# Exercise prescription for axial spondyloarthritis: a systematic review and meta-analysis of randomized controlled trials

## TL;DR

Exercise improves symptoms in axial spondyloarthritis patients, with specific benefits on disease activity, mobility, and fatigue.

## Contribution

A meta-analysis of RCTs provides evidence-based guidance for exercise prescriptions in axial spondyloarthritis.

## Key findings

- Exercise interventions significantly improved disease activity and physical function in axSpA patients.
- Spinal mobility and fatigue levels also showed statistically significant improvement with exercise.
- Subgroup analyses suggest exercise modality and duration influence treatment efficacy.

## Abstract

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic condition that significantly impacts patients’ quality of life. Exercise therapy serves as a core non-pharmacological treatment modality, yet its overall efficacy and optimal prescription parameters require further clarification through high-quality evidence. This study aims to systematically evaluate the efficacy of exercise interventions for axSpA patients.

Computerized searches were conducted across databases including PubMed, Embase, Web of Science, and the Cochrane Library, covering the period from inception to September 2025. Randomized controlled trials (RCTs) comparing exercise interventions with conventional treatments for axSpA were included. Two researchers independently performed literature screening, data extraction, and quality assessment. The heterogeneity of the research results was assessed using the I2 statistic. Continuous variables were presented as weighted mean differences or standard mean differences, with confidence intervals set at 95%. Stata 15.0 was utilized to conduct a meta-analysis.

Fifteen RCTs involving 1,699 patients were included. Meta-analysis revealed that exercise intervention significantly improved disease activity in axSpA patients compared with controls (BASDAI: SMD = –0.75, 95% CI: –1.19 to –0.31; ASDAS: SMD = –0.91, 95% CI: –1.54 to –0.29), physical function (BASFI: SMD = –0.37, 95% CI: –0.47 to –0.26), spinal mobility (BASMI: SMD = –0.26, 95% CI: –0.49 to –0.04), thoracic expansion (SMD = 0.35, 95% CI: 0.04–0.65), and fatigue levels (SMD = –0.53, 95% CI: –0.78 to –0.28). Subgroup analyses indicated that different exercise modalities and intervention durations influenced treatment efficacy.

This meta-analysis confirms that exercise interventions significantly improve core outcome measures including disease activity, physical function, spinal mobility, and fatigue in patients with axial spondyloarthritis, with statistically significant effects. The findings support the incorporation of individualized exercise prescriptions as a key component of standard axSpA treatment, providing evidence-based guidance for clinical practice. Future research should further optimize exercise prescription parameters and validate their long-term efficacy.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251144518, identifier CRD420251144518.