Evidence summary (Updated 2022)
There is a high-quality evidence that physical activity and exercise interventions for patients with Ankylosing Spondylitis improves physical function outcomes and disease activity scores (1-6). Meta-analysis and systematic reviews report improvements in the Bath Ankylosing Spondylitis Functional Index (BASFI) with physical activity/exercises (2-6). However, it should be noted that there is significant heterogeneity amongst the dose and type of intervention. Examples include Swimming/Pilates/Global Posture Retraining, Aquatic exercises/walking/Nordiac walking/specific exercises and therefore we are unable to recommend one specific activity over another.
Since the initial scoping review, there has been further evidence to support the idea that physical activity interventions improve functional outcomes and diseases activity scores in patients with axial spondyloarthritis / ankylosing spondylitis (7-14). Numerous robust systematic reviews in these diseases have shown improvements in the BASFI in a range of exercises including aerobic, strength training, high intensity training and aquatic exercises. However again due to the heterogeneity amongst the interventions, definitive recommendations for one activity over another could not be made. Interestingly, there has been one systematic review and meta-analysis comparing aerobic exercise to physiotherapy that found that both interventions improved function and neither was superior to the other (15). Despite this, the cardiovascular benefits of aerobic exercise in reducing cardiovascular risk in this cohort of patient was also acknowledged as being important and therefore was still strongly recommended.
Furthermore, in psoriatic arthritis a recent robust systematic review by Kessler et al (16) of 13 studies showed that physical activity has widespread benefits in functional capacity, well-being, fatigue and quality of life. Moreover, they found that in the available data, physical activity has a low risk of triggering flares and enthesitis.
Quality of evidence
Grade A – High quality – Numerous systematic reviews with meta-analysis showing good improvement in functional outcomes across a range of inflammatory rheumatic diseases.
Strength of recommendation
Grade 1 – Strong recommendation – consistent benefits seen across studies
There is a strong evidence that physical activity and exercise interventions have been shown to improve physical function outcomes scores in those with axial spondyloarthritis and psoriatic arthritis. ……. Motivating people to keep physically active can help maintain independence and allow them to continue with employment and perform key activities.
- Millner JR, Barron JS, Beinke KM, et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin Arthritis Rheum. 2016;45(4):411-427.
- Pécourneau V, Degboé Y, Barnetche T, Cantagrel A, Constantin A, Ruyssen-Witrand A. Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2017.
- Saracoglu I, Kurt G, Okur EO, et al. The effectiveness of specific exercise types on cardiopulmonary functions in patients with ankylosing spondylitis: a systematic review. Rheumatol Int. 2017;37(3):409-421.
- Martins NA, Furtado GE, Campos MJ, Leitão JC, Filaire E, Ferreira JP. Exercise and ankylosing spondylitis with New York modified criteria: a systematic review of controlled trials with meta-analysis. Acta Reumatol Port. 2014;39(4):298-308.
- Health Do. Start Active, Stay Active. In: Strategy; 2011.
- Sveaas SH, Smedslund G, Hagen KB, Dagfinrud H. Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis. Br J Sports Med. 2017;51(14):1065-1072.
- Zejun Liang, Chenying Fu, Qing Zhang, Feng Xiong, Lihong Peng, Li Chen, Chengqi He & Quan Wei (2021) Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis, Disability and Rehabilitation, 43:7, 895-902, DOI: 10.1080/09638288.2019.1645218
- Liang H, Xu L, Tian X, Wang S, Liu X, Dai Y, Kang L, Chen L, Jin L, Li Q, Chen W. The comparative efficacy of supervised- versus home-based exercise programs in patients with ankylosing spondylitis: A meta-analysis. Medicine (Baltimore). 2020 Feb;99(8):e19229. doi: 10.1097/MD.0000000000019229. PMID: 32080122; PMCID: PMC7034711.
- Zou YY, Zhang HY, Xue L, Ye JJ, Hu GY. Traditional Chinese Eight Brocade Exercise Prescription for Ankylosing Spondylitis: A Quantitative Synthesis. Complement Med Res. 2020;27(6):449-453. English. doi: 10.1159/000505312. Epub 2020 May 28. PMID: 32464629.
- Hu X, Chen J, Tang W, Chen W, Sang Y, Jia L (2020) Effects of exercise programmes on pain, disease activity and function in ankylosing spondylitis: A meta‐analysis of randomized controlled trials. Eur J Clin Invest. https://doi.org/10.1111/eci.13352
- Zhao Q, Dong C, Liu Z, Li M, Wang J, Yin Y, Wang R. The effectiveness of aquatic physical therapy intervention on disease activity and function of ankylosing spondylitis patients: a meta-analysis. Psychol Health Med. 2020 Aug;25(7):832-843. doi: 10.1080/13548506.2019.1659984. Epub 2019 Sep 2. PMID: 31475583.
- Resende, G.G., Meirelles, E.d.S., Marques, C.D.L. et al. The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis – 2019. Adv Rheumatol 60, 19 (2020). https://doi.org/10.1186/s42358-020-0116-2
- Regnaux JP, Davergne T, Palazzo C, Roren A, Rannou F, Boutron I, Lefevre-Colau MM. Exercise programmes for ankylosing spondylitis. Cochrane Database Syst Rev. 2019 Oct 2;10(10):CD011321. doi: 10.1002/14651858.CD011321.pub2. Epub ahead of print. PMID: 31578051; PMCID: PMC6774752.
- Pécourneau V, Degboé Y, Barnetche T, Cantagrel A, Constantin A, Ruyssen-Witrand A. Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2018 Feb;99(2):383-389.e1. doi: 10.1016/j.apmr.2017.07.015. Epub 2017 Aug 30. PMID: 28860095.
- Verhoeven F, Guillot X, Prati C, Mougin F, Tordi N, Demougeot C, Wendling D. Aerobic exercise for axial spondyloarthritis – its effects on disease activity and function as compared to standard physiotherapy: A systematic review and meta-analysis. Int J Rheum Dis. 2019 Feb;22(2):234-241. doi: 10.1111/1756-185X.13385. Epub 2018 Sep 5. PMID: 30187695.
- Kessler, J., Chouk, M., Ruban, T. et al. Psoriatic arthritis and physical activity: a systematic review. Clin Rheumatol 40, 4379–4389 (2021). https://doi.org/10.1007/s10067-021-05739-y