Introduction. The purpose of this study was to investigate body composition, muscle function, and muscle morphology in patients with spondyloarthritis (SpA). Methods. Ten male SpA patients (mean ± SD age 39 ± 4.1 years) were compared with ten healthy controls matched for sex, age, body mass index, and self-reported level of physical exercise. Body composition was measured by dual energy X-ray absorptiometry. Musculus quadriceps femoris (QF) strength was assessed by maximal isometric contractions prior to test of muscular endurance. Magnetic resonance imaging of QF was used to measure muscle size and calculate specific muscle strength. Percutaneous needle biopsy samples were taken from m. vastus lateralis. Results. SpA patients presented with significantly lower appendicular lean body mass (LBM) (p = 0.02), but there was no difference in bone mineral density, fat mass, or total LBM. Absolute QF strength was significantly lower in SpA patients (p = 0.03) with a parallel trend for specific strength (p = 0.08). Biopsy samples from the SpA patients revealed significantly smaller cross-sectional area (CSA) of type II muscle fibers (p = 0.04), but no difference in CSA type I fibers. Conclusions. Results indicate that the presence of SpA disease is associated with reduced appendicular LBM, muscle strength, and type II fiber CSA.

IntroductionInflammatory joint disease (IJD) is associated with increased risk of cardiovascular disease (CVD) fostered by systemic inflammation and a high prevalence of CVD risk factors. Cardiorespiratory fitness (CRF) is an important health parameter and CRF-measures are advocated in routine health evaluations. CRF associates with CVD risk, and exercise modalities such as high intensity interval training (HIIT) can increase CRF and mitigate CVD risk factors. In IJD, exercise is rarely used in CVD risk management and the cardioprotective effect of HIIT is unclear. Furthermore, the clinical applicability of HIIT to primary care settings is largely unknown and warrants investigation. The primary aim is to assess the effect of a HIIT programme on CRF in patients with IJD. Second, we will evaluate the effect of HIIT on CVD risk and disease activity in patients with IJD, feasibility of HIIT in primary care and validity of non-exercise algorithms to detect change in CRF.Methods and analysisExeHeart is a single-blinded, randomised controlled trial. Sixty patients with IJD will be recruited from the Preventive Cardio-Rheuma clinic at Diakonhjemmet Hospital, Norway. Patients will be assigned to receive standard care (relevant lifestyle advice and cardio-preventive medication) or standard care plus a 12-week HIIT intervention by physiotherapists in primary care. HIIT sessions will be prescribed at 90%–95% of peak heart rate. Outcomes include CRF (primary outcome), CVD risk factors, anthropometric measures, disease activity and patient-reported outcomes related to pain, fatigue, disease, physical activity and exercise and will be assessed at baseline, 3 months (primary endpoint) and 6 months postbaseline.Ethics and disseminationEthical approval has been obtained from the Regional Committee for Medical and Health Research Ethics (201227). Participants are required to sign a written informed consent form. Results will be discussed with patient representatives, submitted to peer-reviewed journals and presented at relevant platforms.Trial registration numberNCT04922840.

Background Patient organisations may be an under-utilised resource in follow-up of patients requiring long-term exercise as part of their disease management. The purpose of this study was to explore the feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis (OA). Methods In this pre–post feasibility study, patients aged 40–80 years with hip and/or knee OA were recruited from Diakonhjemmet Hospital. The 12-week intervention was delivered through a patient organisation’s digital platform. Feasibility was evaluated by proportion of eligible patients enrolled, proportion of enrolled patients who provided valid accelerometer data at baseline, and proportion completing the cardiorespiratory exercise test according to protocol at baseline and completed follow-up assessments. Patient acceptability was evaluated for website usability, satisfaction with the initial exercise level and comprehensibility of the exercise program. Change in clinical outcomes were assessed for physical activity, cardiorespiratory fitness and patient-reported variables. Results In total, 49 eligible patients were identified and 35 were enrolled. Thirty (86%) of these attended baseline assessments and provided valid accelerometer data and 18 (51%) completed the maximal cardiorespiratory exercise test according to protocol. Twenty-two (63%) patients completed the follow-up questionnaire, and they rated the website usability as ‘acceptable’ [median 77.5 out of 100 (IQR 56.9, 85.6)], 19 (86%) reported that the initial exercise level was ‘just right’ and 18 (82%) that the exercise program was ‘very easy’ or ’quite easy’ to comprehend. Improvement in both moderate to vigorous physical activity (mean change 16.4 min/day; 95% CI 6.9 to 25.9) and cardiorespiratory fitness, VO2peak (mean change 1.83 ml/kg/min; 95% CI 0.29 to 3.36) were found in a subgroup of 8 patients completing these tests. Across all patient-reported outcomes 24–52% of the patients had a meaningful improvement (n = 22). Conclusion A web-based exercise program delivered by a patient organisation was found to be feasible and acceptable in patients with hip and/or knee OA. Trial registration ClinicalTrials.gov, NCT04084834 (registered 10 September 2019). The Regional Committee for Medical and Health Research Ethics south-east, 2018/2198. URL: Prosjekt #632074 - Aktiv med web-basert støtte. - Cristin (registered 7 June 2019).

