Beskrivelse af træningsinterventioner i RCT.

Studie

Sted

Uger
(antal)
Dage
pr.uge
(antal)
Pr. gang
(min.)
Intensitet
i
træningen

Beskrivelse af træningsinterventionen

Stanek 18

Indlæggelse

på kursted

2

5

60 min.

?

"Whole-Body Cryotherapy procedures lasting 3 minutes a day with a subsequent 60-minute session of kinesiotherapy".

"the temperature in the antechamber was −60° C, whereas in the proper chamber, it reached −120° C. After a 30-second adaptation
process in the antechamber, the patients were exposed to
cryogenic temperatures in the proper chamber for 3 minutes".

"Kinesiotherapy procedures included range-of-motion exercises
of the spine and major joints (including the ankle, knee, hip, wrist, elbow, and shoulder). Chest expansion and breathing exercises were also included. Apart from range-ofmotion exercise, the AS patients received strengthening exercises of the muscles of the major joints (including the ankle, knee, hip, wrist, elbow, shoulder, thoracolumbar spine, and cervical spine) as well as aerobic exercise (including cycling and fast walking). All the exercises were carried out under the supervision of physical therapists".

Souza 16

 

Hold

16

2

50

50-70% af 1RM

"underwent muscle-strengthening exercises with the aid of a ball and dumbbells. All the exercises required simultaneous muscle contraction of the latissimus dorsi, abdominal, paraspinal, gluteus, quadriceps and hamstring muscles to maintain stability on the ball". Udførligt træningsprogram under skema.

Altan 06

Hjemme

3

7

30

?

“respiration–postural exercises and dorsal/lumbar extension exercises”

Altan 12

Hold

12

3

60

Let-middel

Pilates, 9 moduler: “postural education, search for neutral position, sitting exercise, antalgic exercises, stretching exercises, proprioceptivity improvement exercises, breathing education”.

Hold

12

3

60

?

“continued previous standard treatment programs”. Ikke beskrevet

Bulstrode 87

Indiv.

3

5

?

3 x stræk

Udspænde hofteadduktorer: “contract and relax´technigue, follow by a passiv strecht”

Dragoi 15

Hold
+
hjemme

8

1, hold
 
5, hj.
40, ho
 
40, hj.

Borg Sc.

12-14

“motion and flexibility exercises of the cervical, thoracic, and lumbar spine; stretching of the hamstring muscles, erector spine muscle, and shoulder muscles; control abdominal and diaphragm breathing exercises and chest expansion exercises”. “The patients were required to achieve a level of perceived exertion on the Borg Scale 6–20 of ‘somewhat hard’ (12–14). 

Hold
+
hjemme

8

1, hold
 
3, hold
 
5, hj.
40, ho
 
30, ho
 
40, hj.

Borg Sc.

12-14

Se beskriv.

In addition to the conventional exercise training, patients in Group 1 performed supervised inspiratory muscle training in the outpatient rehabilitation centre, three times a week, using a real-time computer-assisted device (Trainair, Project Electronics Limited, United Kingdom). Over an eight-week period, this totalled 24 training sessions. The training load was based on 80% of the patient’s sustained maximum inspiratory pressure. The patients started by performing six loaded inspiration with a 60 sec ond rest period between each inspiration. This sequence of six exercises continued with 45, 30, 15, 10 and five second rest periods up to 36 loaded inspirations. Patients were encouraged to interrupt the training if they reached a perceived exertion of 17 (very strenuous) on the Borg Scale 6–20. The  training session duration was about 30 minutes”.

Dundar 14

Hold
Bassin

 

4

5

60

?

“15 min of poolside exercises including warming up, active range of motion (ROM), and stretching. Poolside exercises were followed with 40 min of aquatic exercises in the pool including warming up (such as walking forwards and backwards in the pool); aerobic exercises (such as jumping, jogging); active ROM of the joints of the all extremities and stretching of neck, trunk and all extremities; strengthening (such as hip adduction and abduction, knee flexion and extension); straight posture, respiratory exercises, and relaxation (such as lying supine). the program ended with cooling-down (such as slow walking and squatting) for 5 min”.

