{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T06:24:39Z","timestamp":1774938279038,"version":"3.50.1"},"reference-count":52,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Norwegian Research Counsel","award":["341869"],"award-info":[{"award-number":["341869"]}]},{"DOI":"10.13039\/100009471","name":"DAM foundation","doi-asserted-by":"crossref","award":["SDAM_HEL569420"],"award-info":[{"award-number":["SDAM_HEL569420"]}],"id":[{"id":"10.13039\/100009471","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Diakonhjemmet hospital"},{"name":"Grete Harbitz legacy"},{"name":"South-Eastern Norway Health Authorities","award":["2022091"],"award-info":[{"award-number":["2022091"]}]},{"name":"South-Eastern Norway Health Authorities","award":["2023086"],"award-info":[{"award-number":["2023086"]}]},{"name":"South-Eastern Norway Health Authorities","award":["2025065"],"award-info":[{"award-number":["2025065"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,18]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Current international guidelines recommend exercise as a first-line treatment of axial spondyloarthritis (SpA). However, there is no consensus on the mode and volume required to effectively reduce disease activity. It is advised that exercise for patients with SpA align with recommendations for the general population. For exercise to be sustainable and beneficial, it must be integrated into daily life and strategies to ensure long-term commitment are essential. The SpA Kardio (SPARK) trial aims to assess the impact of a remote, individually tailored exercise programme in patients with SpA with the proportion of patients reaching Axial Spondyloarthritis Disease Activity Score (ASDAS) inactive at 3\u2009months as the primary outcome. The exercise includes high-intensity cardiorespiratory intervals and muscle strength exercises, with digital follow-up and monitoring, in patients with SpA. The SPARK programme includes regular supervision, personalised follow-up, goal-setting and education delivered through an application available on smartphones or tablets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The SPARK trial is a randomised controlled superiority trial. Individuals recently diagnosed with SpA by a rheumatologist with disease activity measured by the ASDAS \u22651.3\u2009who have not used biological disease-modifying antirheumatic drugs (bDMARDs) are eligible for inclusion. Consenting individuals will be randomised to treatment as usual (n=130) or the SPARK programme (n=130) with 12-week duration. After 12\u2009weeks, all participants will be rerandomised to either a supervised or an unsupervised SPARK programme for weeks 12\u201324. The primary outcome will be achievement of an inactive disease state (ASDAS &lt;1.3) at week 12 in each group. Secondary outcomes include use of medication (bDMARDs and non-steroidal anti-inflammatory drugs (NSAIDs)), cardiorespiratory fitness, muscle strength, sleep quality and quantity, health-related quality of life, work participation, adverse events and disease activity at week 24 (ASDAS and the Bath Ankylosing Spondylitis Disease Activity Index). MRI of the lumbar spine and sacroiliac joints at baseline and full-body dual-energy X-ray absorptiometry will be performed in a subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The SPARK trial is approved by Regional Committee for Medical and Health Research Ethics in South-Eastern Norway (#684555). The SPARK trial will contribute important knowledge on effects of a tailored digital exercise programme with monitored remote follow-up in patients with SpA and may improve the initial care of patients in terms of disease activity and ensure use of bDMARDs according to modern guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06462937\">NCT06462937<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112420","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:56:19Z","timestamp":1774932979000},"page":"e112420","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Remote personalised exercise in axial spondyloarthritis: the SPARK trial \u2013 protocol for a 6-month randomised controlled trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06462937","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0156-5479","authenticated-orcid":false,"given":"Birgitte","family":"Nellemann","sequence":"first","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4109-3317","authenticated-orcid":false,"given":"Camilla","family":"Fongen","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"},{"name":"Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanne","family":"Dagfinrud","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inger Jorid","family":"Berg","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eirik Klami","family":"Kristianslund","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joe","family":"Sexton","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristine R\u00f8ren","family":"Nord\u00e9n","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siri","family":"Lillegraven","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"\u00d8ster\u00e5s","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway"},{"name":"Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanja Schj\u00f8dt","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"The Parker Institute, Value-Based Outcomes Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4401-2551","authenticated-orcid":false,"given":"Loreto","family":"Carmona","sequence":"additional","affiliation":[{"name":"Instituto de Salud Musculoesquel\u00e9tica (Inmusc), Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silje Halvorsen","family":"Sveaas","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sella Aarrestad","family":"Provan","sequence":"additional","affiliation":[{"name":"Centre for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Sykehus AS, Oslo, Norway"},{"name":"Section for Public Health, University of Inland Norway, Elverum, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"2026033021552509000_16.3.e112420.