The effects of spa treatment, acuatic exercise and land exercise on disease activity, symptoms, sleep quality, quality of life and serum sclerostin level in patients with ankylosing spondylitis

Objective: In this study, we aimed to investigate the effects of spa treatment, aquatic exercise and land exercise on disease activity, symptoms, sleep quality, quality of life and serum sclerostin level in patients with ankylosing spondylitis. Materials and Methods: 60 patients diagnosed with AS according to the Modified New York diagnostic criteria were included in our study. Patients were randomly assigned to aquatic exercise (20 patients), spa treatment (20 patients) or land exercise (20 patients) groups. To aquatic exercise group; A total of 60 minutes of treatment was given in the swimming pool at 32-33°C accompanied by a physiotherapist. To the spa group; In the 38-40°C hot spring pool, a total of 20 minutes of treatment was given as a whole body bath. To the land exercise group; A total of 60 minutes of treatment accompanied by a physiotherapist was given. All patients received treatment for 4 weeks, 5 days a week, a total of 20 sessions and a group form physiotherapy session composed of 5 6 people. Evaluation was made at the beginning of the treatment, at the end of treatment and at the 12th week. The demographic data of the patients (age, gender, body mass index (BMI), education level, smoking and alcohol use, duration of the disease and medicines used) were recorded. Disease activity was evaluated with BASDAI and ASDASCRP, functional status with BASFI, enthesitis with MASESS, spinal mobility with BASMI, quality of life with ASQoL, sleep quality with PSQI, fatigue levels with FSS. Serum sclerostin level measurement (with SunRed brand Human Sclerostin Elisa kit) was performed at the beginning of treatment, at the end of treatment and at 12th weeks, and the results were recorded as ng/dl. Statistical analysis was done with IBM SPSS Version 22. P <0.05 was considered statistically significant. Results: In terms of age, gender, duration of illness, education level, smoking and alcohol use, medicines used, BMI, BASDAI, BASFI, ASDAS-CRP, MASES, BASMI, chest expansion, ASQoL, FSS, total PSQI score and PSQI subcomponents, there was no statistically significant difference between the groups at the beginning. In the post-treatment and 12th week controls in all groups; Statistically significant and similar improvement was achieved in BASDAI, BASFI, MASES, BASMI, ASQoL and total PSQI scores (p <0.05). There was a statistically significant development in ASDAS-CRP and FSS in all three treatment groups after treatment and at the 12th week. Statistically more improvement was observed in ASDAS-CRP after treatment in the land exercise group. The advancement seen in the 12th week control in ASDAS-CRP was statistically more in the spa and land exercise groups than the aquatic exercise group. Statistically more progress was observed in FSS after treatment in the land exercise group. There was no significant difference between the groups in terms of improvement in FSS at the 12th week. In the aquatic exercise group; statistically significant enhancement was observed in chest expansion at posttreatment and 12th week. There was an increase in the chest expansion in the spa and land exercise groups after the treatment and at the 12th week controls, but this increase was not statistically significant. Better results were obtained in the sleep latency in the spa and aquatic exercise groups and in the sleep duration in the land exercise group. On the other components of sleep and the total PSQI score, the three groups showed similar efficacy. Changes in serum sclerostin level after treatment and at 12th week were not statistically significant. There was a weak positive correlation between serum sclerostin level and chest expansion, and a weak negative correlation between age, BMI and ESR. There was no correlation between serum sclerostin level and disease duration, BASDAI, ASDASD-CRP, BASFI, MASES, BASMI, ASQoL, PSQI, FSS and CRP. Conclusion: A statistically significant improvement in disease activity, spinal mobility, enthesis, sleep quality, fatigue, function and quality of life continued until 12th week after treatment with aquatic exercise, spa treatment and land exercise. Aquatic exercise was found to be more effective in developing chest expansion. This is the first study to examine the relationship between serum sclerostin level and non-pharmacological treatment approaches (land exercise, inwater exercise and spa treatment) in patients with AS. A similar increase from baseline was observed in serum sclerostin level in the 12th week in all three groups (this increase was not statistically significant). There was a weak positive correlation between serum sclerostin level and chest expansion, and a weak negative correlation between age, BMI and ESR.