EXercise Therapy in Axial SpA, Inflammation and Biologic Therapy (ExTASI-B)

NCT ID: NCT06669702

Last Updated: 2024-11-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-08-01

Study Completion Date

2029-07-31

Brief Summary

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The goal of this randomised controlled trial study is to investigate whether exercise (brisk walking, equal to 13 on a rating of perceived exertion scale; somewhat hard) can be used as an adjuvant therapy for people living with axial spondyloarthritis and taking biologic medications to further improve their quality of life and lower their symptoms and disease burden. The main questions it aims to answer are:

Does a 12-week structured home-based aerobic exercise intervention have a favourable effect on markers of immune-mediated inflammation and symptom severity?

As a secondary aim and outcome, this study will investigate:

* The acceptability of this intervention using questionnaires with free text boxes and one-to-one semi-structured interviews in a subset (50%) of participants (Q-ExTASI-B substudy).
* The effect of the home-based intervention on circulating markers of cardiometabolic health, anthropometrical measures, and immune markers that associate with systemic inflammation.
* The effect of the home-based intervention on objective measures of physical function and exercise tolerance

The study will compare the data of a healthy group with that of people living with axial spondyloarthritis. Within the patient population, 20 of the individuals will be allocated to the exercise group (randomly), and 20 will be allocated to the usual care group. In the exercise group, participants will be asked to do 30 minutes of brisk walking five days a week for 12 weeks, and they will be visiting Loughborough University every four weeks to provide blood samples and fill out questionnaires. Participants in the usual care group will continue with their current care routine and will visit the study site to provide blood samples and questionnaire data every 4 weeks. The data from all axSpA patients will be compared to healthy controls, and subgroup analysis will be conducted to investigate the difference between the exercise group and the usual care group.

Detailed Description

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Over 200,000 people in the UK have axial spondyloarthritis. In 80% of cases the condition begins in the second or third decade of life. Exercise is encouraged as an essential treatment of axial spondyloarthritis (axSpA), with the potential to both promote well-being, increase flexibility and range of movement, improve posture and reduce stiffness and pain. axSpA is an inflammatory arthritis and raised levels of indicators ('markers') of this inflammatory process (e.g. CRP) can be detected in the blood of patients. These markers are released as a consequence of the condition, but some, such as TNF-alpha and interleukin-17 (IL-17), also promote further disease development. In other inflamed patient groups we have shown that regular exercise (brisk walking) can lower the levels of these pro-inflammatory markers in the blood and increase levels of anti-inflammatory markers, independently of weight loss. Despite axSpA being an inflammatory condition with prescribed medication focused on reducing inflammation there are no studies that have assessed the potential of exercise to act as an anti-inflammatory adjuvant to biologic therapy in axSpA. This research will investigate the effect of 12 weeks of a home-based walking exercise intervention on measures of systemic inflammation and body composition, well-being and measures of disease activity using established and validated methods in 20 axSpA patients on regular biologic therapy and compare this group with 20 patients on regular biologic therapy who carry on with their standard care and normal levels of activity. Also, a baseline comparison will be conducted between a group of 20 healthy individuals and axSpA patients (40).This proof-of-concept study will determine the potential of exercise as an adjuvant anti-inflammatory treatment for patients with axSpA taking biologic medication.

Conditions

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Axial Spondyloarthrithis Inflammatory Diseases Arthritis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Random allocation into either a control group or an exercise group (12-weeks of home based exercise).
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Control

Healthy controls

Group Type NO_INTERVENTION

No interventions assigned to this group

Exercise

12-weeks of home based exercise involving 30 minutes of brisk walking on 5 days per week.

Group Type EXPERIMENTAL

12-week home based exercise

Intervention Type BEHAVIORAL

Patients allocated to the exercise arm will be prescribed a home-based walking exercise programme consisting of 30 minutes of walking on 5 days per week at an rating of perceived exertion in the range of 12-14 (somewhat hard). Each patient's heart rate range will be established during the baseline exercise test by recording the heart rate response at the required RPE target range. This will be provided to each patient to use in conjunction with the activity monitor they will be given to wear on their non-dominant wrist. The monitor reports heart rate and records daily steps, distance and activity duration.