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31591-4"},{"key":"2026033021552509000_16.3.e112420.2","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200104)45:2<151::AID-ANR168>3.0.CO;2-T"},{"key":"2026033021552509000_16.3.e112420.3","doi-asserted-by":"publisher","DOI":"10.1080\/00015550252948130"},{"key":"2026033021552509000_16.3.e112420.4","doi-asserted-by":"crossref","DOI":"10.1007\/s11926-020-00932-5","article-title":"Work Disability in Axial Spondyloarthritis","volume":"22","author":"Nikiphorou","year":"2020","journal-title":"Curr Rheumatol Rep"},{"key":"2026033021552509000_16.3.e112420.5","first-page":"2167","article-title":"Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis","volume":"33","author":"Han","year":"2006","journal-title":"J Rheumatol"},{"key":"2026033021552509000_16.3.e112420.6","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.berh.2019.01.002","article-title":"Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis","volume":"32","author":"Liew","year":"2018","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2026033021552509000_16.3.e112420.7","doi-asserted-by":"crossref","first-page":"473","DOI":"10.2174\/1570161117666190426164306","article-title":"Cardiovascular Disease in Spondyloarthritides","volume":"18","author":"Papagoras","year":"2020","journal-title":"Curr Vasc Pharmacol"},{"key":"2026033021552509000_16.3.e112420.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-208174"},{"key":"2026033021552509000_16.3.e112420.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.681"},{"key":"2026033021552509000_16.3.e112420.10","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.010293","article-title":"Cardiorespiratory Fitness and the Risk of First Acute Myocardial Infarction: The HUNT Study","volume":"8","author":"Shigdel","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2026033021552509000_16.3.e112420.11","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1093\/eurheartj\/ehy708","article-title":"Peak oxygen uptake and incident coronary heart disease in a healthy population: the HUNT Fitness Study","volume":"40","author":"Letnes","year":"2019","journal-title":"Eur Heart J"},{"key":"2026033021552509000_16.3.e112420.12","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223296"},{"key":"2026033021552509000_16.3.e112420.13","doi-asserted-by":"crossref","first-page":"S340","DOI":"10.1016\/j.jacr.2021.08.003","article-title":"ACR Appropriateness Criteria\u00ae Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update","volume":"18","author":"Czuczman","year":"2021","journal-title":"J Am Coll Radiol"},{"key":"2026033021552509000_16.3.e112420.14","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099943"},{"key":"2026033021552509000_16.3.e112420.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2017.03.006"},{"key":"2026033021552509000_16.3.e112420.16","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-095841"},{"key":"2026033021552509000_16.3.e112420.17","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-023-01863-8"},{"key":"2026033021552509000_16.3.e112420.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-015-0254-9","article-title":"High-intensity interval exercise training for public health: a big HIT or shall we HIT it on the head?","volume":"12","author":"Biddle","year":"2015","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2026033021552509000_16.3.e112420.19","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00164.2004"},{"key":"2026033021552509000_16.3.e112420.20","doi-asserted-by":"crossref","DOI":"10.1186\/s13102-022-00397-2","article-title":"The effect of exercise on cytokines: implications for musculoskeletal health: a narrative review","volume":"14","author":"Docherty","year":"2022","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"2026033021552509000_16.3.e112420.21","doi-asserted-by":"crossref","first-page":"101504","DOI":"10.1016\/j.berh.2020.101504","article-title":"Exercise and inflammation","volume":"34","author":"Metsios","year":"2020","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2026033021552509000_16.3.e112420.22","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2014.193"},{"key":"2026033021552509000_16.3.e112420.23","doi-asserted-by":"crossref","DOI":"10.1186\/s13102-024-00913-6","article-title":"Facilitators, barriers and support needs to GLA:D exercise adherence - a mixed method study","volume":"16","author":"Matile","year":"2024","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"2026033021552509000_16.3.e112420.24","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.pec.2019.12.017","article-title":"How to optimize exercise behavior in axial spondyloarthritis? Results of an intervention mapping study","volume":"103","author":"Hilberdink","year":"2020","journal-title":"Patient Educ Couns"},{"key":"2026033021552509000_16.3.e112420.25","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.reuma.2017.06.014","article-title":"Recommendations for the prescription of physical exercise for patients with spondyloarthritis","volume":"15","author":"Fl\u00f3rez Garc\u00eda","year":"2019","journal-title":"Reumatol Clin (Engl Ed)"},{"key":"2026033021552509000_16.3.e112420.26","doi-asserted-by":"crossref","DOI":"10.2196\/38501","article-title":"The