title: Outcome of an education and home-based exercise programme for patients with ankylosing spondylitis: a nationwide randomized study. Two Exercise Interventions for the Management of Patients with Ankylosing Spondylitis: A Randomized Controlled Trial Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors Favorable effect of rehabilitation on balance in ankylosing spondylitis: a quasi-randomized controlled clinical trial Self- and manual mobilization improves spine mobility in men with ankylosing spondylitis — a randomized study Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study. Efficacy of High Intensity Exercise on Disease Activity and Cardiovascular Risk in Active Axial Spondyloarthritis: A Randomized Controlled Pilot Study Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions McKenzie training in patients with early stages of ankylosing spondylitis: results of a 24-week controlled study. Efficacy of Incentive Spirometer Exercise on Pulmonary Functions of Patients with Ankylosing Spondylitis Stabilized by Tumor Necrosis Factor Inhibitor Therapy Evaluation of the effects of Global Postural Reeducation in patients with ankylosing spondylitis Effect of Pilates training on people with ankylosing spondylitis Inspiratory muscle training improves aerobic capacity and pulmonary function in patients with ankylosing spondylitis: a randomized controlled study Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices, quality of life and depression Effects of a multimodal exercise program for people with ankylosing spondylitis. A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis. The effect of a home based exercise intervention package on outcome in ankylosing spondylitis: a randomized controlled trial. Effects of Aerobic Training in Patients with Ankylosing Spondylitis The effectiveness of intensive group exercise on patients with ankylosing spondylitis The effects of balneotherapy on disease activity, functional status, pulmonary function and quality of life in patients with ankylosing spondylitis. Supervised training and home-based rehabilitation in patients with stabilized ankylosing spondylitis on TNF inhibitor treatment: a controlled clinical trial with a 12-month follow-up
abstract: OBJECTIVES This study aims to assess the impact of a structured education and home exercise programme in daily practice patients with ankylosing spondylitis . METHODS A total of 756 patients with ankylosing spondylitis ( 72 % males , mean age 45 years ) participated in a 6-month prospect i ve multicentre controlled study , 381 of whom were r and omised to an education intervention ( a 2-hour informative session about the disease and the implementation of a non-supervised physical activity programme at home ) and 375 to st and ard care ( controls ) . Main outcome measures included Bath Ankylosing Spondylitis Disease Activity and Functional Index ( BASDAI , BASFI ) . Secondary outcome measures were 0 - 10 cm visual analog scale ( VAS ) for total pain , nocturnal pain and global disease activity and quality of life ( ASQoL ) , knowledge of disease ( self-evaluation ordinal scale ) and daily exercise ( diary card ) . RESULTS At 6 months , the adjusted mean difference between control and educational groups for BASDAI was 0.32 , 95 % confidence interval ( CI ) 0.10 - 0.54 , p=0.005 , and for BASFI 0.31 , 95%CI 0.12 - 0.51 , p=0.002 . Significant differences were found also in VAS for total pain , patient´s global assessment and in ASQoL. Patients in the education group increased their knowledge about the disease and its treatments significantly ( p<0.001 ) and practised more regular exercise than controls ( p<0.001 ) . CONCLUSIONS A structured education and home exercise programme for patients with ankylosing spondylitis in daily practice was feasible and helped to increase knowledge and exercise . Although statistically significant , the magnitudes of the clinical benefits in terms of disease activity and physical function were poor Fernández-de-las-Peñas C , Alonso-Blanco C , Morales-Cabezas M , Miangolarra-Page JC : Two exercise interventions for the management of patients with ankylosing spondylitis : A r and omized controlled trial . Am J Phys Med Rehabil 2005;84:407–419 . Objective : The purpose of this clinical trial was to evaluate the impact of a 4-month comprehensive protocol of strengthening and flexibility exercises developed by our research group versus conventional exercises for patients with Ankylosing Spondylitis ( AS ) on functional and mobility outcomes . Design : R and omized controlled trial . Forty-five patients diagnosed with AS according to the modified criteria of New York were allocated to control or experimental groups using a r and om numbers table . The control group was treated with a conventional protocol of physical therapy in AS , whereas the experimental group was treated with the protocol suggested by our research group . The conventional intervention consisted of 20 exercises : motion and flexibility exercises of the cervical , thoracic , and lumbar spine ; stretching of the shortened muscles ; and chest expansion exercises . The experimental protocol is based on the postural affectation of the AS and the treatment of the shortened muscle chains in these patients according to the Global Posture Reeducation ( GPR ) method . This intervention employs specific strengthening and flexibility exercises in which the shortened muscle chains are stretched and strengthened . The study lasted 4 mos . During this period , patients received a weekly group session managed by an experienced physiotherapist . Each session lasted an hour , and there were 15 total sessions . Changes in activity , mobility , and functional capacity were evaluated by an assessor blinded to the intervention , using the following previously vali date d scores from the Bath group : BASMI ( tragus to wall distance , modified Schöber test , cervical rotation , lumbar side flexion , and intermalleolar distance ) , BASDAI ( The Bath Ankylosing Spondylitis Disease Activity Index ) , and BASFI ( The Bath Ankylosing Spondylitis Functional Index ) . Results : Both groups showed an improvement ( prepost scores ) in all the outcome measures , mobility measures of the BASMI index , as well as in BASFI and BASDAI indexes . In the control group , the improvement in tragus to wall distance ( P = 0.009 ) and in lumbar side flexion ( P = 0.02 ) was statistically significant . Although the rest of the outcomes also improved , they did not reach a significant level ( P > 0.05 ) . In the experimental group , the improvement in all the clinical measures of the BASMI index ( P < 0.01 ) and in the BASFI index ( P = 0.003 ) was statistically significant . The intergroup comparison between the improvement ( prepost scores ) in both groups showed that the experimental group obtained a greater improvement than the control group in all the clinical measures of the BASMI index , except in tragus to wall distance , as well as in the BASFI index . Conclusions : The experimental protocol developed by our research group , based on the GPR method and specific strengthening and flexibility exercises of the muscle chains , offers promising results in the management of patients suffering from AS . Further trials on this topic are required Abstract Ankylosing spondylitis ( AS ) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability . Aquatic ( water-based ) exercise may have a beneficial effect in various musculoskeletal conditions . The aim of this study was to compare the effectiveness of aquatic exercise interventions with l and -based exercises ( home-based exercise ) in the treatment of AS . Patients with AS were r and omly assigned to receive either home-based exercise or aquatic exercise treatment protocol . Home-based exercise program was demonstrated by a physiotherapist on one occasion and then , exercise manual booklet was given to all patients in this group . Aquatic exercise program consisted of 20 sessions , 5 × per week for 4 weeks in a swimming pool at 32–33 ° C . All the patients in both groups were assessed for pain , spinal mobility , disease activity , disability , and quality of life . Evaluations were performed before treatment ( week 0 ) and after treatment ( week 4 and week 12 ) . The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t test . Paired t test was used for comparison of pre- and posttreatment values within groups . A total of 69 patients with AS were included in this study . We observed significant improvements for all parameters [ pain score ( VAS ) visual analog scale , lumbar flexion/extension , modified Schober test , chest expansion , bath AS functional index , bath AS metrology index , bath AS disease activity index , and short form-36 ( SF-36 ) ] in both groups after treatment at week 4 and week 12 ( p < 0.05 ) . Comparison of the percentage changes of parameters both at week 4 and week 12 relative to pretreatment values showed that improvement in VAS ( p < 0.001 ) and bodily pain ( p < 0.001 ) , general health ( p < 0.001 ) , vitality ( p < 0.001 ) , social functioning ( p < 0.001 ) , role limitations due to emotional problems ( p < 0.001 ) , and general mental health ( p < 0.001 ) subparts of SF-36 were better in aquatic exercise group . It is concluded that a water-based exercises produced better improvement in pain score and quality of life of the patients with AS compared with home-based exercise We investigated the effects of home-based daily exercise on joint mobility , functional capacity , pain , and depression in patients with ankylosing spondylitis ( AS ) . The patients were r and omly assigned to a wait-list control group or to an exercise-therapy group . The exercise-therapy group performed a 20-min exercise program once per day for 8 consecutive weeks . After 8 weeks , compared with the control group , the exercise group showed improvements in joint mobility ( cervical flexion , extension , shoulder flexion , abduction , hip abduction , and knee flexion ) , finger – floor distance , and functional capacity . Pain and depression scores were significantly lower after the exercise program in the exercise group than in the control group . These findings indicate that exercise therapy increases joint mobility and functional capacity , and decreases pain and depression in patients with AS .  Home-based exercise , which is easily accessible to patients , might be an effective intervention for AS Despite advances in pharmacological therapy , physical treatment continues to be important in the management of ankylosing spondylitis ( AS ) . The objective of the present study was to evaluate the effects and tolerability of combined spa therapy and rehabilitation in a group of AS patients being treated with TNF inhibitors . Thirty AS patients attending the Rheumatology Unit of the University of Padova being treated with TNF inhibitors for at least 3 months were r and omized and assessed by an investigator independent from the spa staff : 15 were prescribed 10 sessions of spa therapy ( mud packs and thermal baths ) and  rehabilitation ( exercises in a thermal pool ) and the other 15 were considered controls . The patients in both groups had been receiving anti-TNF agents for at least three months . The outcome measures utilized were BASFI , BASDAI , BASMI , VAS for back pain and HAQ . The evaluations were performed in all patients at the entry to the study , at the end of the spa treatment , and after 3 and 6 months . Most of the evaluation indices were significantly improved at the end of the spa treatment , as well as at the 3 and 6 months follow-up assessment s. No significant alterations in the evaluation indices were found in the control group . Combined spa therapy and rehabilitation caused a clear , long-term clinical improvement in AS patients being treated with TNF inhibitors . Thermal treatment was found to be well tolerated and none of the patients had disease relapse Abstract Balance impairment is a frequent and undertreated manifestation in ankylosing spondylitis , leading to increased risk of falls and lower quality of life . Our aim was to assess supervised training and home-based rehabilitation efficacy on balance improvement in ankylosing spondylitis subjects on biologic agents . This was a single-blinded , quasi-r and omized parallel study in a single outpatient Rehabilitation Clinic of a tertiary referral center . Subjects with ankylosing spondylitis on biologic agents were assigned either to supervised training and home-based rehabilitation program ( rehabilitation group ) plus educational – behavioral therapy , or to educational – behavioral therapy alone ( educational groups ) . The same therapist provided therapy . Outcome measures were assessed at baseline ( T0 ) , end of treatment ( T1 ) and at 7-month follow-up ( T2 ) . Rheumatologic outcomes were Bath Ankylosing Spondylitis Metrology Index , Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Disease Activity Index . Balance parameters ( anterior – posterior oscillation , latero-lateral oscillation , sway area , sway density and sway path ) were evaluated by stabilometry in a condition of open and closed eyes . Forty-six subjects ( 36 M , 10 F ) were enrolled . Demographic data and clinical status at baseline were comparable between the two groups ( 22 rehabilitation group , 20 educational group ) . Primary outcome was sway density that improved both at T1 ( SDy : open eyes p = 0.003 , closed eyes p = 0.004 ) and at T2 ( SDx : open eyes p = 0.0015 , closed eyes p = 0.032 ) . A trend toward improvement in the rehabilitation group rather than in the educational group emerged for balance parameters , especially those measured with closed eyes ( 0.004 < p < 0.048 at T1 and 0.004 < p < 0.036 at T2 ) . Supervised training and home exercise lead to balance improvement in people with ankylosing spondylitis . Eyes-closed trials show a more marked trend toward improvement , and this may suggest a positive effect of rehabilitation on proprioception Aims : To evaluate effects of physiotherapeutic intervention in terms of self- and manual mobilization on chest expansion , vital capacity , posture , spine mobility and experienced consequences of the disease in patients with ankylosing spondylitis . Design : A prospect i ve , r and omized controlled study . Methods : Thirty-two men , aged between 23 and 60 years , with ankylosing spondylitis were r and omized to active or no treatment for eight weeks . Physiotherapeutic intervention included individualized self- and manual mobilization for 1 hour twice a week and individually adjusted home exercises . Two blinded investigators made the assessment s of chest expansion , posture and spinal mobility before and after the treatment period . The patient filled in three and the physiotherapist one of the four Bath Ankylosing Spondylitis scales ( BAS scales ) . Results : In the treatment group chest expansion increased at the level of processus xiphoideus ( P<0.01 ) , with no difference in vital capacity compared with the control group . The posture improved in the cervical ( C7—wall distance ) ( P<0.001 ) and in the thoracic spine ( P<0.05 ) . Thoracic and lumbar spine flexion improved ( P<0.01 ) as did sagittal range of motion P<0.001 and P<0.01 , respectively . The Bath Ankylosing Spondylitis Metrology Index total scoring improved ( P<0.001 ) in the treatment group compared with the control group . The other three BAS scales showed no differences between groups . At four months follow-up of the treatment group , cervical spine posture , lumbar flexion and range of motion as well as BAS Metrology Index were still improved . Conclusion : This study shows that eight weeks of self- and manual mobilization treatment improved chest expansion , posture and spine mobility in patients with ankylosing spondylitis AIM The aim of the study was to compare the effects of conventional exercise ( CE ) , swimming and walking on the pulmonary functions , aerobic capacity , quality of life , Bath indexes and psychological symptoms in patients with ankylosing spondylitis ( AS ) . METHODS Forty-five patients were r and omised into either swimming ( group 1 ) , walking ( group 2 ) , CE group ( group 3 ) . Patients in Group 1 performed CE and swimming , patients in Group 2 performed CE and walking and patients in Group 3 performed CE only . Exercise sessions were performed three times a week for a period of six weeks . Patients were assessed before and after the rehabilitation program , with respect to , pulmonary function test ( forced vital capacity [ FVC , mL ] , forced expiration volume in one second [ FEV1 , mL ] , FEV1/FVC ( % ) and vital capacity [ VC , mL ] ) , maximal oxygen uptake ( pV.O2 ) , 6-minute walking test ( 6MWT ) , Bath Ankylosing Spondylitis Functional Index , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Metrology Index , Nottingham Health Profile and Beck Depression Inventory . RESULTS There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 ( P<0.05 ) . FeV1 , FVC and VC improved significantly with treatment in all three groups ( P<0.05 ) . A statistically significant improvement was observed in energy , emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program ( P<0.05 ) . CONCLUSIONS Swimming , walking and CE had beneficial effects on the quality of life and pulmonary functions . Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients Background Physical therapy is recommended for the management of axial spondyloarthritis ( axSpA ) and flexibility exercises have traditionally been the main focus . Cardiovascular ( CV ) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases . Therefore , the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA. Methods In a single blinded r and omized controlled pilot study the exercise group ( EG ) performed 12 weeks of endurance and strength exercise while the control group ( CG ) received treatment as usual . The primary outcome was the Ankylosing Spondylitis ( AS ) Disease Activity Score ( ASDAS ) . Secondary outcomes included patient reported disease activity ( Bath AS Disease Activity Index [ BASDAI ] ) , physical function ( Bath AS Functional Index [ BASFI ] ) , and CV risk factors measured by arterial stiffness ( Augmentation Index [ Alx ] ) and Pulse Wave Velocity [ PWV ] ) , cardiorespiratory fitness ( VO2 peak ) and body composition . ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences , and Mann Whitney U-test was used for outcomes with skewed residuals . Results Twenty-eight patients were included and 24 ( EG , n = 10 , CG , n = 14 ) completed the study . A mean treatment effect of −0.7 ( 95%CI : −1.4 , 0.1 ) was seen in ASDAS score . Treatment effects were also observed in secondary outcomes ( mean group difference [ 95%CI ] ) : BASDAI : −2.0 ( −3.6 , −0.4 ) , BASFI : −1.4 ( −2.6 , −0.3 ) , arterial stiffness ( estimated median group differences [ 95 % CI ] ) : AIx ( % ) : −5.3 ( −11.0 , −0.5 ) , and for PVW ( m/s ) : −0.3 ( −0.7 , 0.0 ) , VO2 peak ( ml/kg/min ) ( mean group difference [ 95%CI ] : 3.7 ( 2.1 , 5.2 ) and trunk fat ( % ) : −1.8 ( −3.0 , −0.6 ) . No adverse events occurred . Conclusion High intensity exercise  improved disease activity and reduced CV risk factors in patients with active axSpA. These effects will be further explored in a larger trial . Trial Registration Clinical Trials.gov The optimal management of ankylosis spondylitis ( AS ) involves a combination of nonpharmacologic and pharmacologic treatment aim ing to maximize health-related quality of life . The primary objective of our study was to demonstrate the benefits of an original multimodal exercise program combining Pilates , McKenzie and Heckscher techniques on pulmonary function in patients with AS , while secondary objectives were to demonstrate the benefits of the same program on function and disease activity . This is a r and omized controlled study on ninety-six consecutive patients with AS ( axial disease subset ) , assigned on a 1:1 rationale into two groups based on their participation in the Pilates , McKenzie and Heckscher ( group I ) or in the classical kinetic program ( group II ) . The exercise program consisted of 50-min sessions performed 3 times weekly for 48 weeks . St and ard assessment s were done at week 0 and 48 and included pain , modified Schober test ( mST ) and finger – floor distance ( FFD ) , chest expansion ( CE ) and vital capacity ( VC ) , as well as disease activity Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , functional Bath Ankylosing Spondylitis Functional Index ( BASFI ) and metrology index Bath Ankylosing Spondylitis Metrology Index ( BASMI ) . Groups were comparable at baseline ; we demonstrated significant improvement between baseline and after 48 weeks of regular kinetic training for all AS-related parameters in both groups . However , significant improvement was found in pain , lumbar spine motility ( mST , FFD ) , BASFI , BASDAI and BASMI in AS performing the specific multimodal exercise program at the end of study ( p = 0.001 ) . Although there were significant improvements in CE in both groups as compared to baseline ( group I , p = 0.001 ; group II , p = 0.002 ) , this parameter increased significantly only in group I ( p = 0.001 ) . VC measurements were not significantly changed at the end of the study ( group I , p = 0.127 ; group II , p = 0.997 ) , but we found significant differences within groups ( p = 0.011 ) . A multimodal training combining Pilates , McKenzie and Heckscher exercises performed regularly should be included in the routine management of patients with AS for better control of function , disease activity and pulmonary function The home-based exercise therapy recommended to the patients with ankylosing spondylitis ( AS ) is a simply applicable and cheap method . The aim of this study was to investigate the effects of home-based exercise therapy on pain , mobility , function , disease activity , quality of life , and respiratory functions in patients with AS . Eighty patients diagnosed with AS according to the modified New York criteria were included in the study .  Home-based exercise program including range of motion , stretching , strengthening , posture , and respiratory exercises was practically demonstrated by a physiotherapist . A training and exercise manual booklet was given to all patients . Patients following home-based exercise program five times a week at least 30 min per session ( exercise group ) for 3 months were compared with those exercising less than five times a week ( control group ) . Visual analog scale pain ( VASp ) values at baseline were significantly higher in the exercise group . The exercise group showed improvements in VASp , tragus – wall distance , morning stiffness , finger – floor distance , modified Schober 's test , chest expansion , the Bath Ankylosing Spondylitis Disease Activity Index , the Bath Ankylosing Spondylitis Functional Index , Ankylosing Spondylitis Quality of Life Question naire ( ASQoL ) , forced expiratory volume in first second , and forced vital capacity at third month . There was significant difference in ASQoL scores between the two groups in favor of the exercise group at third month . Regular home-based exercise therapy should be a part of main therapy in patients with AS . Physicians should recommend that patients with AS do exercise at least five times a week at least 30 min per session BACKGROUND It is widely accepted that patient education and regular exercises could improve pain , function and maintain posture in ankylosing spondylitis ( AS ) . AIM The main aim of our study was to demonstrate the benefits of a specific , McKenzie training focusing on pain , spine flexibility , disease activity and function , as well as chest expansion in AS . DESIGN Controlled study . SETTING Rheumatology and Rehabilitation Department . POPULATION Patients with early AS . METHODS Prospect i ve 24-week controlled study in 52 patients with early AS ( modified 1984 New York criteria ) r and omly assigned to perform either McKenzie training ( 28 AS ) or classic kinetic exercises ( 24 AS ) . Efficacy parameters comprising pain , lumbar spine mobility ( modified Schober test , mST ; finger-to-floor distance , FFD ; BASMI ) , chest expansion ( CE ) , disease activity ( BASDAI ) and function ( BASFI ) were evaluated during three visits ( week 0 , 12 and 24 after the initiation of the kinetic program ) . The exercise protocol consisted of 50-minute sessions performed 3 times weekly for 24 weeks , with a 12-week learning module assisted by a trained physical therapist in the outpatient rheumatology and rehabilitation department , and a 12-week module performed individually at home .  