Академический Документы
Профессиональный Документы
Культура Документы
DOI 10.1007/s00296-013-2869-y
SHORT COMMUNICATION
Received: 6 April 2013 / Accepted: 10 September 2013 / Published online: 26 September 2013
Springer-Verlag Berlin Heidelberg 2013
Abstract The optimal management of ankylosis spondylitis (AS) involves a combination of nonpharmacologic and
pharmacologic treatment aiming to maximize health-related
quality of life. The primary objective of our study was to
demonstrate the benefits of an original multimodal exercise
program combining Pilates, McKenzie and Heckscher
techniques on pulmonary function in patients with AS, while
secondary objectives were to demonstrate the benefits of the
same program on function and disease activity. This is a
randomized controlled study on ninety-six consecutive
patients with AS (axial disease subset), assigned on a 1:1
rationale into two groups based on their participation in the
Pilates, McKenzie and Heckscher (group I) or in the classical
kinetic program (group II). The exercise program consisted
of 50-min sessions performed 3 times weekly for 48 weeks.
Standard assessments were done at week 0 and 48 and
included pain, modified Schober test (mST) and fingerfloor
distance (FFD), chest expansion (CE) and vital capacity
(VC), as well as disease activity Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional Bath
Ankylosing Spondylitis Functional Index (BASFI) and
metrology index Bath Ankylosing Spondylitis Metrology
Index (BASMI). Groups were comparable at baseline; we
demonstrated significant improvement between baseline and
after 48 weeks of regular kinetic training for all AS-related
parameters in both groups. However, significant improvement was found in pain, lumbar spine motility (mST, FFD),
BASFI, BASDAI and BASMI in AS performing the specific
multimodal exercise program at the end of study
(p = 0.001). Although there were significant improvements
in CE in both groups as compared to baseline (group I,
p = 0.001; group II, p = 0.002), this parameter increased
significantly only in group I (p = 0.001). VC measurements
were not significantly changed at the end of the study (group
I, p = 0.127; group II, p = 0.997), but we found significant
differences within groups (p = 0.011). A multimodal
training combining Pilates, McKenzie and Heckscher exercises performed regularly should be included in the routine
management of patients with AS for better control of function, disease activity and pulmonary function.
Keywords Ankylosing spondylitis Pilates
McKenzie method Heckscher method
Introduction
Ankylosing spondylitis (AS) is a chronic systemic
inflammatory disease that affects mainly the axial skeleton
and causes significant pain and disability [1]. While the
pathophysiology of AS is still not well understood, interactions between HLA-B27 and T cell response, including
the release of TNF-alpha, are widely involved in driving
initial inflammation as well as late ossification [1, 2].
Extra-articular manifestations can often occur, restrictive
respiratory dysfunction being commonly reported in a
significant proportion of patients [1, 3, 4].
The optimal management requires a combination of
nonpharmacologic and pharmacologic treatment modalities
aiming to maximize long-term health-related quality of life
123
368
123
368
123
369
Table 1 Demographics, AS-related parameters and breathing function in group I and group II at baseline
Parameter
Week 0
Group I
(n = 48)
Group II
(n = 48)
Gender (male/female)
39/9
40/8
0.789
Age (years)
25.33 (3.77)
24.98 (3.83)
0.649
Disease durationa
(years)
5.81 (3.02)
5.35 (3.11)
0.466
NSAIDs (%)
52.1
54.2
0.838
20.8
18.8
0.798
Pain (VAS)
36.46 (10.42)
34.79 (12.03)
0.470
mSTa (cm)
2.71 (0.76)
2.83 (0.77)
0.428
FFDa (cm)
-18.94 (8.29)
-18.77 (8.58)
0.923
CEa (cm)
3.94 (0.79)
3.86 (0.78)
0.651
VCa (%)
BASDAIa
99.50 (7.21)
5.41 (1.95)
101.80 (11.46)
5.29 (1.96)
0.243
0.758
BASFIa
3.56 (1.83)
3.42 (1.94)
0.718
BASMIa
3.73 (0.45)
3.3 (0.45)
1.000
Mean (SD)
Data analysis
The statistical analysis was conducted using the SPSS
statistical package, version 13.00. Descriptive statistics
were used for the means and standard deviations, while
Students t and Chi-squared tests were applied for the
comparison of groups. Spearmans rank test was used to
define the intensities of statistical relations, and also their
sense. The level of significance was accepted as p \ 005.