Background Inflammatory joint diseases (IJD) are accompanied by an increased risk of cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable CVD risk factor and low levels of CRF associate with an elevated CVD risk. This study aimed to investigate the associations between CVD risk factors, disease activity and CRF in patients with IJD and to explore differences between patients with normal versus low levels of CRF. Methods CRF was measured as peak oxygen uptake (VO2peak) with a cardiopulmonary exercise test. Participants were also evaluated for: Body composition, blood pressure, blood lipids, inflammatory markers and disease activity. Patient-reported use of cigarettes/snuff, medication, disease duration, pain, fatigue, CVD history, habitual physical activity and exercise beliefs and self-efficacy were collected by questionnaire. Cross-sectional associations between CVD risk factors, disease-related factors and CRF were analyzed by multiple linear regression. CRF was categorized to normal CRF (VO2peak ≥ 80%) or low CRF (VO2peak < 80%) according to age- and gender-stratified reference data. Differences in demographic, CVD and disease-related factors between patients with normal versus low CRF were explored. Results In 60 Norwegian patients with IJD [34 females, age 59 years (IQR: 52–63)], mean VO2peak was 30.2 (± 6.9) mL/kg/min, corresponding to 83% (± 18) of normative reference values. Age (coefficient: − 0.18 years, p = 0.01) and fat mass (coefficient: − 0.67 %, p < 0.001) were inversely associated with CRF, while physical activity index (coefficient: 0.13 points, p = 0.05) was positively associated with CRF (R2 = 0.66). There were no significant associations between CRF, classical CVD risk factors and disease-related variables. Compared to patients with low CRF (n = 30), patients with normal CRF (n = 30) had higher peak oxygen uptake (+ 9.4 mL/kg/min, p < 0.001), high-density lipoprotein cholesterol (+ 0.5 mmol L−1, p < 0.001), and exercise self-efficacy (+ 6.9, p < 0.01) as well as lower fat mass (− 8.7%, p < 0.001), resting heart rate (− 8.0 beats/min, p < 0.01) and triglycerides (− 0.5 mmol L−1, p < 0.01). Conclusions In this sample of IJD-patients, age, fatmass and physical activity level were associated with CRF. CRF was lower than reference values and patients with normal CRF presented with a more favorable health profile. There is a continued need for exercise interventions to improve CRF in patients with IJD. Trial registration: NCT04922840.

