Comparison of factors affecting physical activity level, exercise barriers and exercise compliance in radiographic and non-radiographic axial spondyloarthritis patients

Objective: We aimed to compare factors affecting physical activity (PA) level, exercise barriers and exercise compliance in patients with Radiographic Axial Spondyloarthritis (R-AxSpA) and Non-Radiographic Axial Spondyloarthritis (Nr-AxSpA). Materials and Methods: AxSpA patients who met the ASAS AxSpA classification criteria and healthy volunteers were included in this study. Participants' PA level, sleep quality, fatigue severity, neuropathic pain, perspective on exercise and exercise preferences were evaluated using the International Physical Activity Questionnare Short Form, Pittsburgh Sleep Quality Index, Fatigue Severity Scale, Exercise Barriers and Benefits Scale and questions from the Personalized Exercise Questionnare, respectively. Patients were additionally evaluated using the Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score with C-reactive protein, Bath Ankylosing Spondylitis Functional Index, ASAS Health Index, Health Assessment Questionare-SpA, Visual Analog Scale Pain Score, Bath Ankylosing Spondylitis Patient Global Score, Physician Global Assessment, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Ankylosing Spondylitis Quality of Life Questionnaire, Short Form-36, Fibromyalgia Syndrome Rapid Screening Test and Tampa Kinesiophobia Scale. In addition, data obtained using the accelerometer device (Actiwatch 2) for five consecutive days in AxSpA patients and healthy volunteers who gave written consent to data collection using the device were evaluated. Results: The frequency of being in the low PA category was higher in the AxSpA group than in the healthy control group (p = 0.002). The frequency of being in the high FA category was higher in the healthy control group than in the AxSpA group (p = 0.027). Perceived exercise benefits were lower in the AxSpA group compared to the control group (p<0.001). Perceived exercise barriers were lower in the AxSpA group compared to the control group (p<0.011). The frequency of meeting PA guideline recommendations was lower in the AxSpa group (20.3%) compared to the control group (38.3%) (p=0.009). There was no difference in PA level between Nr-AxSpA patients and R-AxSpA patients (p=0,654). Nr-AxSpA patients in the high PA category had lower HAQ-S, ASAS-HI and TSK scores than those in the low category (p=0,012, p=0,042, p=0,002, respectively). R-AxSpA patients in the high PA category had a lower HADS-A score than those in the low category (p=0,037). R-AxSpA patients' perceived exercise barriers were higher than Nr-AxSpA patients (p=0,023). In Nr-AxSpA patients, the highest level of correlation with PA was observed with BASDAI scores (rho: -0,455, p<0.05). In R-AxSpA patients, the highest correlation with PA was observed with plasma CRP level (rho: -0.448, p<0.001). Among Nr-AxSpA patients, BASDAI, HAQ-S, PSQI and TSK scores of those who met the PA guideline recommendations were lower than those who did not (p=0,043, p=0,030, p=0,046, p=0,004, respectively). Among R-AxSpA patients, those who met the PA guideline recommendations had lower ASQoL scores than those who did not (p=0.025). Conclusion: While there was no difference in physical activity levels and compliance between AxSpA subgroups, perceived exercise barriers were higher in R-AxSpA patients. It was observed that different parameters such as gender, age, disease activity, quality of life, physical function, kinesiophobia and educational status were among the factors affecting the PA and compliance of these patients. These findings emphasize the need to develop individualized approaches in clinical practices and to integrate these factors into treatment strategies to increase the PA level of AxSpA patients. Keywords: Physical activity, radiographic axial spondyloarthritis, non-radiographic axial spondyloarthritis, exercise barriers, exercise compliance