Exercise programmes for ankylosing spondylitis

Ankylosing spondylitis is a chronic, inflammatory rheumatic disease that affects the axial skeleton and sacroiliac joints, causing characteristic inflammatory back pain due to sacroiliitis and spondylitis and the formation of syndesmophytes, leading to ankylosis of the spine. Men are more affected than women (2:1).
Treatments are aimed at reducing pain and stiffness of the back and sacroiliac joints and improving spine function. Exercise programmes focused on improving or maintaining spinal and thoracic mobility have been used to treat these patients and remain a part of disease management.
The aim of this Cochrane systematic review was to assess the benefits and harms of exercise programmes on physical function, pain, fatigue, and global assessment of disease activity in people with ankylosing spondylitis.
Fourteen randomised controlled trials with 1,579 participants (median age 45 years, range 39 to 47) that compared exercise programmes versus no intervention or versus usual care were included.
Authors found moderate- to low-quality evidence indicating that exercise programmes compared to no intervention probably slightly improve function, may reduce pain, and probably slightly reduce patient-assessed disease activity. Similar results were found when exercise programmes were compared to usual care (physiotherapy, medication, or self-management). In fact, moderate- to low-quality evidence showed that exercise programmes probably have little or no effect on improving function and reducing pain, and may have little or no effect on patient-assessed disease activity. Whether there was an effect on spinal mobility and fatigue is uncertain.
Further studies should investigate the effect of exercise therapy in the early stages of the disease, and exercise programmes should be evaluated at different stages as well. This evaluation would be useful to ascertain whether the combination of biologic agents and rehabilitation programmes in people with newly diagnosed or early ankylosing spondylitis are effective to prevent deformity and disability.

Comment by Francesco Agostini