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Poor Exercise Adherence Reported in Patients with Ankylosing Spondylitis

Of 185 outpatients that completed the questionnaire, 146 patients (78.9%) were considered to have poor adherence to exercise therapy.

Patients with ankylosing spondylitis (AS) had a poor adherence to exercise therapy, with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) noted as a significantly associated factor, according to a study published in Springer.1

“Although the treatment of AS has been revolutionized with the advent of biological therapies, rehabilitation is still a promising nonpharmacological therapy in AS, which usually include aerobic exercise, respiratory kinesiotherapy, strengthening, stretching, and balance and gait training,” investigators stated. “In AS, the main goals of exercise focus on pain control, prevention and delay of stiffness, improvement of function and gait, and correction of deformity in combination with pharmacological therapy. However, reports on adherence to physical exercises in patients with AS are relatively rare, and the criteria for adherence to exercises have been inconsistent.”

In this cross-sectional study, data collected included the subject’s sociodemographic (age, sex, body mass index [BMI], education level, smoking habits, outpatient information, and family history), radiographic, disease-related, and laboratory information. Eligible patients were between 18 and 50 years of age, did not have a history of psychiatric disorders or cognitive disfunction, and completed the Exercise Attitude Questionnaire (EAQ) questionnaire.

Adherence to exercise therapy was analyzed using the 18-item EAQ with a 4-point Likert scale. Cases were grouped as either poor adherence or good adherence using the cutoff score of 60. A multivariate logistic regression model was used to identify possible factors related to poor adherence to exercise therapy.

Of 185 outpatients that completed the questionnaire, 146 patients (78.9%) were considered to have poor adherence (EAQ score ≤ 60) to exercise therapy (with only 39 patients [21.1%] exhibiting good adherence). The mean EAQ score among participants was 49.4 (IQR, 40.7–59.3).

Patients in the poor adherence group were more likely to use NSAIDs, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and tumor necrosis factor-α inhibitors (TNFi) (p=0.001, p=0.027, p=0.018, respectively). However, the multivariate logistic model only reported significant associations between current NSAID usage (OR=3.517; p=0.016; 95% CI, 1.259–9.827). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were also significantly higher in patients with poor adherence (p=0.025 and p=0.014, respectively).

The single-center, cross-sectional nature of the study limited it and, as such, results were not generalizable. Further, exercise adherence tends to decline over time. The small sample size did not allow for investigators to draw correlations between other risk factors. Lastly, certain sociodemographic influences, such as marital status, dietary choices, disease-related factors, and income were not included in the assessment.

“Lack of adherence to exercise therapy is a major concern in the treatment of patients with AS,” investigators concluded. “Clinically, there is an urgent need to develop comprehensive strategies to improve adherence to exercise therapy in patients with AS, and future studies can aim to determine the reasons behind the lack of adherence to exercise therapy.”


Ma S, Zhang L, Man S, et al. Patient-reported adherence to physical exercises of patients with ankylosing spondylitis [published online ahead of print, 2022 May 3]. Clin Rheumatol. 2022;10.1007/s10067-022-06189-w. doi:10.1007/s10067-022-06189-w