Measurements
Results
Standard assessments were performed at week 0 and 48
and included the following parameters: pain rated on a
visual analogue scale (VAS) from 0 to 100 mm (0
meaning no pain and 100 unbearable pain) [1];
spine mobility evaluated by the modified Schober test
(mST), finger-to-floor distance (FFD) and Bath Ankylosing
Spondylitis Metrology Index (BASMI) [1]; function
defined as Bath Ankylosing Spondylitis Functional Index
(BASFI) [1]; disease activity as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) [1]; while
breathing capacity based on chest expansion (CE) and vital
capacity (VC \ 75 %) determined by spirometry.
Conventional nonsteroidal anti-inflammatory drugs
(NSAIDs) and biologics were allowed in all cases if
reported at baseline.
The study was approved by the local ethic committee,
and written informed consent was obtained before the
study from all patients.
123
370
Group I
(n = 48)
Group II
(n = 48)
NSAIDs (%)
14.6
52.1
0.0002
14.6
13.54 (7.85)
0.001
18.8
21.04 (8.81)
0.001
0.784
0.001
4.56 (0.56)
0.001
3.48 (0.74)
0.002
0.001
-4.81 (6.15)
0.001
-12.63 (5.89)
0.002
0.001
Discussion
Week 48
5.88 (0.50)
4.39 (0.77)
0.001
p (revaluation vs
pretreatment)
VCa (%)
p (revaluation vs
pretreatment)
BASDAIa
p (revaluation vs
pretreatment)
BASFIa
p (revaluation vs
pretreatment)
BASMIa
0.001
0.002
105.63 (6.94)
0.124
101.31 (9.24)
0.997
0.011
2.10 (0.82)
0.001
4.13 (1.66)
0.002
0.001
1.50 (1.11)
0.001
2.76 (1.56)
0.041
0.001
1.19 (0.84)
3.02 (0.44)
0.001
p (revaluation vs
pretreatment)
0.001
0.004
Mean (SD)
123
371
References
1. Sieper J, Rudwaleit M, Baraliakos X et al (2009) The Assessment
of SpondyloArthritis International Society (ASAS) handbook: a
guide to assess spondyloarthritis. Ann Rheum Dis 68:ii1ii44
2. Braun J, van den Berg R, Baraliakos X et al (2011) 2010 update
of the ASAS/EULAR recommendations for the management of
ankylosing spondylitis. Ann Rheum Dis 70:896904
3. Fisher LR, Crawley MID, Holgate ST (1990) Relation between
chest expansion, pulmonary function, and exercise tolerance in
patients with ankylosing spondylitis. Ann Rheum Dis 49:921925
4. Cerrahoglu L, Unlu Z, Can M, Goktan C, Celik P (2002) Lumbar
stiffness but not thoracic radiographic changes relate to alteration
of lung function tests in ankylosing spondylitis. Clin Rheumatol
21(4):275279
5. Sorosky S, Stilp S, Akuthota V (2008) Yoga and Pilates in the
management of low back pain. Curr Rev Musculoskelet Med
1(1):3947
6. La Touche R, Escalante K, Linares MT (2008) Treating nonspecific chronic low back pain through the Pilates Method.
J Body MovTher 12(4):364370
7. McKenzie R, May S (2003) The lumbar spine: mechanical
diagnosis and therapy, vol 1. Spinal Publications, Waikanae
8. Skikic EM, Soud T (2003) The effects of McKenzie exercises for
patients with low back pain, our experience. Bosn J Basic Med
Sci 3(4):7075
9. Clare HA, Adams R, Maher CG (2004) A systematic review of
efficacy of McKenzie therapy for spinal pain. Aust J Physiother
50(4):209216
10. Simonsen RJ (1998) Principle-centered spine care: McKenzie
principles. Occup Med 13(1):167183
11. Altan L, Korkmaz N, Dizdar M, Yurtkuran M (2012) Effect of
Pilates training on people with ankylosing spondylitis. Rheumatol
Int 32(7):20932099
12. Berea S, Ancuta C, Miu S, Chirieac R (2012) The Pilates method
in ankylosing spondylitis. Rom J Rheumatol vol XXI, Nr. 2,
7279
13. Berea S, Ancut a C, Chiriac R (2010) Rehabilitation of coxitis in
patients with ankylosing spondylitis. Observations in a series of
30 patients hospitalized at the Rheumatology and Recovery
123
372
14.
15.
16.
17.
18.
19.
123