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IRD AS – Manage fatigue, pain and stiffness

Manage fatigue, pain and stiffness

Evidence summary

Fatigue, stiffness and pain are frequent symptoms in people with ankylosing spondylitis. Fatigue can be particularly challenging to manage. There is a strong evidence base that physical activity and exercise interventions can help improve fatigue levels and disease activity scores[2-6]. Meta-analyses and systematic reviews consistently show a small to modest improvement in disease activity scores regardless of the physical activity prescription/specific exercise intervention [3-6].  Pécourneau et al meta analysis reported a weighted mean difference (interval) was -0.90 for the BASDAI and -0.72 for the functions score in favour of exercise programs[3].

Quality of evidence

High quality

Strength of recommendation



There is a strong evidence that physical activity and exercise interventions can help improve symptoms of fatigue, pain and stiffness with improvement seen in disease activity scores. It should be recommended alongside medication. Recommending a gradual start  with paced activity is a helpful way for individuals to regain control and address these symptoms.


  1. Missaoui B, Revel M. Fatigue in ankylosing spondylitis. Ann Readapt Med Phys. 2006;49(6):305-308, 389-391.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.