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Personalized Exercise may have Key Benefits in Axial Spondyloarthritis

In a very interesting study at #EULAR2024, researchers demonstrated that personalized, supervised exercise therapy significantly improves physical function and quality of life for individuals with axial spondyloarthritis (axSpA) and severe functional limitations. This finding marks a critical advancement in the treatment of axSpA, particularly for patients with sustained disease activity, severe ankylosis, or significant comorbidities, who have historically been under-represented in research.

The L-EXSPA trial, a nation-wide, single-blinded, randomized controlled study in the Netherlands, aimed to evaluate the long-term effectiveness of tailored exercise therapy over a period of more than 52 weeks. (Abst #OP0143) The study involved 214 adults with axSpA who faced severe limitations in daily activities such as self-care, mobility, and transfers. Participants were randomized into two groups: one receiving personalized exercise therapy and the other receiving usual care.

Participants in the intervention group underwent a rigorous exercise regimen supervised by specifically trained primary care physical therapists. The therapy focused on enhancing strength, range of motion, endurance, and functional activities, supplemented by education and self-management support. The primary endpoint measured was the change in the Patient-Specific Complaint activity on a Numeric Rating Scale from 0 to 10 at 52 weeks. Secondary endpoints included other PSC activities, the Bath Ankylosing Spondylitis Functional Index (BASFI), a 6-minute walk test (6MWT), the PROMIS Physical Function-10 (PF-10), and the Short Form-36 (SF-36) physical and mental component summary scales.

The results, published after an extensive 52-week trial period, demonstrate that the intervention group experienced significantly greater improvements compared to the usual care group. Improvements were also observed in all secondary outcomes, except for the SF-36 mental component summary scale. Importantly, no serious adverse events were reported during the intervention period, underscoring the safety of the exercise therapy.

This study underscores the importance of personalized, supervised exercise therapy in managing axSpA, particularly for those with severe functional limitations. The therapy not only enhances physical function but also improves the overall quality of life for patients. These findings advocate for the broader implementation of personalized exercise programs tailored to individual patient needs, ensuring sustained treatment benefits.

The L-EXSPA trial has set a new benchmark in the treatment of axSpA. By demonstrating the effectiveness and safety of long-term personalized exercise therapy, this study provides a compelling case for integrating such interventions into standard care practices for axSpA patients with severe limitations. The consistent improvements observed across various physical functioning measures highlight the potential of this therapy to transform the lives of many individuals struggling with this chronic condition.


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