Does Exercise Increases the Quality of Life for the People Suffering from Ankylosing Spondylitis - Essay Example

? Does exercise increases the quality of life for the people suffering from Ankylosing Spondylitis (AS)? [Supervisor’s Name] [Date] Does exercise increases the quality of life for the people suffering from Ankylosing Spondylitis (AS)? Ankylosing Spondylitis (AS) is a condition which has its correspondence with the class of chronic inflammatory rheumatic disorders which are called Spondyloarthropathies (SPAs). It initially attacks the adjacent structure and the axial skeleton which consists of eighty bones in the trunk of the body and the head. AS is a chronic systematic inflammatory disease by which the vertebrae of spine is inflamed that causes discomfort in a patient and chronic pain. There is no certain diagnosis established for AS (Weisman, 2011). The antigen HLA-B27 is found in the majority of patients which can follow that it can be one cause of AS (Brown, 1997), but it does not conclude that HLA-B27 is the actual cause of AS (Benjamin, et al., 1990). There are 0.5 percent male and 0.2 percent female population present in UK which is suffering from AS (Brierley, 2007). The annual cost for the management of AS calculated, in a study, is around 1852 pounds (Ara et al., 2007). The exercise is an alternative to medication in the management of AS and it is effective in reducing the pain and increasing the quality of life in a cheaper cost. The aim of current article is to see whether exercise helps improve the quality of life of a person suffering from AS. What effects exercises have on a patient with AS? and the assistance of physiotherapy in the management of AS. It will be concluded in the end of this paper with the references of some authentic researched studies which are published. Analay, Y. et al., 2003. The effectiveness of intensive group exercise on patients with ankylosing spondylitis. Clinical rehabilitation, 17(6), pp.631-36. Aims / Objectives: The study was conducted to see the effectiveness of an intensive group exercise routine on psychological and functional status and on pain in patients with ankylosing spondylitis (AS). The trial was taken under the administration of a physiotherapist and the subjects were provided the guidance of a home physiotherapy programme. Design / Methods: The design of this study was prospective and a double-blind study in which fifty one patients were selected randomly and were divided into two groups from which for group I, an intensive exercise program was scheduled under the supervision of a physiotherapist at hospital while group II was instructed to practice exercise at their homes. Both groups were educated about AS before the exercises and the intensive exercise program was organized for group I while group II was asked to exercise at their homes individually. Key Findings: The results after evaluation was found in favor of group I patients. The patients exercised in hospitals showed more progress in comparison with the patients exercised individually at homes. The results were sorted on the basis of the effectiveness of exercise on pain, functional status and psychological status by using VAS for pain, BASFI and Beck Depression Scale. Critique: The research has appointed a proximate research method which can be best suitable for the evaluating the subject matter. The reason why the research method is considered as commendable is because it is double blind in nature. This increases the reliability of the research and hence the biasness is relatively lesser (CHIN and Lee, 2008). Conclusions: Home-based exercises may be less effective compared to group exercise in hospitals at decreasing damage associated with AS. The group exercise under a physiotherapist gives more positive results than individual exercises. The exercise (in general) plays a significantly important role and is effective in improving the quality of life of the individuals suffering from AS. Fernandez-de-las-Penas, C.e.a., 2005. Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. American journal of physical medicine & rehabilitation, 84(6), pp.407-19. Aims / Objectives: The purpose of this clinical study was to see the effect of a four month comprehensive protocol of strengthening and flexibility exercises versus conventional exercises for patients with AS on functions and mobility. Design / Methods: Forty five subjects, suffering from AS, were selected and were divided into two groups, control group and experimental group, using a random numbers table. The study was a randomized controlled trail. The control group was asked to do the conventional exercises whereas the experimental group was provided and was asked to do the suggested protocol by the researchers. The conventional exercises consisted of 20 exercises whereas the experimental intervention was based on the treatment of the shortened muscle chains and the postural affectation of AS. BASFI, BASMI and BASDAI were measured during the whole study, multiple times. Key Findings: Both groups showed improved results in all the outcome measures, BASDAI and BASFI indexes as well as mobility measures of BASMI index. The improvement in lumbar side flexion (P = 0.02) and in tragus to wall distance (P = 0.009) was statistically visible in the control group, the remaining outcomes also improved but were not on a significant level, on the other hand all the clinical measures of the BASFI index (P = 0.003) and the BASMI index (P < 0.01) in was statistically improved significantly in the experimental group. Critique: The research method appointed have been made interrelated to the literature which allows the research to fulfil the gap of findings. However, the fact remains that the study