Background/Purpose: Previous systematic reviews [1] and international consensus [2] have agreed that exercise is beneficial in ankylosing spondylitis (AS), and this concept is widely supported by patient groups. However, there is a paucity of information to guide exercise prescription.  There is a need for more information about different types of exercise, how long, to what intensity and how often it should be performed for maximal improvement. Results from studies on spa therapy and hospital in-patients may not be directly transferrable to other countries where most exercise therapy is prescribed on an outpatient basis. Finally, improvements in disease management with biological medication have raised questions about the relevance of exercise as a core component of management. This collaborative project, combining evidence with expertise, was therefore established to develop practical recommendations to guide Australian exercise prescription for individuals with AS.

Methods: Ten Physiotherapists participated in discussion rounds, to determine a set of eight key topic areas, using modified Delphi methodology. A systematic literature review was conducted for each topic, and a range of evidence analysed for level, quality and relevance to the clinical question and local setting.  Ten recommendations were developed, based on the integration of available evidence and expert opinion. The importance of the recommendations was validated by surveying both patient and health professional groups.

Results: A total of 202 papers were allocated to the key topic areas, the majority being surveys, cohort and case-controlled studies. Effect sizes were calculated for 20 randomised controlled trials, the range being 0.12-4.96. Exercise recommendations were developed for the following areas: assessment/evaluation; monitoring of exercise prescription; safety; biological therapy; ankylosing spondylitis-specific exercise; physical activity levels; setting; dosage and compliance. The average Strength of Recommendation was 9.0/10 (range 8.79-9.3) for patients and 9.5/10 (range 9.2-9.8) for health professionals. Valuable patient feedback was obtained regarding the relationship between health professional assessment / monitoring and compliance/ dosage. 

Conclusion: Although insufficient evidence was found to recommend one type of exercise over another, the group concluded that other factors, such as targeted exercise, safety, dosage and compliance were of equal priority, and that exercise prescription remains important (and is additive) for those patients also receiving biological therapy. Widespread dissemination of the recommendations will support appropriate exercise prescription as a key component for optimal patient outcomes.

References: [1]  Dagfinrud H, Hagen KB, Kvien TK. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database of Systematic Reviews Issue 1 2008            [2] Zochling J et al (2006). ASAS/EULAR recommendations for the management of ankylosing spondylitis.  Ann Rheum Dis 65: 442-452

ACR Meeting Abstracts - https://acrabstracts.org/abstract/exercise-for-ankylosing-spondylitis-it%e2%80%b2s-still-important/