ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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ORIJINAL ARAŞTIRMA

Anti-TNF Alfa Tedavisi Alan ve Almayan Ankilozan Spondilit Hastalarında Ev Egzersizlerinin Kas Gücü Üzerine Etkileri
The Effects of Home-Based Exercises on Muscle Strength in Ankylosing Spondylitis Patients Treated with or without Anti-TNF Alpha
Received Date : 04 May 2021
Accepted Date : 09 Sep 2021
Available Online : 13 Jan 2022
Doi: 10.31609/jpmrs.2021-83989 - Makale Dili: EN
J PMR Sci. 2022;25(1):73-81
ÖZET
Amaç: Bu çalışma, tümör nekroz faktörü (TNF) inhibitör ajan tedavisi alan/almayan ankilozan spondilit (AS) hastalarında 6 haftalık evde egzersiz programının hastalık aktivitesi, omurga ağrısı, fonksiyonel durum, kas gücü ve dayanıklılık üzerindeki etkilerini incelemeyi amaçlamaktadır. Gereç ve Yöntemler: Çalışmaya toplam 44 AS hastası dâhil edildi. En az 3 ay anti-TNF ajan tedavisi alan 23 hasta anti- TNF alfa grubunu oluşturdu. Yirmi bir hasta ise non-anti-TNF alfa grubunu oluşturdu. Evde egzersiz programı, her iki gruptaki hastalara bir fizyoterapist tarafından gösterildi ve 6 hafta boyunca her gün uygulandı. Hastalar 6. haftanın başında ve sonunda değerlendirildi. Vizüel analog skala (VAS)-spinal ağrı, Uluslararası Fiziksel Aktivite Anketi-Kısa Form [International Physical Activity Questionnaire-Short Form (IPAQ-SF)], Bath Ankilozan Spondilit Hastalığı Aktivite İndeksi [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)], Bath Ankilozan Spondilit Fonksiyonel İndeksi [Bath Ankylosing Spondylitis Functional Index (BASFI)] ve modifiye Schober testi uygulandı. İzokinetik kas kuvveti, izokinetik dinamometre ile ölçüldü. İzokinetik parametreler, pik tork [peak torque (PT)], pik tork/vücut ağırlığı [peak torque/body weight (PK/BW)] ve iş yorgunluğu [work fatigue (WF)] değerlerini içermekteydi. Bulgular: Altıncı hafta sonunda anti-TNF alfa grubunda BASDAI, BASFI, modifiye Schober, göğüs ekspansiyonu, PT, PT/BW ve WF değerlerinde anlamlı düzelme gözlendi (p<0,05). Non-anti-TNF alfa grubunda BASDAI, BASFI, VAS-spinal ağrı ve göğüs ekspansiyonu parametrelerinde iyileşme sağlanmasına rağmen (p<0,05), modifiye Schober ve izokinetik parametrelerde düzelme olmadı (p>0,05). Sonuç: Evde yapılan egzersizler, medikal tedaviden bağımsız olarak hastalık aktivitesi, fiziksel işlev, ağrı ve omurga hareketliliğinde iyileşme sağlar. Egzersizin anti-TNF alfa kullanan hastalarda kas gücünü artırdığı belirlenmiştir. Olası mekanizmaları netleştirmek için daha fazla çalışmaya ihtiyaç vardır.
ABSTRACT
Objective: The present study aims to examine the effects of 6-week home-based exercise program on disease activity, spinal pain, functional status, muscle strength and endurance among ankylosing spondylitis (AS) patients under medical therapy with/without tumor necrosis factor (TNF) inhibitor agents. Material and Methods: A total of 44 AS patients were included, 23 patients receiving at least three months of anti-TNF agents formed anti-TNF alpha group and 21 patients formed non-anti-TNF alpha group. Home-based exercise program was demonstrated by a physiotherapist to the patients in both groups and done every day for 6 weeks. Patients were evaluated at the beginning and the end of the 6th week. Visual analog scale (VAS)-spinal pain, International Physical Activity Questionnaire-Short Form (IPAQSF), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and modified Schober test were performed. Isokinetic muscle strength was measured by an isokinetic dynamometer. Isokinetic parameters comprised peak torque (PT), peak torque/body weight (PT/BW) and work fatigue (WF) values. Results: At the end of the 6th week, in anti-TNF alpha group, a significant improvement was observed in BASDAI, BASFI, modified Schober, chest expansion, PT, PT/BW and WF values (p<0.05). In nonanti- TNF alpha group, although an improvement was achieved in BASDAI, BASFI, VAS-spinal pain and chest expansion parameters (p<0.05), there was no improvement in modified Schober and isokinetic parameters (p>0.05). Conclusion: Home-based exercises provide improvement in disease activity, physical functioning, pain and spinal mobility, regardless of the medical treatment. Exercise has been determined to improve muscle strength in patients using anti-TNF alpha. Further studies are required to clarify the possible mechanisms.
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