The Impact of Cardiorespiratory Fitness on Cardiovascular Disease Risk in Ankylosing Spondylitis

By Spondylitis Association of America

Wednesday, August 22, 2018

Numerous studies have shown the benefits of exercise in individuals with ankylosing spondylitis (AS.) A consistent program can help maintain proper posture, increase flexibility, and may eventually help lessen pain. However, a study published by The Journal of Rheumatology has shown that cardiorespiratory fitness levels are also strongly associated with risks of cardiovascular disease (CVD) in those with AS. Specifically, those with AS and low cardiorespiratory fitness were shown to be at a much greater risk for CVD. The relationship was found to be independent of conventional CVD risk factors, as well as AS disease activity measures.

The study utilized a pool of 118 AS patients, 64% of which were male, with a mean age of the participants being 48.9 years. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity index (BASDAI) and Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP), both of which are subjective evaluation tools in which patients rate their symptoms on a 1-10 scale.

CVD risk was measured using a multidimensional analysis of the augmentation index (Alx)[1] and pulse wave velocity (PWV)[2], which were then cross referenced to oxygen uptake during treadmill use. After analyzing the data, researchers found an inverse relationship between oxygen uptake and AIx/PWV,  indicating that individuals with lower cardiorespiratory fitness have increased CVD risk. 

The authors noted that regular aerobic exercise can improve cardiorespiratory fitness and decrease CVD risk in those with AS. They also acknowledged that high disease activity or physical disabilities caused by AS can prevent patients from exercising. Improved control of AS symptoms will often be required in these cases. Additional further studies will need to be conducted in order to determine causation and the impact certain biomarkers may have had on study results.

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[1] Augmentation Index (AIx) - A measure of arterial stiffness, which can be used as a predictor for CVD and organ damage. It  is usually calculated based on ascending aortic pressure. 

[2] Pulse Wave Velocity (PWV) - A measure of the velocity at which an arterial pulse travels through the circulatory system. It is a quick and painless test that can be a strong measure for cardiovascular events or potential organ damage. A higher PWV score means higher arterial pressure and overall stiffer arteries, which is an indicator for increased CVD risk.

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Sources used and further reading

Lower Cardiorespiratory Fitness Associated With Increased CVD Risk in Ankylosing Spondylitis

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