Cardiovascular training improves fitness in patients with ankylosing spondylitis

Objective: Several studies suggest that patients with ankylosing spondylitis (AS) have an increased risk of cardiovascular disease. This study aimed to evaluate the effects of a 12-week individually heart rate-monitored, moderately intensive cardiovascular training on cardiovascular fitness and perceived disease activity in AS patients. Methods: Patients diagnosed with AS according to modified New York criteria were to either 'cardiovascular training' or 'attention control'. The training group performed three cardiovascular trainings per week. All participants attended one weekly usual care flexibility training. Attention control contained regular discussion groups on coping strategies. Adherence was self-monitored. Assessments were performed at baseline and after the intervention period of 3 months. Physical fitness was the primary endpoint, measured in watts using a submaximal bicycle test following the PWC75% protocol. All analyses controlled for gender, age, body mass index, baseline fitness and physical activity levels, and BASDAI. Results: Of 106 AS patients enrolled, 40% were women, mean age was 49 (SD +/-12) years. 76.5% of the training group reported exercising at least three times a week. At 3 month follow-up, fitness level in the training group was significantly higher than in the control group (90.32 (SD 4.52) vs.109.84 (SD 4.72) respectively, p=0.001), independent of other covariates. Average BASDAI total score was 0.31 points lower (p = 0.31) in the training group, reaching significance for the 'peripheral pain' subscore (1.19; p=0.01), but not for 'back pain' or 'fatigue'. Conclusions: Cardiovascular training, in addition to flexibility exercise, increased fitness in AS patients and reduced their peripheral pain