Recommendations for Exercise in Ankylosing Spondylitis
by David Borenstein, MD Executive Editor 10/2020
Australian researchers posed a series of questions to 11 experts on ankylosing spondylitis (AS) and produced 10 evidence and consensus-based recommendations on the role of exercise in AS. These recommendations provide an up-to-date, evidence-based approach to the full range of issues related to the use of exercise in AS and patients should discuss a comprehensive exercise program with their doctor.
Ten recommendations for Exercise in Ankylosing Spondylitis
- Assessment: AS patients should work with their physician to develop an individual exercise program that should be created following a thorough clinical assessment, which includes musculoskeletal and psychosocial factors, and AS-specific measures, including objective axial mobility and chest expansion.
- Monitoring: Monitoring and feedback should be provided on an individual basis, to achieve confidence and competence with the exercise program, and to inform changing needs. This is recommended at least annually, and more often as symptoms, function and mobility indicate.
- Safety: Physical changes from AS should be considered in all aspects of the exercise program, especially for those with more severe or later disease - not limited to bony change/ankylosis, balance and mobility changes, osteoporosis and cardiorespiratory consequences of the disease.
- Disease management: Exercise plus anti-TNFα therapy is better than anti-TNFα therapy alone.
- AS-specific exercises: Mobility: an exercise program should be developed with an emphasis on spinal mobility for the best management of AS. Maintaining mobility of peripheral joints is also essential.
- AS-specific exercise: Stretching, strengthening, cardiopulmonary and functional fitness are important components to include in a balanced exercise program (EBR grade A).
- Physical activity: Regular physical activity should be encouraged to promote general health, well-being and functional outcomes. No one activity has been found to be superior. Exercise frequency, intensity, duration and type must be tailored to the individual’s assessment findings, goals and lifestyle.
- Exercise frequency, intensity, duration and type must be tailored to the person findings, goals and lifestyle.
- Adherence: It is important to assess adherence with regular exercise, encourage motivation and promote ongoing self-management.
- Exercise setting: Priority should be given to patient preference in exercise choice, to enhance adherence and optimize positive outcomes.