Only subjects attending the kinetic program on a regular basis ( at least 2 times weekly , at least 60 attended sessions during the study ) were and accepted for the final evaluation . RESULTS After 12 and 24 weeks of exercises we reported significant improvement in pain ( P=0.015 and P=0.003 ) , metrology ( mST : P=0.001 and P=0.001 ; FFD : P=0.002 and P=0.001 ; BASMI : P=0.001 and P=0.001 ) , disease activity ( BASDAI : P=0.004 and P=0.001 ) and function ( BASFI : P=0.001 at both visits ) in the McKenzie group . mST , BASDAI , BASFI and BASMI also improved at both visits in controls ( P<0.05 ) , while CE and FFD significantly changed only in long-term assessment ( P<0.05 ) . Intergroup analysis demonstrated significant differences in all measurements including favoring AS in the McKenzie exercises ( P=0.001 ) . CONCLUSION A specific McKenzie training should be included in the st and ard-care of AS aim ing to improve pain , posture and function , especially in early axial disease . CLINICAL REHABILITATION IMPACT A specific McKenzie training should be included in the st and ard-care of AS Objective . To evaluate the effect of combining incentive spirometer exercise ( ISE ) with a conventional exercise ( CE ) on patients with ankylosing spondylitis ( AS ) stabilized by tumor necrosis factor ( TNF ) inhibitor therapy by comparing a combination group with a CE-alone group . Methods . Forty-six patients ( 44 men , 2 women ) were r and omized to the combination group ( ISE plus CE ; n = 23 ) or the CE group ( n = 23 ) . The CE regimen of both groups consisted of 20 exercises performed for 30 min once a day . The ISE was performed once a day for 30 min . The trial duration was 16 weeks . Patients were assessed before and at the end of treatment by measuring the Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , chest expansion , finger to floor distance , pulmonary function measures , and 6-min walk distance . Results . Both groups improved significantly in terms of chest expansion ( p < 0.01 ) , finger to floor distance ( p < 0.01 ) , and BASFI ( p < 0.05 ) after completing the exercise program . However , only the combination group showed significant improvements in the forced vital capacity ( p < 0.05 ) , total lung capacity ( p < 0.01 ) , and vital capacity ( p < 0.05 ) . Although this did not achieve statistical significance , the combination group was mildly superior to the CE-alone group in functional disability and pulmonary function measures . Conclusion . Combining ISE with a CE can provide positive results in patients whose AS has been clinical ly stabilized by TNF inhibitor therapy The objective of this study is to assess the effects of Global Postural Reeducation ( GPR ) in patients with ankylosing spondylitis and compare GPR with group conventional segmental self-stretching and breathing exercises . This is a controlled interventional study of 38 patients divided into 2 groups : a GPR group ( n = 22 ) and a control group ( n = 16 ) . Both groups were treated for more than 4 months . With the GPR group patients , positions that stretched the shortened muscle chains were used . With the control group patients , conventional segmental self-stretching and breathing exercises were performed . The variables analyzed were pain intensity , morning stiffness , spine mobility , chest expansion , functional capacity ( Health Assessment Question naire – Spondyloarthropathies – HAQ-S ) , quality of life ( Medical Outcome Study Short Form 36 Healthy Survey – SF-36 ) , and disease activity ( Bath Ankylosing Spondylitis Disease Activity Index – BASDAI ) . Statistical analysis was used with a significance level of P < 0.05 . There was a statistically significant improvement for all the parameters analyzed between pre- and post-treatment in both groups . In the intergroup comparison , the GPR group showed a significantly greater improvement in morning stiffness ( P = 0.013 ) , spine mobility parameters , except finger-floor distance ( P = 0.118 ) , in chest expansion ( P = 0.028 ) , and in the physical aspect component of the SF-36 ( P = 0.001 ) . The results of this study showed that individual treatment with GPR ( overall stretching ) seems to have better clinical outcomes than group treatment with conventional segmental self-stretching and breathing exercises for patients with ankylosing spondylitis The objective of this study was to investigate the effects of Pilates on pain , functional status , and quality of life in patients with ankylosing spondylitis . The study was performed as a r and omized , prospect i ve , controlled , and single-blind trial . Fifty-five participants ( 30 men , 25 women ) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study . The participants were r and omly assigned into two groups : in group I , Pilates exercise program of 1 h was given by a certified trainer to 30 participants 3 times a week for 12 weeks , and in group II , design ed as the control group , 25 participants continued previous st and ard treatment programs . In groups , pre-(week 0 ) and post treatment ( week 12 and week 24 ) evaluation was performed by one of the authors who was blind to the group allocation . Primary outcome measure was functional capacity . Evaluation was done using the Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , Chest expansion , and ankylosing spondylitis quality of life ( ASQOL ) question naire . In group I , BASFI showed significant improvement at week 12 ( P = 0.031 ) and week 24 ( P = 0.007 ) . In group II , this parameter was not found to have significantly changed at week 12 and week 24 . Comparison of the groups showed significantly superior results for group I at week 24 ( P = 0.023 ) . We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients . Our study is the first clinical study design ed to investigate the role of Pilates method in AS treatment . We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method in AS Objective : To evaluate the impact of inspiratory muscle training on aerobic capacity and pulmonary function in patients with ankylosing spondylitis . Design : R and omized controlled study . Setting : Rheumatic Rehabilitation Centre . Subjects : A total of 54 ankylosing spondylitis patients , all males , were r and omized to a conventional exercise training associated with