-intensity exercise was provided 3 times per week for 3 months, supervised by a physical therapist. The controls received no intervention. Measurements were self-reported at baseline, 3 months, and 12 months: fatigue, using the Fatigue Severity Scale (range 0 to 7, 7 = worst, >= 5 = severe); vitality, using the RAND 36-item short-form health survey (SF-36, range 0 to 100, 100 = best); sleep, using the Pittsburgh Sleep Quality Index (range 0 to 21, 21 = worst, > 5 = poor quality); mood, using the General Health Questionnaire 12 (range 0 to 36, 36 = worst); and general health, using the EUROQoL (range 0 to 100, 100 = best). RESULTS: Thirty-eight (76%) participants in the exercise group followed >= 80% of the exercise protocol. At 3 months, there was a significant beneficial effect on fatigue (mean group differences -0.4, 95% CI -0.7 to -0.1); vitality (5.0, 95% CI 1.1 to 10.5), mood (-2, 95% CI -3.7 to -0.04), and general health (9.0, 95% CI 3.3 to 14.7), but no effect on sleep (-1.1, 95% CI -2.1 to 0.2). When compared with the control group, the exercise group had a reduced rate of severe fatigue and poor sleep. No differences were seen between the groups at 12 months. CONCLUSIONS: A 3-month exercise program had a beneficial effect on fatigue, sleep, mood, and general health in patients with axSpA at the end of the intervention; however, no long-term effects were seen. IMPACT: High intensity cardiorespiratory and strength exercises should be considered as important in exercise programs for patients with axSpA.

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