should have been cross-sectional as there is a limitation of reliability (GEOFFREY R. MARCZYK, David DeMatteo, David Festinger, 2005). This has rather been a cause behind re-checking of overall findings of the study. Conclusions: The experimental protocol which has been developed by the research group that is based upon flexibility exercises of the muscle chains, specific strengthening and the GPR method, provides promising outcomes in the management of people which are suffering from AS. The study shows that the management of patients with AS is possible with other exercise therapies than conventional exercise therapy only, in improving the quality of life. Ince, G., Sarpel, T., Durgun, B. & Erdogan, S., 2006. Effects of a multimodal exercise program for people with ankylosing spondylitis. Physical therapy, 86(7), pp.924-35. Aims / Objectives: The study was conducted to investigate the effectiveness of a twelve week multimodal exercise protocol in the subjects which are AS patients. Design / Methods: The participants were a convenience sample and were the total of 18 male and 12 female patients with an average age of 34.9 years (mean) suffering from AS. From the total, twenty six subjects were categorized as suffering from stage 1 AS and the remaining having stage 2 AS according to the modified New York criteria. The method used is a randomized controlled trial and the sum of subjects was divided into two groups. One group was assigned with an exercise program and the other was a control group. The exercise protocol was of fifty minutes multimodal exercise (aerobic, stretching and pulmonary exercises) three times a week for three months. All of the patients were physically examined at the beginning and after three months. The subjects were tested in examinations and in the measurements of spinal mobility which incorporated two methods which were clinical measurements and inclinometer measurements. Vital capacity and physical work capacity was also evaluated. Key Findings: The results showed that a multimodal exercise program which includes stretching, aerobics and pulmonary exercises with routine medical management provided prominent improvements in working capacity, chest expansion and spinal mobility of the AS patients. Critique: For studies like this, it is recommended that the sample size for the research is bigger to understand the subject matter. The research protocol selected for this study has been made contextual in terms of theory but the sample size makes the study relatively limited. The validity of studies with smaller sample required validity factors (Sandelowski, 1995). Conclusions: The multimodal exercise program which included stretching, aerobic and pulmonary exercises in conjunction with routine medical management produced major improvements in chest expansion, work capacity, and spinal mobility. The exercise rehabilitation is extremely effective in the improvement of AS patients and their quality of life. Karapolat, H. et al., 2009. Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study. European Journal of Physical and Rehabilitation Medicine, 45(4), p. 449. Aims / Objectives: The aim of the study was to see the comparison of conventional exercise (CE) with walking and swimming on pulmonary functions, psychological symptoms, aerobic capacity, Bath indexes and quality of life in patients having AS Design / Methods: Forty five patients were randomly divided into three groups. Patients who were placed in Group 1 were required to perform CE and swimming, patients assigned to Group 2 performed CE and walking and Group 3 patients performed only CE. Exercise routines were performed three times a week for six weeks. Subjects were evaluated in the beginning and in the end of the rehabilitation protocol in which maximal oxygen uptake, pulmonary function test, 6-minutes walking test, BASDAI, BASFI, BASMI, Beck Depression Inventory and Nottingham Health Profile were assessed. Key Findings: The patients in group one and group two showed a significant increase in oxygen uptake and 6-minutes walking test after treatment. FVC, VC and FeV1 significantly improved in all three groups. There were significantly improved results found in emotional reaction, physical mobility sub-scores of NHP and in energy after the completion of exercises protocols in all three groups. Critique: The research design and overall analysis made by the authors in the study has boarded the context of understanding the context of exercises. The validity of the research has also been done with a number of studies which makes the study more reliable like (Dagfinrud et al., 2011). Conclusions: Walking, swimming and conventional exercises produced a positive impact on pulmonary functions and the quality of life. Aerobic exercises in the combination with CE produced an increased functional capacity in the patients with AS. Exercise is significantly effective in raising the quality of life of the patients suffering from AS. Lehtinen, K., Suni, J., Kautiainen, H. & Viitanen, J.V., 1995. Fifteen months' follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis. Clinical rheumatology, 14(4), pp.413-19. Aims / Objectives: The trial was taken to find out the long term effectiveness of a three or four-week inpateient phisiotherapy and exercise courses. Design / Methods: The study was conducted on 141 adult patients having AS. Eight ROM measurements, straight leg raise test, Vital Capacity (VC) an fitness index were measured at the beginning and the end of a intensive course and measurements reapeated after 15 months time. Key Findings: All of the mobility measurements, fitness index and Vital Capacity were prominently improved after the course. After fifteeen months span only chest expansion and