| 1. |
- Bilberg, Annelie, 1965, et al.
(författare)
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How Do Patients With Axial Spondyloarthritis Experience High-Intensity Exercise?
- 2020
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Ingår i: ACR open rheumatology. - : Wiley. - 2578-5745. ; 2:4, s. 207-213
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Tidskriftsartikel (refereegranskat)abstract
- In a few studies, high-intensity exercise has displayed beneficial effects on cardiovascular health among patients with rheumatic diseases, yet the high-intensity exercise mode is still not fully accepted among health care professionals. The aim of this study was to investigate experiences of high-intensity exercise among patients with axial spondyloarthritis.Fourteen respondents who had participated in a high-intensity exercise program for 12 weeks were included in this qualitative study with individual semistructured, in-depth interviews. The respondents' median age was 53, ranging from 23 to 63 years old, and both men and women of different ethnicities were represented. Interviews were analyzed by qualitative content analysis, including both manifest content and interpretations of underlying latent meaning.The analysis resulted in five categories describing the respondents' experiences with high-intensity exercise: 1) high-intensity exercise as a challenge for both body and mind, 2) increased faith in one's own body, 3) changed attitude toward exercise, 4) taking charge of one's own health by challenging the disease, and 5) exercise in a social context.Supervised high-intensity interval exercise was perceived as challenging for both body and mind but was also described as a positive experience, with rapid bodily effects that strengthened respondents' faith in their own bodies. The new experience seemed to have changed the respondents' attitude and motivation for exercise and made them start taking charge of their health by challenging the disease. Exercise in a social context, under professional leadership, enhanced exercise self-efficacy and helped the respondents to adhere to the exercise program.
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| 2. |
- Bilberg, Annelie, 1965, et al.
(författare)
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Supervised Intensive Exercise for Strengthening Exercise Health Beliefs in Patients With Axial Spondyloarthritis: A Multicenter Randomized Controlled Trial
- 2022
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Ingår i: Arthritis Care & Research. - : Wiley. - 2151-464X .- 2151-4658. ; 74:7, s. 1196-1204
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the effect of a 3-month supervised high-intensity exercise program on exercise health beliefs in patients with axial spondyloarthritis. Methods This was secondary analysis of a randomized controlled trial. Participants (ages 23-69 years) were randomized to an exercise group (n = 50) or a control group (n = 50). The intervention was an individually guided cardiorespiratory and strength exercise program performed 2 times per week, plus an additional individual exercise session of personal choice. The control group received standard care and instructions to maintain their physical activity level. Exercise health beliefs using the Exercise Health Beliefs questionnaire (range 20-100, 100 = best), i.e., barriers, benefits, self-efficacy and exercise impact on arthritis, and physical activity, were assessed with self-reported questionnaires at baseline, 3 months, and 12 months after inclusion. Results The majority of the participants in the exercise group (76%) followed >= 80% of the prescribed exercise protocol. There was a significant effect of the intervention on exercise health beliefs at 3 months (estimated mean group differences 4.0 [95% confidence interval (95% CI) 1.4, 6.6]; P = 0.003) and the effect persisted at 12 months follow-up (estimated mean group differences 3.8 [95% CI 1.0, 6.6]; P = 0.008). Participants with higher exercise health beliefs had a higher odds ratio (1.1 [95% CI 1.0, 1.20]; P = 0.003) for being physically active at 12 months follow-up. Conclusion A supervised high-intensity exercise program had beneficial short- and long-term effects on participants' exercise health beliefs. Stronger exercise health beliefs were positively associated with a higher chance to be physically active on a health-enhancing level at 12 months follow-up.
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| 3. |
- Bilberg, Annelie, 1965, et al.
(författare)
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The impact of a structured weight-loss treatment on physical fitness in patients with psoriatic arthritis and obesity compared to matched controls: a prospective interventional study
- 2022
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Ingår i: Clinical Rheumatology. - : Springer Science and Business Media LLC. - 0770-3198 .- 1434-9949. ; 41, s. 2745-2754
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate the effects of weight loss treatment on physical fitness in patients with psoriatic arthritis (PsA) and obesity compared to matched controls. Methods: In total, 46 patients with PsA (CASPAR) and BMI >= 33 kg/m(2) and 52 obese persons were included in this 12-month prospective open intervention study with a very low energy diet (640 kcal/day), followed by structured reintroduction of an energy-restricted diet and brief support for physical activity. The primary outcome was muscle strength assessed with hand-grip strength (Grippit) and leg muscle strength (timed stand test). Secondary outcomes were cardiorespiratory fitness, body composition, and physical functioning (SF-36PCS). Outcomes were assessed at baseline, 6 (M6), and 12 months (M12). Nonparametric statistics were used. Results: Median weight reduction at M6 was 18.9 kg in patients and 23.0 kg in controls, (p = 0.546). At M12, patients' median weight loss from baseline was 16.1 kg, corresponding with significant loss of total fat mass (- 30.1%), and lean mass (total - 7.0%, arm - 13.7%, and leg - 6.0%). Leg muscle strength improved in patients and controls at M6 (p < 0.001) and remained improved at M12 (p < 0.01), while hand-grip strength was unchanged in both groups. Cardiorespiratory fitness increased in controls at M6 (p = 0.018) and M12 (p = 0.028) but not in patients. Physical functioning improved in both groups at M6 (p < 0.001) and remained improved at M12 (p = 0.008) and (p < 0.01), respectively. Conclusion: The intervention resulted in positive effects on body weight and total body fat. Despite reduced lean body mass, the muscle strength did not deteriorate in patients with PsA and controls.