Participants can break down the exercise time in a way that suits their time, i.e., they can do 3 × 10 minutes, 2 × 15 minutes, etc.

Routine care

Routine care

Group Type EXPERIMENTAL

Routine care

Intervention Type BEHAVIORAL

Participants in this group will continue with their current routine care and will be given a diary of exercises that they can do, which are usually given to them as part of their health care routine by physiotherapists or consultants. The diary has information about yoga-like stretching practices.

Interventions

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12-week home based exercise

Patients allocated to the exercise arm will be prescribed a home-based walking exercise programme consisting of 30 minutes of walking on 5 days per week at an rating of perceived exertion in the range of 12-14 (somewhat hard). Each patient's heart rate range will be established during the baseline exercise test by recording the heart rate response at the required RPE target range. This will be provided to each patient to use in conjunction with the activity monitor they will be given to wear on their non-dominant wrist. The monitor reports heart rate and records daily steps, distance and activity duration.

Participants can break down the exercise time in a way that suits their time, i.e., they can do 3 × 10 minutes, 2 × 15 minutes, etc.

Intervention Type BEHAVIORAL

Routine care

Participants in this group will continue with their current routine care and will be given a diary of exercises that they can do, which are usually given to them as part of their health care routine by physiotherapists or consultants. The diary has information about yoga-like stretching practices.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of axSpA by a consultant rheumatologist
* Age=/\>18 years old
* Without other significant cardiovascular comorbidities
* Receiving stable dose biologic treatment
* Able to commit to the time demands of the study


* Aged between 18 years old and 65 years old
* Not taking any long-term medication that affects inflammation or immune-mediated inflammation.
* Free from infection or infection symptoms

Exclusion Criteria

* Unable to undertake exercise due to physical or psychological barriers
* Presence of hip or peripheral joint disease
* Contraindication to exercise training (American College of Sports Medicine guidelines)
* Excessively active (score of high on IPAQ)
* Unable to communicate sufficiently in English
* Female participants who are pregnant, lactating, or planning pregnancy during the course of the study.
* Inability to give informed consent or comply with testing and training protocol for any reason.
* Presence of chronic anaemia (haemoglobin less than 13.5 g/dL for men; less than 12.0 g/dL for women; or haematocrit less than 41.0% in men, less than 36.0% in women.
* Co-morbidity that the research team determine to be a contraindication to involvement



The participant may not enter the study if ANY of the following apply:

* Unable to undertake exercise due to physical or psychological barriers
* Excessively active (score of high on IPAQ)
* Unable to communicate sufficiently in English
* Female participants who are pregnant, lactating, or planning pregnancy during the course of the study.
* Inability to give informed consent or comply with testing and training protocol for any reason.
* Have been diagnosed with or are aware of at least one of the following health issues:
* Immune system disorder
* Cardiovascular and/or cardiometabolic diseases, including but not limited to high blood pressure, high triglycerides and/or cholesterol levels, diabetes mellitus, etc.
* Any chronic health condition that affects one's ability to partake in physical activity
* Musculoskeletal injury that affects one's ability to partake in physical activity
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University Hospitals, Leicester

OTHER

Sponsor Role collaborator

Loughborough University

OTHER

Sponsor Role lead

Responsible Party

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Nicolette Bishop

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Arumugam Moorthy, Dr

Role: PRINCIPAL_INVESTIGATOR

University Hospitals, Leicester

Locations

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Loughborough University, National Centre for Sport and Exercise Medicine

Loughborough, Leicestershire, United Kingdom

Site Status RECRUITING

University Hospitals of Leicester NHS trust

Leicester, United Kingdom, United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Nicolette C Bishop, PhD

Role: CONTACT

01509226385

Matthew J Roberts, PhD

Role: CONTACT

Facility Contacts

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Nicolette C Bishop, PhD

Role: primary

015092266385

Matthew J Roberts, PhD

Role: backup

Clare Stevinson, PhD

Role: backup

Sepehr Qooja, MSc

Role: backup

Arumugam Moorthy, Dr

Role: primary

01162047800

References

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Roberts MJ, Hamrouni M, Linsley V, Moorthy A, Bishop NC. Exercise as an anti-inflammatory Therapy in Axial Spondyloarthritis Therapeutic Intervention (EXTASI) study: a randomized controlled trial. Rheumatol Adv Pract. 2024 May 11;8(2):rkae062. doi: 10.1093/rap/rkae062. eCollection 2024.

