One approach she recommends is global postural re-education—an active and passive form of physiotherapy that focuses on stretching the anterior kinetic chain muscles. “We really need to try and open up the hip flexors, as well as the anterior trunk muscles and the posterior kinetic chain,” she said. This approach must be facilitated by a physiotherapist and can be used for a number of different spinal disorders, including axSpA.
A study published in 2017 found postural re-education was effective in reducing pain as well as improving function.3 “We know if we can keep our patients in good posture, it will minimize pain and maximize function,” Ms. Passalent said.
Ms. Passalent said exercise guidelines from the American College of Sports Medicine (ACSM) can be adapted for axSpA patients.4 She noted the EULAR recommendations are, to some degree, aligned with the ACSM’s. Specifically, they agree that physical activity should be part of a general plan to optimize health-related quality of life and offers health benefits for people with axSpA. They also agree on the four domains to target with exercise: cardiorespiratory fitness, muscle strength, flexibility and neuromotor performance.
Example: The ACSM recommends stretching major muscle groups two to three times weekly, with a 10- to 30-second hold, and at least two to four repetitions per muscle group. “We want to focus on soft tissue, as well as joint mobility for both the axial and peripheral joints,” Ms. Passalent said.
Strength Training Recommended
Another focus? Strength. “Everyone should do some form of strength training two to three times per week, with 10–15 repetitions for at least one set,” Ms. Passalent said. “We want to target the core muscle groups and also joint stability.
The hip abductors are a good example, because the gluteal muscles are very involved in supporting the hip, and people with ankylosing spondylitis are at higher risk of developing peripheral joint involvement, predominantly in the proximal large joints.
A recent Swedish study reported that a combination of cardiorespiratory and muscular strength exercises at high intensity over three months reduces disease activity.5 The 100 subjects ranged in age from their 20s to their 60s and were supervised two days per week by a physical therapist. The subjects exercised independently at home one day per week. A control group received standard care and maintained their usual physical activity level.
“High-intensity exercise reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improved patients’ function and [cardiovascular] health. This debunks concerns that high-intensity exercise might exacerbate disease activity in patients with axSpA,” the researchers concluded.
