Axial spondyloarthritis is a chronic inflammatory rheumatic disease primarily affecting the spine and SI. Exercise is essential in the management of SpA to maintain or improve mobility, strength, cardiovascular health, function, quality of life and to limit spinal deformity.²

Literature shows that only advice is insufficient and approximately 50 % of patients do not adhere at all to exercises.  That is because when you prescribe certain exercises or  give physical activity advice, you wish that your patient shows new behavior and this new behavior can conflict with certain habits or routines of a patient and can be really hard to perform in their daily life.

Every behavior is influenced by different determinants for example motivation, patient’s self-efficacy, which is the confidence he or she has in their ability to actually perform this behavior. Other determinants include a patient’s planning skills, environment and there are many other factors that can either facilitate behavior or act as a barrier for this behavior. If we know these determinants, then especially for every individual patient, we can apply certain methods which can help to finally change the exercise behavior and eventually a patient’s quality of life.

If you want to learn more about this topic, you can watch Bas Hilberdink's lecture here:

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8 STEPS TO IMPROVE EXERCISE ADHERENCE IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS:

1) Guided practice

In order to improve patients self efficacy instead of just giving advice we can practice the exercises together with the patient which can also help us to check whether the execution is done right.

2) Motivational interviewing

The more you try to pull your patient to do what you think is best for him or her, the more a patient can get resistance to actually do this and in order to prevent this, you can try to evoke change talk. In this way you can stimulate a patient to talk about the pros themselves. We can do this by just asking questions. Some questions you can use to evoke change talk are, ‘what are the best reasons for you to exercise more?’ or ‘what steps can you take in order to improve your exercise? This makes the patient think about why it can be good to exercise more and hopefully get them more motivated to start doing them.

3) Self management training

Self-management is a model of care in which patients are encouraged to use strategies and learn skills to manage their own health needs. Patients are active participants and take responsibility for their own health care behaviours.3

4) Personalizing exercise advice

Personalizing exercise advice can be really helpful to influence a patient’s attitude towards exercise i.e instead of giving general advice about exercise in axSpA, it can be really helpful to get exercise advice for an individual patient according to their needs.

5) Patient education

Patient education about the disease, and the importance of exercise can influence a patient’s knowledge and improve their motivation to exercise more.

6) Exercise in group setting

Exercising in a group setting can be helpful to promote social support. Exercising with people having a similar condition helps to bond with them, increases motivation and prevents isolation.

7) Action planning

After you gave your exercise instructions and practice the exercise with your patients, you ask the patients to plan exactly in their week what to do, when and on what days and what times,where and for how long. You can also start with a less hard exercise routine and from there progress through time and increase their exercise behavior.

8) Training for physical therapists

Trained physical therapists are important as it improves the environment of the patient and plays a huge factor in patients adhering to exercise for long term.

If you want to learn more about this topic, you can watch Bas Hilberdink's lecture here:

Click here

Sources:

1. ‘Exercise therapy in Axial spondyloarthritis’ lecture by Bas Hilberdink

2. Level of adherence to prescribed exercise in spondyloarthritis and factors affecting this adherence: a systematic review; M. T. McDonald, S. Siebert

3. Use of Technology to Enhance Patient Self-Management; Physiopedia