1. FATIGUE Background: Recent studies - over half of people with AS experience fatigue – accepted as a core symptom. Fatigue is the main reason people with AS retire early. Currently - no specific agreed treatment/management for fatigue in AS. Previous studies suggest - pain management - education about improving sleep (NICE, 2007) - pharmacological interventions - graded exercise - psychological interventions such as CBT or Mindfulness may be helpful - NICE guidelines (2009) for RA recommends offering access to psychological interventions.

2. Research activity: Qualitative enquiry using focus groups to explore (1) the effect of fatigue (2) ways of self-managing fatigue and (3) Potential interventions for the future – Findings – (1). Fatigue affects were multi-dimensional including – physical (‘drained’), emotional (‘upset’ ) and psychological (low-mood’ ); (2) Self-management included a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Ref: Davies H, Brophy S, Cooksey R et al (in press) Patients perspectives of managing fatigue in Ankylosing Spondylitis, and views on potential interventions: a qualitative study. BMC Musculoskeletal Disorders

3. Mindfulness -Developed by Kabat-zinn - for managing pain – Mindfulness-Based Stress Reduction (MBSR). - The method of training includes mindfulness meditation techniques, including a body-scan meditation, breath works and mindful movement of simple stretches. -Traditionally MBSR - a group course (8 weeks, 2.5 hrs) -Through this method of training participants learn to become less reactive to personal experience, thereby decreasing suffering and increasing wellbeing. http://www.youtube.com/watch?v=NbizmVKHdgs&feature=related Previous research -A meta analysis (Grossman 2004) MBSR shown to have physical and psychological benefits in numerous health conditions. - Improve psychological distress and strengthen wellbeing in people with RA (Pradhan 2007) and QOL and fatigue in MS (2010) -MBCT – derived from MBSR is recommended in NICE guidelines (2009) for recurrent depression. -Media – schools – business – increasing popularity with NHS. -AS?

4. Current research Feasibility study of Mindfulness Intervention in AS - BUPA Foundation Mixed-method study - Is MBSR an acceptable management intervention for AS? (process evaluation) Invited n=126 PAS in Cardiff – (funding n=40) How many: interested, attended, completed, loss to follow-up – examined in relation to gender age, family status, employment, disease duration etc - Which participants attend? Explore the challenges and motivators of MBSR (telephone interviews) completed –part-completed – not interested. Examine the potential effectiveness of MBSR in AS - baseline questionnaires and 3 and 6 months follow-up to assess changes in: -Fatigue, pain, psychological wellbeing, QOL, sleep and Mindfulness practice Future research ideas RCT – MBSR v/s TAU (physiotherapy) 12 months + follow-up RCT – MBSR delivery (distance/group) Other ideas ? Questions? H.davies@swansea.ac.ukH.davies@swansea.ac.uk