Physical activity assessment in patients with axial spondyloarthritis compared to healthy controls: a technology-based approach

Abstract

Introduction: Traditionally, assessment in axial Spondyloarthritis (aSpA) includes the evaluation of the capacity to execute tasks, conceptualized as physical function. The role of physical activity, defined as movement-related energy expenditure, is largely unknown and almost exclusively studied using patient-reported outcome measures. The aims of this observational cross-sectional study are to compare physical activity between patients with aSpA and healthy controls (HC) and to evaluate the contribution of disease activity to physical activity differences between groups.

Methods: Forty patients with aSpA were matched by age, gender, period of data acquisition in terms of days and season to 40 HC. Physical activity was measured during five consecutive days (three weekdays and two weekend days) using ambulatory monitoring (SenseWear Armband). Self-reported disease activity was measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Differences in physical activity between patients with aSpA and HC were examined with Wilcoxon signed-rank tests and a mixed linear model. Difference scores between patients and HC were correlated with disease activity.

Results: Average weekly physical activity level (Med(IQR); HC:1.54(1.41-1.73); aSpA:1.45(1.31-1.67),MET) and energy expenditure (HC:36.40(33.43-41.01); aSpA:34.55(31.08-39.41),MET.hrs/day) were significantly lower in patients with aSpA. Analyses across intensity levels revealed no significant differences between groups for inactivity and time spent at light or moderate physical activities. In contrast, weekly averages of vigorous (HC:4.02(1.20-12.60); aSpA:0.00(0.00-1.20),min/d), very vigorous physical activities (HC0.00(0.00-1.08); aSpA:0.00(0.00-0.00),mind/d) and moderate/(very)vigorous combined (HC2.41(1.62-3.48); aSpA:1.63(1.20-2.82),hrs/d) were significantly lower in patients with aSpA. Disease activity did not interact with differences in physical activity between patients with aSpA and HC, evidenced by non-significant and very low correlations (range: -0.06-0.17) between BASDAI and HC-aSpA patients' difference scores.

Conclusions: Patients with aSpA exhibit lower physical activity compared to HC and these differences are independent of self-reported disease activity. Further research on PA in patients with aSpA should be prioritized.

Figure 1. Individual physical activity data between controls (n = 40) and patients with axial spondyloarthritis (n = 40): physical activity level expressed in metabolic equivalent (MET) (A), time spent at moderate and (very)vigorous physical activity (MVPA) in hrs/d (B), time spent at vigorous (C) and very vigorous (D) physical activities in min/d; *p<0.05, **p<0.01.

Figure 2. Scatterplots of healthy control versus axial spondyloarthritis (aSpA) difference scores and disease activity as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): Physical activity level (PAL) A) and Vigorous PA (B); PA, physical activity; MET, metabolic equivalent; diff, difference score: for each matched pair (n = 40 pairs) healthy control value minus aSpA patient value.

Figure 3. Vigorous (A) and very vigorous (B) physical activities (PA) expressed in min/d for patients with axial spondyloarthritis (aSpA, n = 40) and matched healthy controls (n = 40). Horizontal lines represent median values for weekly average and time point estimates; *p<0.05, **p<0.01.