Exercise behaviour in Ankylosing Spondylitis

Abstract

Background
Ankylosing spondylitis (AS) is an incurable, fluctuating, long-term condition for which prescribed
exercise is central to management. However, many people with AS do not undertake prescribed
exercises, the reasons for which are poorly-understood.

Aims
The project sought to develop a grounded understanding of the exercise beliefs of people with AS, the exercise behaviours they adopt, and the decision making processes they undergo when choosing
exercise behaviours.

Design
Adopting a constructivist approach, 23 semi-structured interviews and 7 focus groups were undertaken with people with AS in the North West of England. In-depth data were analysed using open, axial and selective coding to inform the development of a conceptual model of exercise behaviour in AS. Ethical approval and informed consent were obtained.

Key findings
48 people participated in interviews and focus groups, with a disease duration ranging from 6 months to 29 years, and age range 19-62 (mean age 44.8 years ) there were 37 men and II women.
Participants described the need to predict and respond to a changing disease trajectory and utilised a number of informed strategies for long- and short-term exercise management. Participants described a process of ongoing appraisal of their AS status and used approaches similar to cost—benefit analyses to make decisions about exercise behaviour. In the context of the patient journey, four discrete exercise behaviours (no prescribed exercise, other exercise, two tier behaviour, prescribed exercise), and four responses to changing disease status (no behaviour change, transient change, goal oriented change, non exercise change) were identified. Some key determinants of exercise behaviour were also revealed.

Conclusion
This study has led to the grounding of participant perspectives on exercise in AS, rendering the
proposed model both relevant and understandable to people with AS, and may have use in helping
people understand and plan their future exercise behaviour in AS and forms a baseline for future study.