Hjemme

4

5

60

15-20 rep.
af hver øvelse

“muscle relaxation (such as deep breathing, stretching, and relaxing of different muscle groups in the body, lying supine) for 10 min; flexibility exercises for cervical, thoracic, and lumbar spine (such as bringing chin to the chest, looking up to the ceiling, thoracic flexion and extension, lumbar flexion and extension) ROM exercises of hip joints, stretching exercises for the major muscle groups (such as stretching exercises for shoulder muscles, abdominal muscles, erector spine, hamstring, quadriceps, hip flexors, and stretching of neck, trunk and all extremities) for 30 min; straight posture, respiratory exercises, and muscular strengthening (such as strengthening of muscle groups of upper and lower limbs and isometric exercise of the superficial trunk muscles) for 20 min”.

Fernan.-Peñas 05

 

Hold
(GPR)

15

1

60

Typisk 8-10 rep.

2 gange

“The experimental protocol is based on the postural affectation of the AS and the treatment of the shortened muscle chains in these patients according to the Global Posture Reeducation (GPR) method”. Øvelsesprogrammet er beskrevet rimeligt detaljeret.

Hold

(conv.)

15

1

60

Typisk 10 rep. 2 gange

“The conventional intervention consisted of 20 exercises: motion and flexibility exercises of the cervical, thoracic, and lumbar spine; stretching of the shortened muscles; and chest expansion exercises”. Øvelsesprogrammet er beskrevet rimeligt detaljeret, og vist efter skema. Udførligt træningsprogram under skema.

Gurcay 08

Hjemme

3

5

30

?

“The exercise program included range of motion, muscle strengthening, respiration, and postural exercises”.

Hidding 93 og 94

Hold

39

1

180

?

“1 hr of physical training, follow by 1 hr of sporting activities and 1 hr of hydrotherapy. The physical training included exercises to improve the mobility of the spine and peripheral joints and to strengthen the muscles of the trunk and legs. During the sporting activities the therapist emphasized stretching of the back, for instance through volleyball or badminton. Hydrotherapy was given in heated water (mean, 310 C; range, 290 – 320 C) to reduce pain and improve mobility of the spine and peripheral joints”.

Hjemme

39

7

30

?

“The patients received and individual exercise program that was directed at the hips joints, peripheral joints, and the entire spine”.

Studie

Sted

Uger
(antal)
Dage
pr.uge
(antal)
Pr. gang
(min.)
Intensitet
i
træningen

Beskrivelse af træningsinterventionen

Hsieh 2014

Hjemme

13

7, bevæg

?

Hver øv.

5 gange.

Let strækøv.

“the ROM group received instruction in range-of-motion exercise of the spine and major joints (including the shoulder, elbow, wrist, hip, knee, and ankle) from a senior physical therapist. Chest expansion and breathing exercise were also included”.

Hjemme

13

7, bevæg
2, styrk
3, kondi
?
?
30
10 rep., 60-80% 1RM.
50-80% af VO2 peak

“The COMB group received not only range-of-motion exercise, but also strengthening of the muscles of the major joints (including the cervical spine, thoracolumbar spine, shoulder,elbow,wrist,hip,knee,and ankle) and aerobic exercise (including fast walking, cycling, and swimming as suggested)”. 

Jennings 15

 

Hold

12

3

30

Hver øv.
3 gange i
30 sek.

“Stretching exercises were directed to the segments and muscle groups for the trunk and upper and lower limbs. Stretching exercises were performed in 3 repetitions of 30 s each”. “performed only stretching exercises for about 30 min 3 times per week for 12 weeks”. SE DETALJERET TRÆNINGSPROGRAM UNDER SKEMA.

Hold

12

3

80

anaerobic threshold heartrate

Konditionstræning: “(1) warmup for 5 min; (2) walking for 40 min at anaerobic threshold heartrate, previously

determined by ergospirometric test; (3) cool down for 5 min”. og “(4) stretching exercises for 30 min.”

Karapolat 09

Hjemme

6

6

30

?

1: “CE: all patients were instructed to perform CE comprised of flexibility exercises for cervical, thoracis an lumbar spine, stretching exercises for the muscle groups (erector spine, shoulder muscles, hipflexores, hamstrings and quadriceps stretch) and expiratory exercises (pursed-lip breathing, expiratory abdominal augmentation, and synchronization of thoracic and abdominal movement)”.

Hjemme
+ basin

6

+3

30

60-70%

Se beskriv.

