Evidence summary (Updated 2022)
Maintaining spinal and peripheral joint mobility is essential for people with ankylosing spondylitis. Millner et al. meta-analysis (included 11 RCTs) and consensus statement suggest that this can be achieved through a variety of exercise interventions including active stretching, specific physiotherapy-based programmes, swimming, walking and tai chi (1). Mobility outcomes included lumbar flexion, cervical mobility, chest expansion and fingertip to floor distance were all improved following exercise interventions (1). One approach was found not to be superior to another. Activity selection should be based on the individuals’ preference and goals. Millner et al. recommends an individual exercise prescription with an emphasis on spinal mobility is paramount for best management of ankylosing spondylitis.
There has been conflicting evidence regarding mobility since the last scoping review in ankylosing spondylitis. No systematic reviews were identified measuring flexibility directly however the BASMI is often used as a surrogate marker for this given the nature of the measurements. A robust systematic review by Regnaux et al (2) found very low quality of evidence of any important clinically meaningful improvement with exercise (MD ‐1.2, 95% CI ‐2.8 to 0.5; 2 studies, 85 participants; absolute reduction 12%, 95% CI 5% less to 28% more). However, another systematic review by Liang et al (3) found that a supervised based exercise programme compared to a home-based programme was associated with a reduction in BASMI (mean difference [MD], -0.45; 95% confidence interval [CI], -0.73, -0.17).
In view of the lack of evidence and low- quality nature of the studies found, it is difficult to make any significant changes in recommendations compared to the previous scoping review.
Quality of evidence
Grade B – Moderate quality evidence in AxSpA
Strength of recommendation
Grade 2 – Weak recommendation in AxSpA
A variety of physical activity and exercise interventions have been shown to improve mobility outcomes in the original scoping review however this has not been replicated in more recent systematic reviews. Generally, it is advised that activity selection should be based on individual preference and a specific emphasis on spinal mobility is recommended.
- 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.
- 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.
- 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.