Walking Football for Axial Spondyloarthritis

NICE guidelines recommend structured exercise programme as the non-pharmacological management of Axial Spondyloarthritis (axSpA), with hydrotherapy to be considered as adjunctive therapy. While limited hydrotherapy is provided at our hospital via the National Axial Spondyloarthritis Society (NASS) for some of our patients, there is a gap in the provision of structured exercise programme for axSpA patients in our community. We propose to offer Walking Football to fill this gap.

Walking Football is an inclusive sport, accommodating those with mild mobility impairments, as no jumping or running is allowed, and the ball in play is not permitted to exceed players' head-height. It could be an ideal form of exercise for axSpA patients, whose treatment goal is to maintain mobility in order to maximise quality of life. While the hydrotherapy currently offered helps to maintain joint flexibility and range of movement, Walking Football provides weight-bearing exercise which is key to maintaining bone health. Furthermore, the proposed Walking Football sessions will be led by exercise and football coaches, building on recent findings (van Wissen et al, 2024) that longstanding supervised exercise therapy was more effective in axSpA patients than usual care.

We have a group of axSpA patients who are interested in using Walking Football as part of their axSpA management, but there is a lack of literature on the safety and effectiveness of this. We thus plan to design and undertake a pragmatic feasibility study.

OBJECTIVES:

* To assess safety of Walking Football in players with axSpA
* To assess objective as well as patient-reported outcomes of a Walking Football intervention, including disease burden measures
* To assess feasibility of providing Walking Football in our community
* To maximise Patient and Public Involvement (PPI), gather information to inform a larger pilot/RCT

PLANNED OUTPUTS:

* Quantitative results showing effects of Walking Football on axSpA patients
* Qualitative results showing effects of Walking Football on patients' quality of life, and patient feedback on the intervention
* Academic publication, presentation at professional conference

IMPLEMENTATION:

Pompey in the Community (PitC), the charitable arm of Portsmouth Football Club, has agreed to run a 12-week programme of Walking Football at a local stadium, for up to 20 of our axSpA patients. This will be twice-weekly hour-long sessions, to be led by experienced exercise and football coaches. We intend to run clinical assessments (including MASES and BASMI) as well as self-reported disease burden surveys (including ASQoL, AS-WIS, HADS, BASFI, BASDAI, BAS-G, VAS, WASTEd scores) of each participant prior to, at the mid-point and after the end of this intervention.

Using our team's connection with axSpA patients via NASS and our Physiotherapy service, we will involve patients and relevant members of the community in PPI activities, to facilitate the qualitative elements of our research, including patient interviews and focus groups.

• Walking Football (Other), also known as Weight-bearing aerobic exercise: Walking football is a non-contact 5- to 7-a-side game, lower-impact on joints than standard football as no running or jumping is permitted.

Primary outcomes

• Clinical measurement and standardised disease burden questionnaires [12 weeks]: Clinical assessments including biometric data, MASES and BASMI scores, 6-minute walk test, sit-to-stand test, and injury surveillance reporting. Participant self-reported disease outcome and quality of life questionnaires including ASQoL, AS-WIS, HADS, BASFI, BASDAI, BAS-G, VAS, WASTEd and loneliness scale. All of the above clinical assessments, tests, as well as qualitative results will combine to determine whether Walking Football is/isn't a safe and beneficial form of exercise for axSpA patients.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Has a formal diagnosis of axial spondyloarthritis, as stated in existing clinical documents
* Able to walk independently without walking aids (note: there will be no upper age limit)
* Good understanding of spoken and written English

Exclusion Criteria:

* Under 18 years of age
* Significant disability affecting ability to play walking football
* Inability to commit to at least 18 of the 24 planned sessions of walking football
* Already a regular participant in local walking football sessions