Impact of a Theory-Based mHealth Intervention on Disease Knowledge, Self-efficacy, and Exercise Adherence Among Ankylosing Spondylitis Patients: Randomized Controlled Trial","volume":"24","author":"Song","year":"2022","journal-title":"J Med Internet Res"},{"key":"2026033021552509000_16.3.e112420.27","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s00296-018-4225-8","article-title":"Level of adherence to prescribed exercise in spondyloarthritis and factors affecting this adherence: a systematic review","volume":"39","author":"McDonald","year":"2019","journal-title":"Rheumatol Int"},{"key":"2026033021552509000_16.3.e112420.28","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093224"},{"key":"2026033021552509000_16.3.e112420.29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/sms.12581","article-title":"Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases","volume":"25 Suppl 3","author":"Pedersen","year":"2015","journal-title":"Scand J Med Sci Sports"},{"key":"2026033021552509000_16.3.e112420.30","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-020-0461-x"},{"key":"2026033021552509000_16.3.e112420.31","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2019-001014","article-title":"EULAR points to consider for the development, evaluation and implementation of mobile health applications aiding self-management in people living with rheumatic and musculoskeletal diseases","volume":"5","author":"Najm","year":"2019","journal-title":"RMD Open"},{"key":"2026033021552509000_16.3.e112420.32","doi-asserted-by":"crossref","first-page":"92","DOI":"10.37349\/emd.2024.00038","article-title":"Empowering rheumatology through digital health technologies: contributions and barriers","volume":"2","author":"Benavent","year":"2024","journal-title":"Explor Musculoskeletal Dis"},{"key":"2026033021552509000_16.3.e112420.33","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"2026033021552509000_16.3.e112420.34","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-3-201302050-00583"},{"key":"2026033021552509000_16.3.e112420.35","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20150668"},{"key":"2026033021552509000_16.3.e112420.36","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h2147","article-title":"The PRECIS-2 tool: designing trials that are fit for purpose","volume":"350","author":"Loudon","year":"2015","journal-title":"BMJ"},{"key":"2026033021552509000_16.3.e112420.37","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e318213fefb"},{"key":"2026033021552509000_16.3.e112420.38","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0b013e3180304570"},{"key":"2026033021552509000_16.3.e112420.39","first-page":"2286","article-title":"A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index","volume":"21","author":"Garrett","year":"1994","journal-title":"J Rheumatol"},{"key":"2026033021552509000_16.3.e112420.40","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.100826"},{"key":"2026033021552509000_16.3.e112420.41","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(89)90047-4"},{"key":"2026033021552509000_16.3.e112420.42","doi-asserted-by":"publisher","DOI":"10.1002\/art.22226"},{"key":"2026033021552509000_16.3.e112420.43","doi-asserted-by":"crossref","DOI":"10.1186\/1477-7525-5-63","article-title":"The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation","volume":"5","author":"Tennant","year":"2007","journal-title":"Health Qual Life Outcomes"},{"key":"2026033021552509000_16.3.e112420.44","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-199304050-00006"},{"key":"2026033021552509000_16.3.e112420.45","first-page":"675","article-title":"An experimental study of physical fitness of Air Force personnel","volume":"10","author":"BALKE","year":"1959","journal-title":"U S Armed Forces Med J"},{"key":"2026033021552509000_16.3.e112420.46","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908-1590ST"},{"key":"2026033021552509000_16.3.e112420.47","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.a2390","article-title":"Improving the reporting of pragmatic trials: an extension of the CONSORT statement","volume":"337","author":"Zwarenstein","year":"2008","journal-title":"BMJ"},{"key":"2026033021552509000_16.3.e112420.48","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-221007"},{"key":"2026033021552509000_16.3.e112420.49","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/978-981-15-1792-1_1","article-title":"An Overview of the Beneficial Effects of Exercise on Health and Performance","volume":"1228","author":"Kramer","year":"2020","journal-title":"Adv Exp Med Biol"},{"key":"2026033021552509000_16.3.e112420.50","unstructured":"Ligouri Gm Feito Y , Brad AR . ACSM\u2019s guideline for exercise testing and prescription. 11th edn. 2021: Wolters Kluwer,"},{"key":"2026033021552509000_16.3.e112420.51","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.140337"},{"key":"2026033021552509000_16.3.e112420.52","unstructured":"Andersen SA , Kolle E , Lohne Seiler H , et al . Fysisk form blant voksne og eldre i Norge. Resultater fra en kartlegging i 2009-2010. 2010."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-112420","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:56:33Z","timestamp":1774932993000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-112420"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":52,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,30]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bmjopen-2025-112420"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-112420","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}