vital capacity was significantly disimproved, while fitness index, CR and FFD were significantly better. Critique: The research is surely relevant to the subject matter because it appoints a more systematic research design which is much needed for evaluating effectiveness. The contextual background and statistics provided in the research are indicators of the reliability test as well (WARD and Michael, 2002). Conclusions: It can be concluded by the study that the prevention of deterioration of spinal function and fitness is possible for more than a year by the means of intensive rehabilitation courses in AS. The exercise therapy significantly improves the condition of individuals having AS even in the long term and is positively effective in the improvement of quality of life for patients. Conclusion: In the study papers above, all of the Bath indexes are improved as a result of exercise in AS management, the functional and vital capacity measures show a significant positive change and all of the pulmonary functions were improved after exercise in AS patients. Exercise also reduces depression, fatigue and pain in the patients of AS (Lim, et al., 2005). Studies show a positive impact of exercise on the people suffering from AS. Exercise increases the flexibility in the patients and it reduces pain which is suffered by the individuals having AS. Exercises are a recommended treatment for AS (Uhrin et al., 2000) and are the most important activity which helps AS patients in flexibility, posture, sleep, stiffness and pain (NASS, 2012). There are further researches required to see the impact of non-conventional exercises like aerobics on AS in a longer time span and to reduce the impact of AS even after a long time period by any designed physiotherapy (KARAPOLAT, H. et al., 2009) & (LEHTINEN, K. et al., 1995). Exercises are significant in the management and diagnosis of AS and the researches shows the statistical improvements that exercise results in the patients suffering from AS and these improvements. List of References ANALAY, Y., E. OZCAN, KARAN et al. 2003. The effectiveness of intensive group exercise on patients with ankylosing spondylitis. Clinical rehabilitation. 17(6), pp.631-636. ARA, RM, Packham JC, and Haywood KL. 2007. The direct healthcare costs associated with ankylosing spondylitis patients attending a UK secondary care rheumatology unit. Oxford Journals. 47(1), pp.68-71. BENJAMIN, RICHARD, and Peter PARHAM. 1990. Guilt by association: HLA-B27 and ankylosing spondylitis. Immunology today. 11, pp.137-142. BRIERLEY, Craig. 2007. Major genetic breakthrough for ankylosing spondylitis brings treatment hope. [online]. [Accessed 25 April 2013]. Available from World Wide Web: < HYPERLINK "http://www.wellcome.ac.uk/News/Media-office/Press-releases/2007/WTX041500.htm" http://www.wellcome.ac.uk/News/Media-office/Press-releases/2007/WTX041500.htm > BROWN, Matthew A., L. Gail Kennedy, Alex J. Macgregor, Chris Darke, Emma Duncan, Jane L. Shatford, Andrew Taylor, Andrei Calin, and Paul Wordsworth. 1997. Susceptibility to ankylosing spondylitis in twins the role of genes, HLA, and the environment. Arthritis & Rheumatism. 40(10), pp.1823-1828. CHIN and LEE. 2008. Principles and Practice of Clinical Trial Medicine. Oxford: Elsevier Inc. DAGFINRUD, HALVORSEN, VoLLESTAD et al. 2011. Exercise programs in trials for patients with ankylosing spondylitis: Do they really have the potential for effectiveness? Arthritis care & research. 63(4), pp.597-603. FERNANDEZ-DE-LAS-PENAS, Cesar, et al. 2005. Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. American journal of physical medicine & rehabilitation. 84(6), pp.407-419. GEOFFREY R. MARCZYK, David DeMatteo, David Festinger. 2005. Essentials of Research Design and Methodology. New Jersey: John Wiley & Sons Inc. INCE, G., T. SARPEL, B. DURGUN, and S. ERDOGAN. 2006. Effects of a multimodal exercise program for people with ankylosing spondylitis. Physical therapy. 86(7), pp.924-935. KARAPOLAT, H., S. EYIGOR, M. ZOGHI et al. 2009. Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study. European Journal of Physical and Rehabilitation Medicine. 45(4), p.449. LEHTINEN, K., J. SUNI, H KAUTIAINEN, and J.V. VIITANEN. 1995. Fifteen months' follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis. Clinical rheumatology. 14(4), pp.413-419. LIM, Hyun-Ja, Young-Im MOON, and Myeong Soo LEE. 2005. Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis. Rheumatology international. 25(3), pp.225-229. NASS. 2012. Exercise for your AS. [online]. [Accessed 25 April 2013]. Available from World Wide Web: < HYPERLINK "http://www.nass.co.uk/exercise/" http://www.nass.co.uk/exercise/ > SANDELOWSKI, Margarete. 1995. Sample size in qualitative research. Research in nursing & health. 18(2), pp.179-183. UHRIN, Zuzana, Susana KUZIS, and Michael WARD. 2000. Exercise and Changes in Health Status in Patients With Ankylosing Spondylitis. Arch Intern Med. 160(19), pp.2969-2975. WARD and MICHAEL. 2002. Predictors of the progression of functional disability in patients with ankylosing spondylitis. The Journal of Rheumatology. 29(7), pp.1420-1425. WEISMAN, Michael H. 2011. Ankylosing Spondylitis. New York: Oxford University Press. Appendix VAS: Visual Analogue Scale, used to measure subjective or behavioural phenomena such as pain. Beck Depression Inventory: is a twenty one multiple choice questions self report. BASFI: Bath Ankylosing Spondylitis Functional Index. BASMI: Bath Ankylosing Spondylitis Metrology Index. BASDAI: Bath Ankylosing Spondylitis Disease Activity Index. FVC: Forced Vital Capacity. VC: Vital Capacity. FeV1: Forced expiratory Volume in 1 second.  NHP: Nottingham Health Profile. CR: Complete Response. FFD: Finger-to-Floor Distance Read More