An Approach to Physical Activity & Exercise in Axial Spondyloarthritis

‘Physical therapy is a mainstay of managing rheumatic diseases, but what’s the evidence, how do we monitor, and what types of therapy should we advocate?’ asks Physician Editor Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS. ‘Here, we provide some practical recommendations for the everyday rheumatologist.’

Physical activity, including occupational and recreational activities, is one of the cornerstones of nonpharmacological therapy in patients with axial spondyloarthritis (axSpA). Engaging in regular physical activity offers a wide range of benefits with positive impacts on individuals, promoting not only physical health, but also mental and emotional well-being.

Defined as “any bodily movement produced by skeletal muscles that results in energy expenditure,” physical activity encompassing all forms of movement, whether planned or spontaneous.¹ Exercise is considered a specific type of physical activity, a planned, structured and repetitive bodily movement done to improve or maintain one or more components of physical fitness.¹

The Effects in axSpA

In patients with axSpA, physical activity, including exercise, has positive effects on several disease outcomes independent from pharmacological therapy, such as disease activity, physical function and general health.^2,3 A study by Coulter et al. found that physical activity can improve physical function, exercise capacity and spinal mobility in patients with axSpA.⁴ Conversely, inactivity was found to be associated with lower quality of life.⁴

Pécourneau et al. found that exercise programs can improve disease activity and physical function in patients with axSpA.⁵

A systematic review by O’Dwyer et al. found that exercise interventions in patients with axSpA can improve physical function, disease activity, chest expansion, pain, stiffness, spinal mobility and cardiorespiratory function.⁶

In a study by Liang et al., the authors found that home-based exercise interventions can improve physical function, disease activity, depression and pain scores in patients with axSpA.⁷ However, a recent review also underscores the paradoxical effects of physical exercise in patients with axSpA, finding that excessive or inappropriate physical activity can lead to increased inflammation, pain and potential damage.⁸

Considering the overall evidence points to a more favorable outcome than harm, it is important to achieve a balance and tailor the exercise plan to each patient’s specific needs and limitations.

Exercise Recommendations

For adults with chronic rheumatic conditions, including axSpA, recommendations include performing 150–300 minutes of moderate intensity exercise or 75–150 minutes of vigorous intensity aerobic exercise each week, or an equivalent of combined aerobic exercise.^9,10 Additionally, muscle strengthening activities of moderate or high intensity involving all major muscle groups on two or more days a week is recommended.⁹