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| 4. |
- Fongen, C., et al.
(författare)
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Reduced sleep quality is highly prevalent and associated with physical function and cardiorespiratory fitness in patients with axial spondyloarthritis: a cross-sectional study
- 2024
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Ingår i: Scandinavian Journal of Rheumatology. - 0300-9742 .- 1502-7732. ; 53:2, s. 130-139
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To assess sleep quality, and its associations with physical function, cardiorespiratory fitness, and spinal mobility, in axial spondyloarthritis (axSpA) patients. Method: Baseline data from the Exercise for Spondyloarthritis trial were used. Assessments included [Pittsburgh Sleep Quality Index (PSQI), 0–21, 21=worst], performance-based physical function [Ankylosing Spondylitis Performance Index (ASPI), seconds, higher=worse], patient-reported physical function [Bath Ankylosing Spondylitis Functional Index (BASFI), 0–10, 10=worst], cardiorespiratory fitness [peak oxygen uptake ((Formula presented.) O2peak), mL/kg/min, lower=worse], and spinal mobility [Bath Ankylosing Spondylitis Metrology Index (BASMI), 0–10, 10=worst]. Associations were examined in separate models using multiple linear regression. Results: Ninety-nine patients with axSpA were included, 53% female, mean age 46years, and 72% with high disease activity (ASDAS-C-reactive protein ≥2.1), of whom 84 (85%) had reduced sleep quality. Sleep disturbance was most frequently reported (65%), followed by poor subjective sleep quality (53%), daytime dysfunction (41%), and increased sleep latency (41%). Positive associations were observed between PSQI and ASPI [β=0.10, 95% confidence interval (CI) 0.01, 0.19] and PSQI and BASFI (β=0.85, 95% CI 0.51, 1.20), and there was an inverse association between PSQI and (Formula presented.) O2peak (β=−0.14, 95% CI −0.27, −0.01), adjusted for age and sex. There was no association between PSQI and BASMI. Conclusion: Reduced sleep quality was common in axSpA patients with moderate to high disease activity. Better sleep quality was associated with better physical function and higher cardiorespiratory fitness. There was no association between sleep quality and spinal mobility. Trial registration: ClinicalTrials.gov NCT02356874.
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| 5. |
- Fongen, Camilla, et al.
(författare)
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Responsiveness and Interpretability of 2 Measures of Physical Function in Patients With Spondyloarthritis.
- 2020
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Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 100:4, s. 728-738
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Tidskriftsartikel (refereegranskat)abstract
- Maintenance or improvement of physical function is an important treatment target in the management of patients with axial spondyloarthritis (axSpA); measurement tools that can detect changes in physical function are therefore important.The objective of this study was to compare responsiveness and interpretability of the patient reported Bath Ankylosing Spondylitis (AS) Functional Index (BASFI) and the AS performed based Improvement (ASPI) in measuring change in physical function after exercise in patients with axSpA.This was a sub-study of 58 patients nested within a randomized controlled trial comparing the effect of 12-weeks exercise with usual care.Responsiveness and interpretability was assessed according to the Consensus-based Standards for the selection of health status Measurement Instrument (COSMIN). Responsiveness was assessed by testing eight predefined hypotheses for ASPI and BASFI. Interpretability was assessed by (1) using patients' reported change as an anchor ("a little better" = minimal important change [MIC]) and (2) by categorizing patients with a 20% improvement as responders.For ASPI and BASFI; 5 of 8 (63%) vs. 2 of 8 (25%), of the predefined hypotheses for responsiveness were confirmed. The MIC values for improvement in physical function were 3.7sec in ASPI and 0.8 points (on a scale from 0-10) for BASFI. In the intervention group, 21 of 30 (70%) and 13 of 30 (43%) of the patients were categorized as responders measured with ASPI and BASFI, respectively. There was a tendency towards a floor effect in BASFI, as 8 of 58 (14%) patients scored the lowest value at baseline.This study was limited by its moderate sample size.Our findings suggest that ASPI is preferable over BASFI when evaluating physical function after exercise interventions in patients with axSpA.
