Axial spondyloarthritis (axSpA) is a long-term inflammatory condition affecting the spine. Patients with this condition can have pain and stiffness in their back and neck. NICE Guidelines recommend that these patients should follow a structured exercise programme with additional hydrotherapy, to maintain mobility and flexibility, so as to improve quality of life.

While there is limited hydrotherapy provided in Portsmouth to approximately 40 axSpA patients via the National Axial Spondyloarthritis Society (NASS), there is no bespoke structured exercise programme for over 400 axSpA patients under the care of the Rheumatology Department, other than exercise advice which patients are asked to follow in their own time.

We propose twice-weekly Walking Football sessions for our axSpA patients as a structured exercise programme. Walking Football is an inclusive sport, with proven health benefits to other patient groups. Unlike traditional football, walking football is a non-contact sport; players are not allowed to run or jump, and the ball must stay below head height. In this way, people with some mobility impairment or mild frailty can still play. In addition to getting regular physical exercise, twice-weekly sessions would provide training in a sporting skill, as well as give opportunities to connect with other players socially, providing mental health benefits.

We have a number of axSpA patients who are keen to try Walking Football as part of their axSpA management, but there is a lack of evidence on the safety and effectiveness of this. We thus plan to undertake a 12-week pragmatic feasibility study to gather this evidence.

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.

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