an inspiratory muscle training group , or to a conventional exercise training group . Interventions : Group 1 ( 27 patients ) performed eight weeks of conventional exercise training ( supervised weekly group sessions followed by a home-based exercise programme ) associated with inspiratory muscle training sessions . Group 2 ( 27 patients ) received eight weeks of conventional exercise training only . Main measures : Resting pulmonary function ( forced vital capacity − FVC , forced expiratory volume in one second − FEV1 ) ; effort ventilatory efficiency ( lowest ventilatory equivalent ratio for oxygen and carbon dioxide – VE/VO2 and VE/VCO2 ) and aerobic capacity ( peak oxygen uptake – VO2peak ) were assessed at baseline and after eight weeks of exercise-based intervention . Results : After eight weeks follow-up , patients in Group 1 had a significant increased chest expansion and VO2peak compared with Group 2 ( 3.6 ±0.8 cm vs. 3.2 ±0.5 cm , P = 0.032 ; 2.0 ±0.5 l/min vs. 1.8 ±0.3 l/min , P = 0.033 ) . There were no significant differences of spirometric measurements , except FVC which significantly improved in patients who performed inspiratory muscle training ( 82.7 ±5.1 % vs. 79.5 ±3.5 % , P = 0.014 ) . VE/VCO2 also improved significantly in Group 1 ( 26.6 ±3.6 vs. 29.2 ±4.7 , P = 0.040 ) . Conclusions : Ankylosing spondylitis patients who performed eight weeks of inspiratory muscle training associated to conventional exercise training had an increased chest expansion , a better aerobic capacity , resting pulmonary function and ventilatory efficiency than those who performed conventional exercise training only The objective of this non-r and omised controlled trial was to evaluate the impact of group-based exercise programme and a home-based exercise programme on Bath Ankylosing Spondylitis Indices , depression and quality of life in patients with ankylosing spondylitis ( AS ) . Approximately 41 patients in a rehabilitation unit were divided into two groups , either group- or home-based exercise programme . Exercise sessions were performed three times a week for a period of 6 weeks . The patients were compared before and after the rehabilitation programme , with respect to Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Disease Assessment Index ( BASDAI ) , Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , Beck Depression Inventory ( BDI ) and The Nottingham Health Profile ( NHP ) . A statistically significant improvement was observed on BASDAI , BASMI and energy , pain , reaction of emotional and sleep subscores of NHP in both exercise groups after the exercise programme ( p < 0.05 ) . No statistically significant changes were detected in BASFI , BDI and social and mobility subscores of NHP in both exercise groups ( p > 0.05 ) . No statistically significant differences were found between the two exercise programmes ( p > 0.05 ) . Group and home-based exercise programmes are efficient in improving symptoms and mobility and had an important effect on quality of life in patients with AS . Home-based exercise programme , as it is cheaper , more easily performed and efficient , may be preferable for the management programme in AS BACKGROUND AND PURPOSE Few r and omized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis ( AS ) . This study investigated the effects of a 12-week , multimodal exercise program in patients with AS . SUBJECTS A convenience sample of 30 patients with AS ( 18 male , 12 female ) , with a mean age of 34.9 years ( SD=6.28 ) , participated in the study . Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria . METHODS This study was a r and omized controlled trial . Subjects were assigned to either a group that received an exercise program or to a control group . The exercise program consisted of 50 minutes of multimodal exercise , including aerobic , stretching , and pulmonary exercises , 3 times a week for 3 months . Subjects in both groups received medical treatment for AS , but the exercise group received the exercise program in addition to the medical treatment . All subjects received a physical examination at baseline and at 12 weeks . The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods : clinical measurements ( chin-to-chest distance , Modified Schober Flexion Test , occiput-to-wall distance , finger-to-floor distance , and chest expansion ) and inclinometer measurements ( gross hip flexion , gross lumbar flexion , and gross thoracic flexion ) . In addition , vital capacity was measured by a physiologist , and physical work capacity was evaluated by a doctorally prepared exercise instructor . RESULTS The measurements of the exercise group for chest expansion , chin-to-chest distance , Modified Schober Flexion Test , and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period . The spinal movements of the exercise group improved significantly at the end of exercise program , but those of the control group showed no significant change . In addition , the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group . Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group . DISCUSSION AND CONCLUSION In this study , a multimodal exercise program including aerobic , stretching , and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility , work capacity , and chest expansion OBJECTIVE To evaluate the mean overall effects over a 1-year period of a multidisciplinary in-patient rehabilitation programme for patients with ankylosing spondylitis . DESIGN Observer-blinded , r and omized controlled trial , with assessment s made after 4 and 12 months . PATIENTS Forty-six patients received a 3-week in-patient rehabilitation programme and 49 patients received treatment as usual .  