Reference Type BACKGROUND
PMID: 38854418 (View on PubMed)

Dungey M, Young HML, Churchward DR, Burton JO, Smith AC, Bishop NC. Regular exercise during haemodialysis promotes an anti-inflammatory leucocyte profile. Clin Kidney J. 2017 Dec;10(6):813-821. doi: 10.1093/ckj/sfx015. Epub 2017 Mar 27.

Reference Type BACKGROUND
PMID: 29225811 (View on PubMed)

Minuzzi LG, Rama L, Bishop NC, Rosado F, Martinho A, Paiva A, Teixeira AM. Lifelong training improves anti-inflammatory environment and maintains the number of regulatory T cells in masters athletes. Eur J Appl Physiol. 2017 Jun;117(6):1131-1140. doi: 10.1007/s00421-017-3600-6. Epub 2017 Apr 8.

Reference Type BACKGROUND
PMID: 28391394 (View on PubMed)

Viana JL, Kosmadakis GC, Watson EL, Bevington A, Feehally J, Bishop NC, Smith AC. Evidence for anti-inflammatory effects of exercise in CKD. J Am Soc Nephrol. 2014 Sep;25(9):2121-30. doi: 10.1681/ASN.2013070702. Epub 2014 Apr 3.

Reference Type BACKGROUND
PMID: 24700875 (View on PubMed)

Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol. 2011 Aug 5;11(9):607-15. doi: 10.1038/nri3041.

Reference Type BACKGROUND
PMID: 21818123 (View on PubMed)

Pecourneau V, Degboe Y, Barnetche T, Cantagrel A, Constantin A, Ruyssen-Witrand A. Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2018 Feb;99(2):383-389.e1. doi: 10.1016/j.apmr.2017.07.015. Epub 2017 Aug 30.

Reference Type BACKGROUND
PMID: 28860095 (View on PubMed)

Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta. 2010 Jun 3;411(11-12):785-93. doi: 10.1016/j.cca.2010.02.069. Epub 2010 Feb 25.

Reference Type BACKGROUND
PMID: 20188719 (View on PubMed)

Borg G, Hassmen P, Lagerstrom M. Perceived exertion related to heart rate and blood lactate during arm and leg exercise. Eur J Appl Physiol Occup Physiol. 1987;56(6):679-85. doi: 10.1007/BF00424810.

Reference Type BACKGROUND
PMID: 3678222 (View on PubMed)

Highton PJ, White AEM, Nixon DGD, Wilkinson TJ, Neale J, Martin N, Bishop NC, Smith AC. Influence of acute moderate- to high-intensity aerobic exercise on markers of immune function and microparticles in renal transplant recipients. Am J Physiol Renal Physiol. 2020 Jan 1;318(1):F76-F85. doi: 10.1152/ajprenal.00332.2019. Epub 2019 Nov 18.

Reference Type BACKGROUND
PMID: 31736354 (View on PubMed)

Billany RE, Smith AC, Stevinson C, Clarke AL, Graham-Brown MPM, Bishop NC. Perceived barriers and facilitators to exercise in kidney transplant recipients: A qualitative study. Health Expect. 2022 Apr;25(2):764-774. doi: 10.1111/hex.13423. Epub 2022 Jan 10.

Reference Type BACKGROUND
PMID: 35014114 (View on PubMed)

Schafer JL. Multiple imputation: a primer. Stat Methods Med Res. 1999 Mar;8(1):3-15. doi: 10.1177/096228029900800102.

Reference Type BACKGROUND
PMID: 10347857 (View on PubMed)

Other Identifiers

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IRAS project ID: 333667

Identifier Type: -

Identifier Source: org_study_id

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