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BackgroundCardiorespiratory fitness (CRF) is recognized as an independent risk factor for cardiovascular disease (CVD) and improved CRF associates with lower risk of CVD [1]. High-intensity interval training (HIIT) is an effective mode of exercise to increase CRF. However, HIIT is seldom utilized in physiotherapy primary care in the context of inflammatory joint disease (IJD), and the sustainable effects of HIIT have been questioned [2].ObjectivesTo investigate short- and long-term effects of twelve weeks of supervised HIIT in physiotherapy primary care on CRF, pain and fatigue in patients with IJD.MethodsIn this assessor-blinded randomized controlled trial (NCT04922840), 60 patients were allocated to a control group (n=30) or a HIIT group (n=30) that received a 12-week intervention in physiotherapy primary care including two weekly supervised 4x4 minute HIIT sessions at 90-95% peak heart rate and one non-supervised exercise session at moderate intensity. Patients were assessed at baseline, 3 and 6 months. Primary outcome was change in CRF from baseline to 3 months, measured as peak oxygen uptake (VO2peak) by a cardiopulmonary exercise test. Secondary outcomes were pain and fatigue (Numeric Rating Scale 0-10, 0= no pain/fatigue). Group differences were assessed by pre-specified intention-to-treat analysis of covariance with multiple imputation of missing data for the primary outcome. Per-protocol analysis was applied for the primary outcome.ResultsMedian age was 59 years (IQR 52-63) and 34 participants (57%) were female. A total of 55 patients completed assessment at 3 and 6 months for the primary outcome; 27 in the HIIT group and 28 in the control group. Following HIIT, there was a significant between-group difference in VO2peak(2.5 mL/kg/min,p<0.01) in favor of the exercise group at 3 months with no corresponding differences in pain and fatigue (Table 1). At 6 months, the between-group difference in VO2peakwas maintained (2.6 ml/kg/min,p<0.01) and there were no significant differences in pain and fatigue (Table 1). Per-protocol analysis at 3 months showed a between-group difference in VO2peak(3.2 mL/kg/min,p<0.001, 95% CI 1.7-4.8) in the 19 (70%) patients that adhered to ≥17/24 HIIT sessions compared to the 20 (71%) control group patients that refrained from aerobic exercise.ConclusionCRF increased in patients with IJD following 12 weeks of supervised HIIT and the effect was maintained at 6 months. The beneficial response on CRF was not accompanied by changes in pain or fatigue and the intervention can be regarded as feasible in physiotherapy primary care. HIIT is a viable physiotherapy intervention with sustainable effects in patients with IJD.Table 1.Effects of HIIT at 3 and 6 months. Data presented as mean (SD).HIIT group Baseline Follow-upControl group Baseline Follow-upnMean group difference (95%CI)apVO2peak, mL/kg/minBaseline to 3 monthsBaseline to 6 months30.4 (5.9)30.4 (5.9)32.9 (6.4) 33.2 (7.4)30.1 (7.9)30.4 (8.0)30.3 (7.5)30.7 (7.8)60§ 60§2.5 (0.9-4.0) 2.6 (0.8-4.3)<0.01 <0.01Fatigue, NRS 0-10, 0= no fatigueBaseline to 3 monthsBaseline to 6 months3.1 (2.1)3.1 (2.1)3.0 (1.9)3.1 (2.2)3.6 (2.5)3.6 (2.5)3.5 (2.7)3.8 (2.4)59 58-0.1 (-0.9-0.8)-0.4 (-1.2-0.5)b0.87 0.41Pain, NRS 0-10, 0= no painBaseline to 3 monthsBaseline to 6 months2.9 (2.1) 2.9 (2.2)2.8 (1.8)2.9 (2.0)2.9 (2.5)2.9 (2.5)3.1 (2.7)3.2 (2.4)59 58-0.3 (-1.3-0.7)b-0.4 (-1.2-0.5)0.57 0.38§ Primary analysis with multiple imputation of estimate,n=60.aANCOVA; gender, group, age and baseline value as covariates.bBootstrap CI with 10000 replications. HIIT: High-intensity Interval Training, NRS: Numeric rating scale, VO2peak: Peak oxygen uptakeReferences[1] Agca R et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Annals of the rheumatic diseases. 2017;76(1):17-28.[2] Ross R et al. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation. 2016;134(24):e653-e99.AcknowledgmentsWe thank the patients that participated in the ExeHeart trial, patient representatives and physiotherapists in primary care for valuable commitment and contribution to the trial.Disclosure of InterestsKristine Nordén Speakers bureau: Lecture honoraria from UCB, Anne Grete Semb Speakers bureau: Lecture honoraria from AbbVie, Novartis, Bayer, Eli Lilly, Pfizer and Sanofi, Hanne Solveig Dagfinrud: None declared, Jonny Hisdal: None declared, Joseph Sexton: None declared, Camilla Fongen: None declared, George Metsios Speakers bureau: Lecture honoraria from Novartis, Anne Therese Tveter: None declared.

