Detailed guides to painful problems, treatments & more

Effects of exercise therapy in axial spondyloarthritis: A systematic review, meta-analysis and meta-regression of randomized trials

PainSci » bibliography » Zhang et al 2024
updated
Tags: exercise, inflammation, self-treatment, treatment, pain problems

One page on PainSci cites Zhang 2024: STUDY: Exercise eases inflammatory back pain—but why?

PainSci notes on Zhang 2024:

This is an encouraging review of exercise for axial spondyloarthritis, inflammatory pathology of the spine. (This is a whole category of related rheumatic diseases, but it’s mostly about inflammatory back pain and ankylosing spondylitis.)

Zhang et al. reviewed twenty randomized controlled trials of exercise therapy for spondyloarthritis, including 1700 patients, looking at many different outcomes: four different scoring systems, oxygen consumption and chest expansion (because spondyloarthritis often affects the ribcage), two major biomarkers (C-reactive protein and erythrocyte sedimentation rate), and, last but not least, the two most consistent symptoms of inflammation: pain and fatigue.

That’s ten outcomes, and seven of them improved, most of them quite a bit. That’s a fantastic result! Leading to this unstintingly positive conclusion:

“Exercise therapy is an effective strategy for improving disease control and symptom relief in axial spondyloarthritis.”

So what didn’t improve? The two biomarkers for inflammation, and “chest expansion.” CRP and ESR are rather blunt instruments, and it’s possible that they could not detect clinically significant changes in inflammation in the short term.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: This study aimed to assess the effectiveness of exercise therapy for Axial spondyloarthritis (axSpA) patients.

DATA SOURCES: From the database inception to March 2024, we searched PubMed (via Medline), Cochrane Library, Embase, Web of Science, Scopus, and SPORTDiscus for all relevant publications without any language restriction.

STUDY SELECTION: We included randomized controlled trials (RCTs) for axSpA patients in which at least one group received exercise therapy.

DATA EXTRACTION: Two independent reviewers assessed the quality of the literature using the Cochrane Collaboration Risk of Bias Tool 2.0. The outcomes were ankylosing spondylitis (AS) disease activity score (ASDAS), Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index (BASMI), 6-minute walk distance (6MWT), Chest expansion capacity, Peak oxygen consumption (VO2peak), pain, fatigue, C-reactive protein (CRP), and Eythrocyte sedimentation rate (ESR).

DATA SYNTHESIS: A total of 20 RCTs, including 1,670 patients, were included in this study. Compared with the control group, exercise therapy improved BASFI (weighted mean difference [WMD]: -0.49, 95% confidence interval [CI]: -0.65 to -0.32, I2= 3.4%, P=0.414), BASMI (WMD: -0.49, 95% CI: -0.87 to -0.11, I2= 71.9%, P=0.679), BASDAI (WMD: -0.78, 95% CI: -1.08, -0.47, I2=55.9%, P=0.021), ASDAS (WMD: -0.44, 95% CI: -0.64 to -0.24, I2 =0.0%, P=0.424), VO2peak (WMD: 3.16, 95% CI: 1.37 to 4.94, I2=0.0%, P=0.873), 6MWT (WMD: 27.64, 95% CI: 12.04 to 43.24, I2= 0.0%, P=0.922), Pain (standardized mean difference [SMD]: -0.47, 95% CI: -0.74 to -0.21, I2= 66.0%, P=0.046) and Fatigue (SMD: -0.49, 95% CI: -0.71 to -0.27, I2= 0.0%, P=0.446). However, no significant benefit was found in Chest expansion, CRP, and ESR outcomes.

CONCLUSIONS: Exercise therapy is an effective strategy for improving disease control and symptom relief in axSpA.

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher