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 Undue reliance on I2 in assessing heterogeneity may mislead High-intensity cardiorespiratory and strength exercises reduced emotional distress and fatigue in patients with axial spondyloarthritis: a randomized controlled pilot study Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors Self- and manual mobilization improves spine mobility in men with ankylosing spondylitis — a randomized study Efficacy of High Intensity Exercise on Disease Activity and Cardiovascular Risk in Active Axial Spondyloarthritis: A Randomized Controlled Pilot Study The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection Swiss ball exercises improve muscle strength and walking performance in ankylosing spondylitis: a randomized controlled trial. Dose-Response of Aerobic Exercise on Cognition: A Community-Based, Pilot Randomized Controlled Trial The impact of tumor necrosis factor α inhibitors on radiographic progression in ankylosing spondylitis. Effect of Pilates training on people with ankylosing spondylitis Rehabilitation Treatment in Patients with Ankylosing Spondylitis Stabilized with Tumor Necrosis Factor Inhibitor Therapy. A Randomized Controlled Trial The Effectiveness of Exergames in Patients with Ankylosing Spondylitis: A Randomized Controlled Trial. A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. Gender-attributable differences in outcome of ankylosing spondylitis: long-term results from the Outcome in Ankylosing Spondylitis International Study. Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis--an 8-month followup. Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort
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 Background The heterogeneity statistic I2 , interpreted as the percentage of variability due to heterogeneity between studies rather than sampling error , depends on precision , that is , the size of the studies included . Methods Based on a real meta- analysis , we simulate artificially ' inflating ' the sample size under the r and om effects model . For a given inflation factor M = 1 , 2 , 3 , ... and for each trial i , we create a M-inflated trial by drawing a treatment effect estimate from the r and om effects model , using si2MathType@MTEF@5@5@+=feaagaart1ev2aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacPC6xNi = xH8viVGI8Gi = hEeeu0xXdbba9frFj0xb9qqpG0dXdb9aspeI8k8fiI+fsY = rqGqVepae9pg0db9vqaiVgFr0xfr = xfr = xc9adbaqaaeGaciGaaiaabeqaaeqabiWaaaGcbaGaem4Cam3aa0baaSqaaiabdMgaPbqaaiabikdaYaaaaaa@2FBE@/M as within-trial sampling variance . Results As precision increases , while estimates of the heterogeneity variance τ2 remain unchanged on average , estimates of I2 increase rapidly to nearly 100 % . A similar phenomenon is apparent in a sample of 157 meta-analyses . Conclusion When deciding whether or not to pool treatment estimates in a meta- analysis , the yard-stick should be the clinical relevance of any heterogeneity present . τ2 , rather than I2 , is the appropriate measure for this purpose Objective : To investigate the effect of high-intensity exercise on emotional distress , fatigue , and ability to do a full day ’s activities in patients with axial spondyloarthritis ( axSpA ) . Method : A total of 28 physically inactive axSpA patients were r and omized to either an exercise group ( EG ) , which performed 12 weeks of cardiorespiratory and strength exercises , or a control group ( CG ) , which received treatment as usual . The outcomes reported in this paper are secondary outcomes in the trial and included emotional distress ( General Health Question naire-12 , 0–36 , 36 = worst ) , fatigue [ numeric rating scale ( NRS ) , 0–10 , 10 = worst ] , and ability to do a full day ’s activities ( NRS , 0–10 , 10 = worst ) . Post-intervention differences were assessed by analysis of covariance with baseline values as covariates . Results : Twenty-four patients were included in the analyses . All patients in the EG followed the exercise protocol . The EG had a statistically significant beneficial effect [ mean group differences ( 95 % confidence interval ) ] on emotional distress [ −5.8 , ( −9.7 , −1.9 ) , p < 0.01 ] , fatigue [ −2.4 , ( −4.3 , −0.4 ) , p = 0.02 ] , and ability to do a full day ’s work [ −2.2 , ( −3.9 , −0.4 ) , p = 0.02 ] compared to the CG . Conclusion : This pilot study showed promising effects of cardiorespiratory and strength exercises  on emotional distress , fatigue , and ability to do a full day ’s activities in patients with axSpA. The findings need to be confirmed in a larger trial 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 IMPORTANCE The 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week ( 7.5 metabolic-equivalent hours per week ) of aerobic activity for substantial health benefit and suggested additional benefits by doing more than double this amount . However , the upper limit of longevity benefit or possible harm with more physical activity is unclear . OBJECTIVE To quantify the dose-response association between leisure time physical activity and mortality and define the upper limit of benefit or harm associated with increased levels of physical activity . DESIGN , SETTING , AND PARTICIPANTS We pooled data from 6 studies in the National Cancer Institute Cohort Consortium ( baseline 1992 - 2003 ) . Population -based prospect i ve cohorts in the United States and Europe with self-reported physical activity were analyzed in 2014 . A total of 661,137 men and women ( median age , 62 years ; range , 21 - 98 years ) and 116,686 deaths were included . We used Cox proportional hazards regression with cohort stratification to generate multivariable-adjusted hazard ratios ( HRs ) and 95 % CIs . Median follow-up time was 14.2 years . EXPOSURES Leisure time moderate- to vigorous-intensity physical activity . MAIN OUTCOMES AND MEASURES The upper limit of mortality benefit from high levels of leisure time physical activity . RESULTS Compared with individuals reporting no leisure time physical activity , we observed a 20 % lower mortality risk among those performing less than the recommended minimum of 7.5 metabolic-equivalent hours per week ( HR , 0.80 [ 95 % CI , 0.78 - 0.82 ] ) , a 31 % lower risk at 1 to 2 times the recommended minimum ( HR , 0.69 [ 95 % CI , 0.67 - 0.70 ] ) , and a 37 % lower risk at 2 to 3 times the minimum ( HR , 0.63 [ 95 % CI , 0.62 - 0.65 ] ) . An upper threshold for mortality benefit occurred at 3 to 5 times the physical activity recommendation ( HR , 0.61 [ 95 % CI , 0.59 - 0.62 ] ) ; however , compared with the recommended minimum , the additional benefit was modest ( 31 % vs 39 % ) . There was no evidence of harm at 10 or more times the recommended minimum ( HR , 0.69 [ 95 % CI , 0.59 - 0.78 ] ) . A similar dose-response relationship was observed for mortality due to cardiovascular disease and to cancer . CONCLUSIONS AND RELEVANCE Meeting the 2008 Physical Activity Guidelines for Americans minimum by either moderate- or vigorous-intensity activities was associated with nearly the maximum longevity benefit . We observed a benefit threshold at approximately 3 to 5 times the recommended leisure time physical activity minimum and no excess risk at 10 or more times the minimum . In regard to mortality , health care professionals should encourage inactive adults to perform leisure time physical activity and do not need to discourage adults who already participate in high-activity levels 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 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 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 Objective : To vali date and refine two sets of c and i date criteria for the classification/diagnosis of axial spondyloarthritis ( SpA ) . Methods : All Assessment of SpondyloArthritis international Society ( ASAS ) members were invited to include consecutively new patients with chronic ( ⩾3 months ) back pain of unknown origin that began before 45 years of age . The c and i date criteria were first tested in the entire cohort of 649 patients from 25 centres , and then refined in a r and om selection of 40 % of cases and thereafter vali date d in the remaining 60 % . Results : Upon diagnostic work-up , axial SpA was diagnosed in 60.2 % of the cohort . Of these , 70 % did not fulfil modified New York criteria and , therefore , were classified as having “ non-radiographic ” axial SpA. Refinement of the c and i date criteria result ed in new ASAS classification criteria that are defined as : the presence of sacroiliitis by radiography or by magnetic resonance imaging ( MRI ) plus at least one SpA feature ( “ imaging