Exercise programs in trials for patients with ankylosing spondylitis: Do they really have the potential for effectiveness?

Abstract

Objective. To evaluate if exercise programs in trials for patients with ankylosing spondylitis (AS) have the potential for effectiveness. Methods. A systematic literature search was performed and randomized trials examining the effectiveness of exercise programs for AS patients were analyzed according to 3 elements: whether the exercise programs were designed according to the American College of Sports Medicine (ACSM) recommendations for developing cardiorespiratory fitness, muscular strength, and flexibility; whether physiologic responses were properly measured; and whether adherence to programs was monitored. Results. Twelve trials with a total of 826 AS patients were evaluated. Five trials included cardiorespiratory exercise as a part of the exercise programs. One of these met the ACSM recommendations for intensity, duration, frequency, and length of the exercise period. This trial showed the greatest within-group improvement in aerobic capacity (effect size [ES] 2.19). Five trials included muscular strength training, but none measured the physiologic responses nor met the recommendations for improving muscular strength. Eleven trials included flexibility training, but the programs were poorly described overall. Small improvements in spinal mobility (ES range 0.02-0.67) were reported in all trials. Finally, 4 trials reported on participants' adherence to the exercise programs, but only 1 provided sufficient information to evaluate the possible influence of the adherence. Conclusion. The quality of interventions in exercise trials for patients with AS can be improved. Future trials should also focus on measuring and reporting physiologic responses and adherence to exercise interventions.

Exercise therapy for spondyloarthritis: a systematic review

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The Pilates method in the rehabilitation of musculoskeletal disorders: a systematic review

“…Ankylosing Spondylitis (AS) is a chronic disease characterized by rheumatic in lammation (37) of the axial skeleton and sacroiliac joints (38), which affects men more than women (37). Its main clinical manifestations include back pain and stiffness for more than three months, which improves with exercise, but is not relieved by rest (37).…”

“…Its main clinical manifestations include back pain and stiffness for more than three months, which improves with exercise, but is not relieved by rest (37). Involvement of peripheral joints is reported in approximately one third of patients, most often in the hip, shoulder and knee (38). Its etiology is unknown and there is still no cure, therefore treatment is aimed at relieving and preventing the symptoms (39).…”

“…The commonly used therapies consist of the administration of drugs and physical exercise. Physical activity and exercise are increasingly considered an important part of the treatment program (38). Hydrotherapy and exercises based on overall postural reeducation seem to offer a valid and promising alternative for these patients (39).…”

Efficacy of Intensive Physiotherapy in Combination with Low-dose Etanercept in Active Spondyloarthritis: A Monocentric Pilot Study

“…In contrast, nonpharmacological measures, such as physical therapy, appear to be more economical in this setting and have also shown a positive effect on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functionality Index (BASFI), as well as on pain and mobility 4 . Although the idea of combining these 2 treatment modalities is attractive, there is still a lack of high-quality studies that examine the effects of physical therapy in combination with drugs such as TNFi, particularly in everyday clinical settings 5,6 .…”