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| 6. |
- Klingberg, Eva, et al.
(författare)
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Weight loss is associated with sustained improvement of disease activity and cardiovascular risk factors in patients with psoriatic arthritis and obesity: a prospective intervention study with two years of follow-up
- 2020
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obesity is overrepresented in patients with psoriatic arthritis (PsA) and associated with increased disease activity. We have previously shown in 41 patients with PsA (Caspar criteria) and obesity (body mass index; BMI >= 33 kg/m(2)) that weight loss treatment with Very Low Energy Liquid Diet (VLED), 640 kcal/day during 12-16 weeks, followed by a structured reintroduction of an energy restricted diet resulted in a median weight loss of 18.6% and concomitantly a significant improvement of the disease activity in joints, entheses and skin. The objectives of this follow-up were to study the effects of the weight loss treatment on disease activity in longer term (12 and 24 months) and to study the effects on cardiovascular risk factors. Methods: The patients were assessed with 66/68 joints count, Leeds enthesitis index (LEI), body surface area, blood pressure, BMI, questionnaires and fasting blood samples at the 12- and 24-month visits. Results: In total, 39 and 35 PsA patients attended the 12- and the 24-month visits, respectively. Median weight loss since baseline was 16.0% (IQR 10.5-22.4) and 7.4% (IQR 5.1-14.0) at the 12- and 24-months follow-up. The 66/68 swollen/tender joints score, LEI, CRP and HAQ score were still significantly reduced at the 12- and 24-month visits compared to baseline. The number of patients with Minimal Disease Activity increased from 28.2% (11/39) at baseline, to 38.5% (15/39;p = 0.008) and 45.7% (16/35;p = 0.016) at the 12- and 24-month visits. The weight loss was also associated with improved levels of serum lipids, glucose and urate and the antihypertensive treatment was reduced or stopped in five patients during the follow-up. Conclusions: Weight loss treatment, with VLED included in the program, was associated with long-term improvement of measures of disease activity, self-reported function and markers of the metabolic syndrome after 24-months follow-up.
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| 7. |
- Landgren, Anton J., 1989, et al.
(författare)
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Cardiovascular risk factors are highly overrepresented in Swedish patients with psoriatic arthritis compared with the general population.
- 2020
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Ingår i: Scandinavian journal of rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 49:3, s. 195-99
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We aimed to determine the prevalence of cardiovascular risk factors in patients with psoriatic arthritis (PsA) followed at a large Swedish Rheumatology Clinic, and to compare differences in cardiovascular risk factors between men and women with PsA and with the general population. Method: A questionnaire was sent to patients with PsA registered at the Rheumatology Clinic at Sahlgrenska University Hospital, Gothenburg (n=982). Comparisons with the general population were made using data from the Swedish National Public Health Survey. Descriptive statistics are presented. Body mass index (BMI) was calculated using self-reported height and weight. Results: Overall, 692 (70.6%) of the patients with PsA responded. The mean±sd age was 55.6±11.4years and 52% were women. Obesity (BMI ≥30 kg/m2) was more prevalent (p<0.001) in patients with PsA (28.6%) than in matched subjects from the general population (16.3%). Hypertension was also more prevalent (p<0.001) in PsA (40.3%) than in matched subjects from the general population (24.1%), as was diabetes, with a prevalence of 10.5% in the PsA population compared with 6.2% in matched subjects (p<0.001). Conclusion: We found obesity to be highly overrepresented in patients with PsA compared with matched subjects from the general population. This difference was particularly seen in women with PsA. Hypertension and ever smoking were also more prevalent in women with PsA compared with matched subjects from the general population.
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| 8. |
- Landgren, Anton J., 1989, et al.
(författare)
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Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention.
- 2023
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Ingår i: Arthritis research & therapy. - 1478-6362. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Patients with psoriatic arthritis (PsA) are frequently obese. We have previously shown decreased disease activity in patients with PsA with a body mass index (BMI)≥33kg/m2 following weight loss treatment with Very Low Energy Diet (VLED), resulting in a median weight loss of 18.6% at six months (M6) after baseline (BL). In this study we assessed the effects of VLED on cytokines and adipokines at M6 in the same patients with PsA and controls (matched on sex, age and weight).VLED (640kcal/day) during 12 or 16weeks, depending on BL BMI<40 or≥40kg/m2, was taken and followed by an energy-restricted diet. Cytokines and adipokines were measured with Magnetic Luminex Assays at BL and M6.Serum interleukin (IL)-23, (median (interquartile range) 0.40 (0.17-0.54) ng/mL vs. 0.18 (0.10-0.30) ng/mL, p<0.001) and leptin (26.28 (14.35-48.73) ng/mL vs. 9.25 (4.40-16.24) ng/mL, p<0.001) was significantly decreased in patients with PsA. Serum total (tot)-adiponectin and high molecular weight (HMW) adiponectin increased significantly. Similar findings were found in controls. Also, in patients with PsA, ∆BMI was positively correlated with ∆IL-23 (rS=0.671, p<0.001). In addition, significant positive correlations were found between ΔBMI and ΔDisease Activity Score (DAS28CRP), ΔCRP, Δtumor necrosis factor (TNF)-α, ΔIL-13, ∆IL-17 and Δleptin, and negative correlations between ΔBMI and Δtot-adiponectin.Weight loss was associated with decreased levels of leptin and cytokines, in particular IL-23. These findings may partly explain the anti-inflammatory effect of weight reduction in PsA.ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016, retrospectively registered.