arm ” ) or the presence of HLA-B27 plus at least two SpA features ( “ clinical arm ” ) . The sensitivity and specificity of the entire set of the new criteria were 82.9 % and 84.4 % , and for the imaging arm alone 66.2 % and 97.3 % , respectively . The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI ( sensitivity 85.1 % , specificity 65.1 % ) and slightly better than that of the modified Amor criteria ( sensitivity 82.9 , specificity 77.5 % ) . Conclusion : The new ASAS classification criteria for axial SpA can reliably classify patients for clinical studies and may help rheumatologists in clinical practice in diagnosing axial SpA in those with chronic back pain . Trial registration number : NCT00328068 OBJECTIVE The purpose was to evaluate the effectiveness of a progressive muscle strengthening program using a Swiss ball for AS patients . METHODS Sixty patients with AS were r and omized into the intervention group ( IG ) or the control group ( CG ) . Eight exercises were performed by the IG patients with free weights on a Swiss ball two times per week for 16 weeks . The evaluations were performed by a blinded evaluator at baseline and after 4 , 8 , 12 and 16 weeks using the following instruments : the one-repetition maximum test ( 1 RM ) , BASMI , BASFI , HAQ-S , SF-36 , 6-minute walk test , time up and go test , BASDAI , ASDAS , ESR and CRP dosage and Likert scale . RESULTS There was a statistical difference between groups for : strength ( 1 RM capacity ) in the following exercises : abdominal , rowing , squat , triceps and reverse fly ( p<0.005 ) ; 6-minute walk test ( p<0.001 ) ; timed up and go test ( p=0.025 ) and Likert scale ( p<0.001 ) , all of them with better results for the IG . No differences were observed between the groups with respect to the functional capacity evaluation using the BASFI , HAQ-S , BASMI , SF-36 , TUG , ASDAS , ESR and CPR dosage . CONCLUSIONS Progressive muscle strengthening using a Swiss ball is effective for improving muscle strength and walking performance in patients with AS Epidemiological studies suggest a dose-response relationship exists between physical activity and cognitive outcomes . However , no direct data from r and omized trials exists to support these indirect observations . The purpose of this study was to explore the possible relationship of aerobic exercise dose on cognition .  Underactive or sedentary participants without cognitive impairment were r and omized to one of four groups : no-change control , 75 , 150 , and 225 minutes per week of moderate-intensity semi-supervised aerobic exercise for 26-weeks in a community setting . Cognitive outcomes were latent residual scores derived from a battery of 16 cognitive tests : Verbal Memory , Visuospatial Processing , Simple Attention , Set Maintenance and Shifting , and Reasoning . Other outcome measures were cardiorespiratory fitness ( peak oxygen consumption ) and measures of function functional health . In intent-to-treat ( ITT ) analyses ( n = 101 ) , cardiorespiratory fitness increased and perceived disability decreased in a dose-dependent manner across the 4 groups . No other exercise-related effects were observed in ITT analyses . Analyses restricted to individuals who exercised per- protocol ( n = 77 ) demonstrated that Simple Attention improved equivalently across all exercise groups compared to controls and a dose-response relationship was present for Visuospatial Processing . A clear dose-response relationship exists between exercise and cardiorespiratory fitness . Cognitive benefits were apparent at low doses with possible increased benefits in visuospatial function at higher doses but only in those who adhered to the exercise protocol . An individual ’s cardiorespiratory fitness response was a better predictor of cognitive gains than exercise dose ( i.e. , duration ) and thus maximizing an individual ’s cardiorespiratory fitness may be an important therapeutic target for achieving cognitive benefits . Trial Registration Clinical Trials.gov OBJECTIVE To study the effect of tumor necrosis factor α ( TNFα ) inhibitors on  progressive spinal damage in patients with ankylosing spondylitis ( AS ) . METHODS All AS patients meeting the modified New York criteria who had been monitored prospect ively and had at least 2 sets of spinal radiographs