Objectives: To describe adherence to a 12-week web-based aerobic exercise programme, to compare characteristics between those who adhere or not, and to identify barriers for exercising in patients with hip or knee osteoarthritis. Design: Single-arm feasibility study. Subjects: Patients with hip or knee osteoarthritis in specialist healthcare, age 40–80 years, and not candidates for joint surgery. Methods: Adherence to a 12-week exercise programme was defined as having completed ≥ 2 exercise sessions a week for at least 8 weeks. Baseline differences between adherent and non-adherent groups in demographics, symptoms, disability, physical activity and fitness were assessed using Mann–Whitney U or χ2 tests. Reasons for not completing exercise sessions were reported in weekly diaries.  Results: A total of 29 patients (median age 64 years, 72% female) were included. Median baseline pain (numerical rating scale 0–10) was 5. Fifteen patients adhered to the exercise programme, 14 did not. Non-adherent patients were less active (p = 0.032) and had lower cardiorespiratory fitness (p = 0.031). The most frequently reported barrier to exercising was sickness. Less than 10% reported pain as a barrier. Conclusion: Half of the patients with hip or knee osteoarthritis adhered to the digitally delivered exercise programme and the most frequently reported barrier for adherence was sickness, while less than 10% reported pain as a reason for not exercising. Trial registration: ClinicalTrials.gov, NCT04084834. The Regional Committee for Medical and Health Research Ethics South-East, 2018/2198.

Background:Long-term physical activity (PA) and exercise is recommended as a cornerstone in the treatment of people with osteoarthritis (OA) (1), yet adherence to exercise is challenging (2). The treatment needs for this large group of patients cannot be fully managed within the health-care system, thus developing innovative and effective follow-up strategies is urgently needed.Objectives:To explore the feasibility and preliminary efficacy of a web-based, peer-supported exercise program for people with hip or knee OA.Methods:This study was a single-group, pre-post feasibility study. Patients aged 40-80 years with hip or knee OA who were not candidates for surgery were eligible. The 12-week intervention was delivered through a patient-organizations (The Norwegian Association for Rheumatic Diseases) web-based platforms, and included weekly exercise programs, weekly motivational messages, an OA and exercise website and assigned peer-supporters. Feasibility was evaluated by calculating the proportion of eligible patients who were enrolled and retained at follow-up, as well as time resources used on delivery of the intervention. Acceptability was evaluated by calculating proportion of patients who had valid baseline accelerometer data and completed the maximal cardiorespiratory exercise test according to protocol. Primary efficacy measures were change in PA assessed by accelerometers and change in exercise capacity (VO2peak) assessed by indirect maximal cardiorespiratory exercise test. Secondary efficacy measures were change in patient reported outcomes assessed by HOOS and KOOS (www.koos.nu) (a 10-point change in normalized scores was considered a minimally important change). Data was analysed using paired sample t-test, given as mean change (95% confidence interval) and p-values.Results:We identified 49 eligible patients of which 35 (71%) consented and were enrolled. Among those who consented, 22 (63%) were retained. Time resources used on delivery of the exercise programs and motivational messages were mean (SD) 7.3±1.1 min per week/patient. Compliance with wearing the accelerometer was mean (SD) 6.1±1.0 valid days (mean (SD) 13.8±1.3 hours/day). Twenty (67%) out of 30 patients who attended baseline testing performed the maximal cardiorespiratory exercise test, of which 18 completed according to protocol. Due to Covid-19 restrictions, follow-up testing of primary efficacy measures included only eight patients. For these patients there was a significant increase from baseline to follow-up on moderate-to-vigorous PA (mean change 16.4 minutes/day; 95% CI 6.9, 25.9, p=0.005) and VO2peak (mean change 1.83 ml/kg/min; 95% CI 0.29, 3.36, p=0.026). Across all secondary efficacy measures 30-52% of the patients (n=21) improved from baseline to follow-up (Figure 1).Figure 1.Proportion (%) of patients with Minimally Important Change (from baseline to follow-up) in normalized scores in subdomains of Hip disability and Osteoarthritis Outcome Score (HOOS) / Knee injury and Osteoarthritis Outcome Score (KOOS).Conclusion:Overall, the examined study processes were considered to be feasible and acceptable. Some minor amendments should be applied to improve the recruitment and retention rate before it can be carried out in a larger trial. The efficacy results should be interpreted with caution due the small sample size. However, if the positive results in this study are confirmed in a power-calculated randomised controlled trial, our novel follow-up strategy may be implemented and recommended for long-term management of hip and knee OA.References:[1]Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72(2):220-33.[2]Williamson W, Kluzek S, Roberts N, Richards J, Arden N, Leeson P, et al. Behavioural physical activity interventions in participants with lower-limb osteoarthritis: a systematic review with meta-analysis. BMJ Open. 2015;5(8):e007642.Acknowledgements:The authors wish to acknowledge all patients for participating, the patient representative who gave invaluable input on interventional components and the peer-supporters for volunteering to provide interventional support.Disclosure of Interests:None declared