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| 9. |
- Landgren, Anton J., 1989, et al.
(författare)
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Sex differences in cytokines and adipokines in obese patients with PsA and controls undergoing a weight loss intervention.
- 2024
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Ingår i: RMD open. - 2056-5933. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- In this post hoc analysis of a previously published study, we compared cytokines and adipokine levels in women and men with psoriatic arthritis (PsA) at baseline (BL) and 6 months (M6) following a weight loss intervention.Patients with PsA (n=41) between 25 and 75 years of age, with body mass index (BMI)≥33 kg/m2 were included in a weight loss intervention with a very low energy diet (VLED) for 12 or 16 weeks depending on BL BMI<40 or ≥40 kg/m2. As controls (n=39), obese individuals, already planned for VLED treatment were recruited and matched for sex, age and weight to the patients with PsA. Cytokines and adipokines were measured at BL and M6.At BL, serum levels of interleukin (IL)-23, leptin and high molecular weight-adiponectin were higher in women with PsA compared with men, whereas serum levels of interferon (IFN)-γ, IL-12/IL-23 p40 and IL-13 were significantly lower in women. Serum IL-23 was significantly reduced at M6 compared with BL in women but not in men with PsA. In women with PsA, the reduction in IL-23 at M6, ∆IL-23, were positively correlated with ∆Disease Activity Score 28 C reactive protein (CRP) (Spearman's correlation (rS)=0.486, p=0.016), ∆CRP (rS=0.468, p=0.021), ∆leptin (rS=0.683, p<0.001) and negatively correlated with ∆total-adiponectin (rS=-0.433, p=0.035). Also in women, ∆Disease Activity in Psoriatic Arthritis was positively correlated with ∆tumour necrosis factor-α (rS=0.417, p=0.034), ∆IL-1β (rS=0.550, p=0.034), ∆IFN-γ (rS=0.414, p=0.035) and ∆leptin (rS=0.410, p=0.038). None of these correlations were significant in men with PsA.Women and men with PsA differed with regard to serum levels of cytokines and adipokines before and after weight loss.
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| 10. |
- Sveaas, Silje Halvorsen, et al.
(författare)
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Beneficial long-term effect on leisure time physical activity level in individuals with axial spondyloarthritis: secondary analysis of a randomized controlled trial.
- 2020
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Ingår i: The Journal of rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 47:8
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Tidskriftsartikel (refereegranskat)abstract
- To explore long-term effect of a 3-month exercise programme on leisure time physical activity level in individuals with axial spondyloarthritis (axSpA).A secondary analysis was performed on data from 100 individuals with axSpA who were included in a randomized controlled trial. The exercise group (EG) participated in a 3-month exercise programme while the control group (CG) received no intervention. Physical activity during leisure time was measured with a questionnaire (physically active = ≥1 hour/week with moderate/vigorous intensity physical activity). Disease activity was measured with the Ankylosing Spondylitis Disease Activity Scale (ASDAS, higher score=worst). Statistical analyses were performed on an intention to treat basis using chi-square tests, logistic regression and mixed models. Clinical Trials.gov (NCT02356874).At 12-month follow-up, significantly more individuals in the EG than in the CG were physically active (29 [67%] vs. 13 [30%], p<0.001) and exercised 2-3/week (25 [58%] vs. 15 [34%], p=0.02), and fewer exercised at light intensity (3 [8%] vs. 14 [44%], p=0.002). "Participation in the EG" (Odds ratio [OR] 6.7 [95%CI: 2.4, 18.6], <0.001) and "being physically active at baseline" (OR 4.7 [95%CI: 1.4, 15.8], p=0.01) were the factors most associated with being physically active. There were no differences between the groups in ASDAS (p=0.79).A 3-month exercise programme had a beneficial long-term effect on leisure time physical activity in individuals with axSpA, thus indicating a more beneficial health profile. Still, few individuals continued the intensive programme, and there was no difference between the groups in disease activity after 12 months.
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