a minimum of 1.5 years apart were included in the study ( n=334 ) . The patients received st and ard therapy , which included nonsteroidal antiinflammatory drugs and TNFα inhibitors . Radiographic severity was assessed by the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ) . Patients with a rate of AS progression that was ≥1 mSASSS unit/year were considered progressors . Univariable and multivariable regression analyses were done . Propensity score matching and sensitivity analysis were performed . A zero-inflated negative binomial ( ZINB ) model was used to analyze the effect of TNFα inhibitors on the change in the mSASSS with varying followup periods . Potential confounders , such as disease activity ( as assessed by the Bath Ankylosing Spondylitis Disease Activity Index ) , the erythrocyte sedimentation rate , C-reactive protein level , HLA-B27 positivity , sex , age at onset , smoking burden ( number of pack-years ) , and baseline damage , were included in the model . RESULTS TNFα inhibitor treatment was associated with a 50 % reduction in the odds of progression , with an odds ratio ( OR ) of 0.52 ( 95 % confidence interval [ 95 % CI ] 0.30 - 0.88 , P=0.02 ) . Patients with a delay of > 10 years in starting therapy were more likely to experience progression as compared to those who started earlier ( OR 2.4 [ 95 % CI 1.09 - 5.3 ] , P=0.03 ) . In the ZINB model , the use of TNFα inhibitors  significantly reduced disease progression when the gap between radiographs was > 3.9 years . The protective effect of TNFα inhibitors was stronger after propensity score matching . CONCLUSION Treatment with TNFα inhibitors appears to reduce radiographic progression in AS patients , especially with early initiation and with longer duration of followup 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 assess the 2- ( T1 ) and 6-month ( T2 ) followup effects on pain , spine mobility , physical function , and disability outcome of a rehabilitation intervention in patients with ankylosing spondylitis ( AS ) stabilized with tumor necrosis factor ( TNF ) inhibitor therapy . Methods . Sixty-two out patients ( 49 men , 13 women , mean age 47.5 ± 10.6 yrs ) were r and omized to rehabilitation plus an educational-behavioral ( n = 20 ) program , to an educational-behavioral program only ( n = 20 ) , or to a control group ( n = 22 ) . The educational-behavioral program included 2 educational meetings and 12 rehabilitation exercise sessions ( stretching , strengthening , chest and spine/hip joint flexibility exercises ) , which patients then performed at home . Outcome assessment at the end of rehabilitation training ( T1 ) and at T2 was based on spinal pain intensity in the previous 4 weeks by self-report visual analog scale ( VAS ; 100 mm : 0 = no pain , 100 = maximum pain ) , BASMI , BASFI , BASDAI , and on chest expansion and the active range of motion of the cervical and lumbar spine measured by a pocket goniometer . Results . The 3 groups were comparable at baseline . On intragroup comparison at T1 , the rehabilitation group showed significant improvement in the BASMI and BASDAI , in chest expansion , and in most spinal active range of motion measurements . BASFI and cervical and lumbar VAS scores improved in both the rehabilitation and educational-behavioral groups . The positive results achieved in the rehabilitation group were maintained at the 6-month followup . Conclusion . Combining intensive group exercise with an educational-behavioral program can provide promising results in the management of patients with clinical ly stabilized AS on TNF inhibitor treatment BACKGROUND Exergames are a well-known type of game based on a virtual avatar 's body movements . This hightech approach promotes an active lifestyle . OBJECTIVES The aim of this r and omized controlled trial was to evaluate the effects of exergames on pain , disease activity , functional capacity and quality of life in patients with ankylosing spondylitis ( AS ) . MATERIAL AND METHODS The study involved 60 patients , who were r and omized into either the exergame group ( EG ) or the control group ( CG ) . The EG patients engaged in exergaming , and CG patients did not engage in any exercises . The exergaming sessions were performed five times a week for eight weeks ( 40 sessions in total ) . The