High-intensity interval training for individuals with inflammatory back disease

Chronic back pain is a major public health issue with significant consequences, both for the individuals affected and for society. In most cases, the pain is temporary. Few cases are linked to a serious underlying condition, but in about one in ten, the symptoms become chronic. Chronic back pain causes both physical and mental suffering and leads to societal consequences such as increased healthcare use and reduced work capacity. By identifying and supporting those at the highest risk of developing chronic back pain at an early stage, suffering can be reduced and the impact on society limited.

Inflammatory back disease – spondyloarthritis – is a type of back pain caused by an underlying rheumatic condition. The disease is chronic, typically begins in young adulthood, and affects approximately 0.5 percent of the population. Stiffness, pain, and fatigue are characteristic symptoms that impact health and the ability to participate in society (for example, in work and leisure activities). Without treatment, the disease leads to inflammation around the spine and pelvic joints, causing the vertebrae to fuse together, which results in stiffness and pain. The condition also increases the risk of developing other diseases, such as cardiovascular disease, which is common among those affected.

Inflammatory back disease includes several sub-diagnoses, such as ankylosing spondylitis and psoriatic arthritis. Treatment involves both medication and regular, specific exercise to manage symptoms. Recent research has shown that higher-intensity exercise may reduce the risk of developing comorbidities, such as cardiovascular disease. Some studies also suggest that high-intensity exercise may help lower the inflammatory activity of the disease itself.

In an ongoing project conducted in collaboration with rheumatology clinics in southern Sweden, we aim to better understand and map both the short- and long-term effects of high-intensity interval training in individuals with inflammatory back disease.

The project began with an initial cross-sectional study in the fall of 2019, investigating the acute effects of a single high-intensity interval session. In a randomized controlled trial (RCT) launched in 2022, we are following participants with spondyloarthritis over the course of one year, comparing those who undergo 3 months of high-intensity training with a control group that does not engage in high-intensity training. The training takes place outside of conventional healthcare settings but is supported by digital physiotherapist coaching.

The aim is to examine the effects on inflammatory markers, as well as physiological and self-reported outcomes, after three months and one year. We also seek to gain insights into adherence to this type of personalized high-intensity training. Furthermore, the study is expected to provide a deeper understanding of how this training model and digital coaching can be implemented as a sustainable part of rehabilitation and care for individuals with inflammatory back disease.

In addition to pharmacological treatment, physical exercise is an important part of rehabilitation and self-care for individuals with inflammatory back disease. Exercise can have positive effects on both disease activity and cardiovascular health, but more knowledge is needed on how to best design, implement, and sustain such training. By monitoring inflammatory markers, physiological and self-reported health parameters, as well as incorporating participants' perspectives, the project can contribute to more personalized training and effective strategies for coaching and follow-up. A setup combining self-selected activities with tailored coaching may increase motivation and the ability to maintain higher-intensity exercise over time. With relatively simple methods, there is potential to support long-term behavioral change, and ultimately implement the model in clinical practice to improve quality of life and reduce morbidity in this or similar groups.

Preliminary results have been presented at national and international conferences, and scientific articles have been or are currently being prepared as data collection is completed.