Which Exercises Help Spondyloarthropathies, and How

O’Dwyer T, O’Shea F, Wilson F. Exercise therapy for spondyloarthritis: a systematic review. Rheumatology International. (2014) [Epub Feb 19 2014] DOI 10.1007/s00296-014-2965-7.

Dundar U, Solak O, Toktas H, et al., Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial.Rheumatology International (2014) [Epub March 14 2014]. DOI 10.1007/s00296-014-2980-8.

Oana Roşu MO, Ţopa I, Chirieac R, Ancuta C. Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial.Rheumatology International. 2014;34(3):367-372. [Epub September 13 2013]

Recent research gives new guidance on types of therapy that can relieve back pain and improve physical function in adults with various forms of inflammatory spondyloarthropathies, including psoriatic arthritis (PsA) and ankylosing spondylitis (AS). 

A systematic review and two randomized controlled trials published in Rheumatology International also found that exercise, in particular supervised group workouts such as aquatic exercise and Pilates, reduces disease activity and increases chest expansion capability.

Adding aerobic components to flexibility exercise programs improves cardiorespiratory outcomes, the review of 24 studies involving almost 1,500 patients over a decade revealed. But it does not reduce the cardiovascular risk factors associated with AS and PsA.

While the review found some evidence that other types of exercise can improve pain, stiffness, spinal mobility, and cardiorespiratory function in AS and PsA, it concluded that the most effective protocol for other subtypes of spondyloarthropathies is still unclear.

In Water or On Land?

The review did note, however, that exercising in water is easier and often less painful than the same movements performed on land, and could help in painful spinal conditions.

Swimming has often been recommended for AS patients. Water’s natural buoyancy reduces pressure on bones, joints, and muscles and provides natural resistance to help strengthen muscles. Water can also be soothing and can ease perceptions of pain.

On the other hand, specific land-based exercise techniques such as Pilates and McKenzie, have also been found effective in easing low back pain and promoting flexibility in healthy people. They may also have beneficial effects if spinal stiffness begins to limit breathing.

Plunging into Aqua Exercise

One randomized study, conducted in Turkey, randomly assigned 69 patients in their mid-40s to a month-long program of pool exercises or to a four-week home program guided by an exercise physiologist and a manual.

The aquatic therapy group (n=35) took part in a pool-based exercise program cthat took place 5 times a week for 4 weeks. The program included active range of motion (ROM) and stretching exercises, as well as walking, jumping, jogging, and strengthening and posture exercises.

The home-based exercise group (n=34) used a 60-minute program done once a day for four weeks. After one demonstration by a physiotherapist, participants used an exercise manual. Exercises included deep breathing, stretching and relaxing different muscle groups, flexibility exercises for the neck and spine, ROM and strengthening exercises. Weekly telephone calls helped participants stick to the program.

Patients in both groups were assessed for pain, spinal mobility, disease activity, disability, and quality of life before and after treatment and 12 weeks later. They were allowed to continue their usual medications, including biologics.

Compared to the home exercise group, aquatic exercisers had significantly greater improvement on pain scores (Visual Analog Scale, VAS), bodily pain, and in physical functioning, general health, vitality, and mental health. Assessment tools such as the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) alsob showed significant improvements for the water exercise group.

Combining Techniques

Another randomized clinical trial compared conventional home-based exercises with a program combining the Pilates, McKenzie, and Heckscher techniques to address specific areas of functional impairment of AS.

The Heckscher method, which originated in Denmark, is directed at the upper back and arms and at correcting breathing difficulties, while Pilates focuses on the dorsal spine and trunk, as well as breath control. The McKenzie method is mainly involved in correcting posture and restoring the natural curve, or lordosis, in the lumbar spine to reduce back pain and stiffness.

The study, conducted in Romania, randomly assigned 96 AS patients to three exercise sessions a week for 48 weeks, either a multimodal combined program or conventional exercises (as a control), both performed at home.

The combined program (n=48) consisted of 20 minutes of Pilates breathing, strengthening, and stretching exercises for key muscle groups in the back, legs, and arms, and 20 minutes of aerobic Heckscher exercises to correct posture and tone the diaphragm and respiratory muscles, followed by 10 minutes of McKenzie exercises for the lower back and abdomen.

The conventional exercise control program (n=48) included step-aerobic exercises, stretching exercises, plus a cool-down period featuring pulmonary exercises and stretching.

While participants in both programs benefited, the combined program produced greater improvements in pain, disease activity, pulmonary and physical function, as well as increases in lumbar spine flexibility and vital capacity.

The combination group also had greater improvements in BASMI, BASDI, and BASFI scores. Chest expansion improved in both groups.

The researchers recommended that such a combined exercise program be included in the routine management of AS to lessen disability and pain.