patients were assessed before and after the eight-week program on a visual analog scale ( VAS ) , the Bath Ankylosing Spondylitis Functional Index ( BASFI ) , the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) and the Ankylosing Spondylitis Quality of Life ( ASQOL ) question naire . RESULTS A statistically significant improvement was observed in VAS , BASFI , BASDAI and ASQoL scores in the EG group after completion of the exercise program ( p < 0.05 ) . CONCLUSIONS This study is a first step in investigating the possibilities of using an exergame platform to help patients with spondyloarthropathies to adopt a more physically active lifestyle . The results of this study suggest that exergames increase physical activity and decrease the pain scores in AS patients and also could , therefore , be feasible and safe 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 OBJECTIVES To investigate gender-attributable differences regarding clinical outcome [ disease activity , physical function and quality of life ( QoL ) ] and radiographic damage in patients with AS over time . METHODS Data from the Outcome in AS International Study were used . Disease activity was assessed by the BASDAI , ASDAS and CRP ; physical function by BASFI ; QoL by the Short Form-36 , Ankylosing Spondylitis Quality of Life ( ASQoL ) score and European Quality Of Life scale ; and radiographic damage by the modified Stoke AS Spine Score ( mSASSS ) . Cross-sectional comparative analyses were done at baseline . Next , separate models were created to assess gender-attributable differences on each outcome measure over time using time-adjusted generalized estimating equations . RESULTS A total of 216 patients [ 154 ( 72.3 % ) males , mean age 43.6 years ( s.d . 12.7 ) , symptom duration 20.5 years ( s.d . 11.8 ) , mean follow-up duration 8.3 years ( s.d . 4.1 ) ] were included . At baseline , male compared with female patients had lower self-reported disease activity ( BASDAI 3.2 vs 3.9 , P = 0.03 ) but more radiographic damage ( mSASSS 13.8 vs 6.5 , P = 0.02 ) . No significant gender-attributable differences in other clinical parameters were found . In multivariable analysis , male gender was significantly associated with a better ASQoL ( B = -1.18 , 95 % CI : -2.17 , -0.20 , P = 0.02 ) , and in a separate model with a higher mSASSS over time ( B = 8.24 , 95 % CI : 4.38 , 12.09 , P < 0.01 ) . CONCLUSION In this prospect i ve cohort study , no gender-attributable differences in disease activity or physical function over time were found . However , radiographic damage was more severe in males . Furthermore , males had a better QoL over time OBJECTIVE To evaluate the effect of infliximab on progression of structural damage over 2 years in patients with ankylosing spondylitis ( AS ) . METHODS In the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy ( ASSERT ) , a r and omized , double-blind , placebo-controlled trial of the efficacy of infliximab compared with placebo , 279 patients with active AS received either placebo through week 24 and then infliximab 5 mg/kg from week 24 through week 96 ( n=78 ) or infliximab 5 mg/kg from baseline through week 96 , administered every 6 weeks after a loading dose ( n=201 ; these patients were the focus of the radiographic analyses ) . Radiographic findings  in patients from the ASSERT trial were indistinguishable from those in a historical control cohort of patients who had no prior use of anti-tumor necrosis factor agents ( from the Outcome in Ankylosing Spondylitis International Study [ OASIS ] data base ; n=192 ) . Radiographic progression of structural damage from baseline to the 2-year followup was scored using the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ) . All images were scored in one batch . RESULTS Median changes in the mSASSS from baseline to year 2 were 0.0 for both the OASIS and the ASSERT cohorts ( P=0.541 ) . Mean changes in the mSASSS were also similar between the OASIS and ASSERT cohorts ( mean+/-SD change over 2 years 1.0+/-3.2 and 0.9+/-2.6 , respectively ) . In addition , results from sensitivity analyses did not show a statistically significant difference in the mSASSS between the OASIS and ASSERT cohorts . CONCLUSION AS patients who received infliximab from baseline through week 96 did not show a statistically