METHODS Primary outcomes were disease activity measured with the Bath Ankylosing Spondylitis Disease Activity Scale ( BASDAI ) , and function measured with the Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Secondary outcomes included well-being , spinal and hip mobility , and health-related quality of life measured with the Medical Outcome Study Short Form-36 . Overall treatment effects were estimated with Mixed models repeated measures analyses . RESULTS Significant overall treatment effects in favour of the rehabilitation group were found in the BASDAI score ( mean difference over the 1-year period -10.0 , 95 % confidence interval : -3.7 to -16.3 ) , in well-being ( -7.3 , 95 % confidence interval : -1.0 to -14.7 ) , and in the Medical Outcome Study Short Form-36 variables social functioning , role physical , role mental and bodily pain ( mean differences ranging from 5.8 ( pain ) to 10.7 ( role physical ) ) . CONCLUSION A 3-week in-patient rehabilitation programme had positive overall effects on disease activity , pain , function and well-being , and should be considered an important complement to medical disease management in persons with ankylosing spondylitis OBJECTIVE The aim of this study was to evaluate the impact of two different home-based daily exercise programs on pulmonary functions in the patients with ankylosing spondylitis ( AS ) . METHODS Fifty-one patients with AS were distributed into three groups . Group 1 ( n=19 ) was given a conventional exercise regimen . Group 2 ( n=19 ) received exercises based on the Global Posture Reeducation ( GPR ) method . Group 3 ( n=13 ) was accepted as the control group . Patients were assessed according to pain , functional capacity ( The Bath Ankylosing Spondylitis Functional Index - BASFI ) , disease activity ( The Bath Ankylosing Spondylitis Disease Activity Index - BASDAI ) , chest expansion , pulmonary function parameters , and 6-min walk distance ( 6MWD ) test . RESULTS Although there were significant improvements for BASDAI and BASFI scores in all groups , significant improvements in the VAS pain , chest expansion , pulmonary function parameters and 6MWD test were observed in the exercise groups . The improvements in pain , functional capacity , disease activity , chest expansion , pulmonary function parameters and 6MWD test were better in the exercise groups than in the control group . The GPR method result ed in greater improvements than the conventional exercise program in specific pulmonary function parameters like forced vital capacity , forced expiratory volume in 1s , and peak expiratory flow parameters . CONCLUSION Both exercises are efficient in improving pulmonary functions . Since the improvements in pulmonary function tests were greater in the patients who performed the exercise according to GPR method , motivated patients should be encouraged to perform this exercise program OBJECTIVE Home based self-care is essential for successful management of ankylosing spondylitis ( AS ) . We design ed an intervention package aim ed at promoting self-care and regular longterm exercise and evaluated its effect on outcome . METHOD Members of our data base ( n = 4569 ) were r and omly selected and r and omized to an intervention group ( IG ) or a followup control group ( CG ) . The intervention consisted of an exercise/information video , exercise progress chart , patient education booklet , and AS exercise reminder stickers . The outcome measures were function ( BASFI ) , disease activity ( BASDAI ) , global well being ( BAS-G ) , exercise self-efficacy ( ESE ) , arthritis self-efficacy ( SES ) , and quantity of AS mobility/aerobic exercise assessed at baseline and 6 months . RESULTS Of the 200 subjects , 155 completed the study ( 75 IG and 80 CG ) . Baseline analysis showed no differences between the CG and the IG . At 6 months , analysis revealed no statistically significant between-group differences for the BASFI , BASDAI , and BAS-G. although the p value of 0.08 for function approached significance . Self-efficacy for exercise showed a significant improvement in the IG ( p = 0.045 ) . There were no between-group differences for the SES pain and other symptoms subscales . Finally , there was a significant increase in self-reported AS mobility ( p < 0.001 ) and aerobic exercise ( p < 0.05 ) in the IG . CONCLUSION An exercise intervention package design ed to promote self-management in AS ( 1 ) significantly improves self-efficacy for exercise ; ( 2 ) significantly improves self-reported levels of exercise ; ( 3 ) reveals a trend for improvement in function ( BASFI ) Objective . To evaluate the effects of aerobic exercise in patients with ankylosing spondylitis ( AS ) . Methods . Seventy patients classified with AS by the modified New York criteria were included . The patients were r and omly assigned into 2 groups . The intervention group ( IG ) performed 50 min of walking followed by stretching exercises 3 times a week for 12 weeks . The control group ( CG ) performed only stretching exercises . The outcome measurements were the Bath indexes [ Bath AS Functional Index ( BASFI ) , Bath AS Disease Activity Index ( BASDAI ) , and Bath AS Metrology Index ( BASMI ) ] , Health Assessment Question naire for the Spondyloarthropathies ( HAQ-S ) , AS Disease Activity Score ( ASDAS ) , the 6-min walk test ( 6MWT ) , chest expansion , and the Medical Outcomes Study Short Form-36 . Aerobic capacity was assessed by ergospirometry on a treadmill . Routine laboratory techniques were used in determining lipid levels . Assessment s were performed immediately before r and omization and after 6 , 12 , and 24 weeks . Results . Thirty-five patients were r and omized to the IG and 35 to the CG . There was significant improvement in the BASFI , HAQ-S , BASMI , BASDAI , and ASDAS in both groups ( p < 0.05 ) , but did not differ between groups . There was a significant increase in the walking distance in the 6MWT in the IG compared with CG ( p < 0.001 ) . The IG showed significant improvement in cardiopulmonary capacity compared with CG . Cholesterol and triglyceride levels did not change in either group . Conclusion . In patients with AS , aerobic training improved walking distance and aerobic capacity . Aerobic training did not provide additional benefits in functional capacity , mobility , disease activity , quality of life , and lipid levels when compared with stretching exercises alone Objective : To compare , in patients with ankylosing spondylitis ( AS ) , the effectiveness on pain , functional and psychological status of an intensive group exercise programme under the supervision of a physiotherapist and a home physiotherapy programme . Design : Fifty-one patients with