Som 1 + Instructed to swim in free-style in a community swimming pool.””Sessions comprised of 10 min warm-up and 5 min stretching followby 30 min of swimming at a moderate intensity (60-70% heart rate [HR] reserve – 12 beats/minute), 10 min cooling down and 5 min stretching”

Hjemme
+ gå

6

+3

30

13-15 Borg.

Se beskriv.

Som 1 + “Walking exercise was performed at 60-70% of pVO2, at a level of 13-15 on the Borg scale and 60-70% heart reserve.

Kjeken 13

Indlæg-
gelse

3

5-7

100 –
130
Styrke: til udmattelse.
Kondi:
55-90% af
aldermax.
hjerte frekv.

“The physiotherapist designed a weekly exercise programme, which was a combination of exercises in the gym, in a hot water pool, and outdoor physical activities (Table I). In line with best practice in physiotherapy, doses, intensity, and frequency of the different elements in the package was individually adopted, to ensure an optimal starting level and progression for each patient. As recent research has revealed that AS is associated with an increased risk of CVD (5, 20), at least one of the daily exercise bouts had sufficient intensity for developing cardio-respiratory fitness (controlled by use of a heart rate monitor)”. Program efter skema

Kraag 90

Hjemme

16

7

?

?

“application of therapeutic exercise design to increase mobility of the spine, rib cage and peripheral joints as well as to increase muscle strength and endurance. These exercise were based on normal movement patterns and proprioceptive neuromuscular used worldwide by PT”.

Lim 05

Hjemme

8

7

30

?

“The exercise program consisted of 16 movements based on the exercise program recommended by the Spondylitis Association of America [10]. The program included exercises for muscle relaxation, flexibility, muscular strength, stronger breathing, and straight posture. The entire exercise duration was about 30 min, which included exercises such as the ‘‘stretch out’’, ‘‘cat-back’’ (sway-back), ‘‘hands and knees rock’’, neck flexion and extension, neck lateral movement, body rotation, hip flexor–quadriceps stretch, hamstring stretch, abdominal strengthening, hip extensor exercise, alternative hip extensor exercise, breathing, ‘‘shoulder circle’’, and pectoral muscle stretch”.  

Studie

Sted

Uger
(antal)
Dage
pr.uge
(antal)
Pr. gang
(min.)
Intensitet
i
træningen

Beskrivelse af træningsinterventionen

Masiero 11

 

Hold
 
Hjemme
6
 
6
2
 
3-4
60
 
60
Typisk 10 rep. 2 gange
 
Gang/cykel:
Lav fart og
ingen mod-stand

 

“The exercises illustrated in Appendix 2 consisted of 12 twice-weekly sessions lasting 60 minutes each, with groups of 4–6 subjects, supervised by an experienced physiotherapist. The protocol included analytic flexibility and muscle stretching exercises for the spine and limbs, proprioceptive training, and exercises to expand the chest and control abdominal and diaphragmatic breathing. Patients were taught how to perform the programmed exercises and encouraged to perform them at home at least 3 to 4 times per week in order to comply with the study. At the end of each meeting patients received an illustrated brochure on the program meeting with a home guide. At the Start of each session, feedback was provided and problems with home practice were discussed”. Øvelsesprogrammet er beskrevet rimeligt detaljeret, og vist efter skema.

Niedermann 13

Hold
Kondi.
+
Bevæg.

 

12

12

2

1

30

60

55-85% af
max. hjerte-frekvens.
?

Cardiovascular training.The training group performed a 12-week supervised NW [Nordic walking] training for 30 minutes twice a week using individually monitored, moderate-intensity heart rate (HR) levels. Moderate-intensity HR ranges of 55–75% and 65–85% of the maximum HR (HR) were used for participants who reached less than 100W and those who reached at least 100W, respectively, in the baseline bicycle test (10,11). The intensity range was adjusted if an individual exceeded the upper HR limit repeatedly or constantly during at least 20 minutes of activity. Participants with a low fitness status, i.e., having reached less than 100W in the test and not being able to perform the training in their individual lower fitness range for a sufficient duration of at least 20 minutes, were first max asked to keep walking for at least 20 minutes, and if this was achieved, to perform NW within the intensity range”. “Standard exibility exercise. All study participants received the current standard of care and attended a weekly 1-hour exercise group supervised by a physiotherapist, with focus on spinal flexibility as offered by the Swiss AS Association throughout Switzerland”.

Rodrig.-Lozano 13

Hjemme

24

?

?

?

”Patients were invited to implement the physical activity program at home, which involved stretching, deep brething, spinal extension, and range of motion exercises for the three spine segments, shoulders and hips (written version available on line at http://gresser.es). Patiens received the hole education programme in a printed and audiovisual DVD format to take home. The kit included 30 home exercises and 10 water exercises fro the swimming pool”. “The DVD included and “off voice” explaining each exercise and the number of repititions recommended”.

So 12

Hjemme

 

 

16

7

30

?

1: “The CE regimen consisted of 20 exercises for 30 min once a day. The exercises were motion and flexibility Exercises of the cervical, thoracic, and lumbar spine; stretching of the erector spine muscle, hamstring muscles, and shoulder muscles; chest expansion exercises; and control abdominal and diaphragm breathing exercises5.

Spirometer-øv.
med
modstand mod inspiration

17

7

30

Se beskrivelse

Som 1 + The combination group was also instructed how to use the incentive spirometer, as follows: (1) hold the device straight up in front; (2) breathe out; (3) close lips tightly around the mouthpiece; (4) inhale slowly and deeply through the mouth until the 3 balls in the incentive spirometer rise; (5) when the patient feels he or she cannot breathe in any longer, take the mouthpiece out of the mouth; (6) hold the breath for 3-5 seconds, then breathe out slowly. This was repeated for 30 min once a day”.

Tubergen 01

Indlæg-
gelse

3

5

120 –
240

?

“Every morning patients started with 1 hour of physical exercises, followed by 30 minutes of walking, and postural correction therapy by lying supine on a bed (initially 14 minutes, but increasing daily by 2 minutes to a final period of 30 minutes a day)”.

Hold

3

1

180

?

“Weekly group physical therapy consisted of 1 hour of physical exercises, 1 hour of sports, and 1 hour of hydrotherapy”.

Widberg 09

Indiv.

8

2

60

1

“The physiotherapeutic intervention consisted initially of warming up the soft tissue of the back muscles (with vibrations via a vibrator) and gentle mobility exercises. This was followed by both active angular and passive mobility exercises in the physiological directions of the joints in the spinal column and in the chest wall in three directions of motion (flexion/extension, lateral flexion and rotation) and in different starting positions (lying face down, sideways, on the back and in a sitting position). Passive mobility exercises consisted of general, angular movements and specific, translatory movements. Stretching of tight muscles was done using the contracting–relaxing method. Soft tissue treatment (manual massage) of the neck was performed followed by relaxation exercises in a standing position and resting for some minutes lying on the treatment bench”.

 
Nedenfor følger 4 udførlige træningsprogrammer af Souza 16, Jennings 2015, Fernández-de-las-Peñas 2005 og Masiero 2011,
og to overordnede træningsprogrammer af Kjekken 2013 og Tubergen 2001.

 Jennings 2015.


Fernández-de-las-Peñas 2005:

 

 

Masiero 2011:

 

 Kjekken 2013:

 

Tubergen 2001:

Souza 2016:

(A) Biceps – sitting on the ball, flexes and extends the forearm against resistance of free weight. Major muscles
acting: biceps, radial brachiobasilic; (B) triceps – sitting on the ball, hold the dumbbell with both hands, raise your arms so
they are perpendicular to the ground and performs flexion and extension of the forearm. Major muscles acting: triceps,
deltoid; (C) rowing – standing position, with one leg up and over the ball and the contralateral limb in extension and the
upper performs motion similar to rowing. Major muscles acting: teres major, teres minor, rhomboids and serratus anterior;
(D) squat – standing position, with the support of the ball in the lumbar, performs squat movement with weights in hands.
Major muscles acting: quadriceps, hamstrings, gluteus maximus and middle, rectus abdominis and latissimus dorsi;

(E) lateral rise – sitting on the ball, makes abduction of the upper limb against resistance. Major muscles acting: clavicular e
acromial deltoid; (F) crucifix – supine on the ball, with thoracic and lumbar spines on the ball, performs the abduction
movement of the upper limbs. Major muscles acting: pectoralis major, long head of the biceps; (G) abdominal – supine on
the ball, with a load on the pectoral region and lumbar spine on the ball, performs flexion of the trunk. Major muscles
acting: rectus abdominis, external and internal oblique, gluteus; (H) reverse crucifix – prone on the ball, kneeling on a
pillow, performs full extension of the arms. Major muscles acting: posterior deltoid, teres major, teres minor, trapezius.