significant difference in inhibition of structural damage progression at year 2 , as assessed using the mSASSS scoring system , when compared with radiographic data from the historical control OASIS cohort . Improvements in clinical outcomes and spinal inflammation have been previously demonstrated with the use of infliximab therapy OBJECTIVE Our previous r and omized clinical trial showed a 4-month home physiotherapy program was effective for patients with ankylosing spondylitis . This followup study reports on 22 control patients who received the previously withheld treatment and 24 experimental patients who received followup treatment as needed . METHODS The primary outcome measure was spinal mobility measured by fingertip-to-floor distance using a portable measuring device specially design ed and vali date d for this study . RESULTS Following treatment , fingertip-to-floor distance did not change in control patients ( P2 = 0.145 ) . Between 4 and 8 months , fingertip-to-floor distance did not change in experimental patients ( P2 = 0.143 ) ; however , initial improvement achieved was maintained . The experimental group at 4 months was better than the control group at 8 months ( P2 = 0.038 ) . CONCLUSION The home physiotherapy treatment program must be delivered as rigorously as it was in the initial trial to be effective . The benefit from this treatment program can be maintained with very little intervention Objective To investigate the influence of non-steroidal anti-inflammatory drugs ( NSAIDs ) intake on radiographic spinal progression over 2 years in patients with ankylosing spondylitis ( AS ) and non-radiographic axial spondyloarthritis ( SpA ) . Methods 164 patients with axial SpA ( 88 with AS and 76 with non-radiographic axial SpA ) were selected for this analysis based on availability of spinal radiographs at baseline and after 2 years of follow-up and the data on NSAIDs intake . Spinal radiographs  were scored by two trained readers in a concealed r and omly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ) system . An index of the NSAID intake counting both dose and duration of drug intake was calculated . Results High NSAIDs intake ( NSAID index≥50 ) in AS was associated with lower likelihood of significant radiographic progression defined as an mSASSS worsening by ≥2 units : OR=0.15 , 95 % CI 0.02 to 0.96 , p=0.045 ( adjusted for baseline structural damage , elevated C reactive protein ( CRP ) and smoking status ) in comparison with patients with low NSAIDs intake ( NSAID index<50 ) . This effect was most pronounced in patients with baseline syndesmophytes plus elevated CRP : mean mSASSS progression was 4.36±4.53 in patients with low NSAIDs intake versus 0.14±1.80 with high intake , p=0.02 . In non-radiographic axial SpA , no significant differences regarding radiographic progression between patients with high and low NSAIDs intake were found . Conclusion A high NSAIDs intake over 2 years is associated with retarded radiographic spinal progression in AS . In non-radiographic axial SpA this effect is less evident , probably due to a low grade of new bone formation in the spine at this stage
target: There was no important clinical meaningful benefit .
  Adverse effectsWe found very low- quality evidence of the effect of exercise versus either no intervention , or usual care .
  We found moderate- to low- quality evidence that exercise programmes probably slightly improve function , may reduce pain , and probably slightly reduce global patient assessment of disease activity , when compared with no intervention , and measured upon completion of the programme .
  We found moderate- to low- quality evidence that exercise programmes probably have little or no effect on improving function or reducing pain , when compared with usual care , and may have little or no effect on reducing patient assessment of disease activity , when measured upon completion of the programmes .
  We are uncertain whether exercise programmes improve spinal mobility , reduce fatigue , or induce adverse effects
background: BACKGROUND Exercise programmes are often recommended for managing ankylosing spondylitis ( AS ) , to reduce pain and improve or maintain functional capacity .
  OBJECTIVES To assess the benefits and harms of exercise programmes for people with AS .