AS were r and omly allocated into study and control groups . The study was design ed as a prospect i ve , double-blind study . Setting : Outpatient department , Istanbul Medical Faculty . Subjects : Patients who consulted with complaints of pain , morning stiffness and restricted range of movement with a confirmed diagnosis of ankylosing spondylitis . Interventions : Before exercise , both groups were given an education programme about AS . For group I patients an intensive exercise programme was organized under the supervision of a physiotherapist for six weeks . Group II patients had to practise exercises individually at home . Main outcome measures : Both groups were evaluated and compared for pain , functional and psychological status before treatment , at the end of treatment and three months after treatment using a visual analogue scale ( VAS ) for pain , Beck Depression Scale and Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Results : Six patients withdrew , four from group I. Results from the remaining 45 showed more positive changes in the patients undertaking group exercise at six weeks and three months after treatment . Values showed a statistical significant difference in favour of group I. Conclusion : Group exercise in hospital may be more effective than home-based exercises at reducing impairment associated with ankylosing spondylitis OBJECTIVE This study aim ed to determine the effects of balneotherapy on disease activity , functional status , metrology index , pulmonary function and quality of life in patients with ankylosing spondylitis ( AS ) . MATERIAL S AND METHODS The study included 28 patients ( 27 male and 1 female ) diagnosed with AS according to modified New York criteria . The patients were treated with balneotherapy for 3 weeks ( 30 min/day , 5 days/week ) . The patients were evaluated using the global index , Bath ankylosing spondylitis disease activity index ( BASDAI ) , disease functional index ( BASFI ) , metrology index ( BASMI ) , chest expansion measures , pulmonary function testing , and the medical outcomes study -short form-36 Health Survey ( SF-36 ) ( measure of quality of life ) before balneotherapy and 1 month after treatment . RESULTS Post balneotherapy  BASDAI and global index decreased , BASMI parameters improved , chest expansion increased , and some SF-36 parameters improved ; however , none of these changes were statistically significant ( P > 0.05 ) , except for the decrease in BASMI total score ( P < 0.05 ) . Before balneotherapy 6 patients had restrictive pulmonary disorder , according to pulmonary function test results . Pulmonary function test results in 3 ( 50 % ) patients were normalized following balneotherapy ; however , as for the other index , balneotherapy did not significantly affect pulmonary function test results . CONCLUSION The AS patients ' symptoms , clinical findings , pulmonary function test results , and quality of life showed a trend to improve following balneotherapy , although without reaching significant differences . Comprehensive r and omized controlled spa intervention studies with longer follow-up periods may be helpful in further delineating the therapeutic efficacy of balneotherapy in AS patients Objective : To assess the 12-month ’s follow-up effects on pain , mobility , and physical function outcomes of a supervised training and home-based rehabilitation for ankylosing spondylitis patients stabilized with TNF-inhibitor therapy . Design : Controlled clinical trial ( sequentially determined allocation ) with 12-months ’ follow-up . Setting : Patients ’ homes . Subjects : A total of 69 subjects were allocated to either a rehabilitation programme ( rehabilitation group , n = 22 ) , an educational-behavioural programme ( educational group , n = 24 ) , and to neither programme ( control group , n = 23 ) . Interventions : Rehabilitation programme included supervised training and home exercises ( stretching , strengthening , aerobic , chest , and spine/hip joint flexibility exercises ) ; educational-behavioural programme included information on ankylosing spondylitis , pain and stress mechanisms , and control . Main measures : Spinal pain intensity , Bath Ankylosing Spondylitis Metrology Index , Bath Ankylosing Spondylitis Functional Index , Bath Ankylosing Spondylitis Disease Activity Index , chest expansion , and cervical and lumbar spine active range of motion measured by a pocket goniometer . Results : At baseline , the three groups exhibited comparable demographic characteristics and basal evaluations . Intra-group changes in the rehabilitation group from baseline to 12 months yielded statistically significant gains ( p < 0.05 ) for all outcomes . At 12-months follow-up , compared with the control and educational-behavioural , the rehabilitation group exhibited significant differences in chest expansion ( p = 0.001 and p < 0.001 ) , Bath Ankylosing Spondylitis Disease Activity Index ( p = 0.012 and p = 0.050 ) , and in some goniometric measurements as cervical rotation ( p = 0.007 and p = 0.014 ) , toraco-lumbar rotation ( p = 0.009 and p = 0.050 ) , and total cervical movements ( p = 0.009 and p = 0.001 ) . Conclusion : In comparison with the educational-behavioural programme or no intervention , supervised training and home exercises improved long-term outcome in patients with ankylosing spondylitis
target: Most studies showed a positive effect of exercise on Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Functional Index , pain , mobility , function and quality of life .
  Results support a multimodal approach , including educational sessions and maintaining home-based program .
background: Ankylosing spondylitis ( AS ) is a chronic and inflammatory rheumatic disease , characterized by pain and structural and functional impairments , such as reduced mobility and axial deformity , which lead to diminished quality of life .
  Its treatment includes not only drugs , but also nonpharmacological therapy .
  Exercise appears to be a promising modality .
  The aim of this study is to review the current evidence and evaluate the role of exercise either on l and or in water for the management of patients with AS in the biological era .