Exercise Recommendations Developed for Ankylosing Spondylitis
Written by Editor   
Wednesday, October 21, 2015 12:00 AM

An expert panel has developed 10 evidence-based recommendations for exercise among patients with ankylosing spondylitis (AS), an inflammatory type of arthritis.

The recommendations are:

1) Assessment: Individual exercise prescriptions should be informed by a thorough and reproducible assessment that includes musculoskeletal and psychosocial factors, and AS-specific measures, including objective axial mobility and chest expansion. (CBR)

2) Monitoring: Sufficient monitoring and feedback should be provided on an individual basis and done at least annually. (CBR)

3) Safety: Physical changes of AS -- including the amount of bony change, balance and mobility changes, osteoporosis, and cardiorespiratory consequences of the disease -- should be considered throughout all aspects of the exercise prescription, especially for those with more severe or advanced disease. (CBR)

4) Disease management: Patients taking anti-tumor necrosis factor alpha (TNFα) therapy should continue with their regular exercise prescription. "The trials consistently demonstrated the beneficial effect of a combination of anti- TNFα therapy and an AS-specific exercise program, compared with either anti-TNFα treatment or exercise alone, for both self-reported measures (such as function and disease activity) and objective measures such as the Bath Ankylosing Spondylitis Metrology Index," wrote the authors. (EBR Grade B)

5) AS-specific exercise -- mobility: Although the panel was unable to recommend one exercise approach over another, they concluded that an individual exercise prescription with an emphasis on spinal mobility is essential, as is maintaining mobility of peripheral joints. Individual goals, they wrote, should be informed by assessment findings. (EBR Grade A)

6) AS-specific exercise -- other: It's important to include stretching, strengthening, cardiopulmonary, and functional fitness in a balanced exercise program. (EBR Grade A)

7) Physical Activity: Healthcare personnel should encourage regular physical activity to promote general health, well-being, and functional outcomes. (EBR Grade B)

8) Dosage: Since a precise "one size fits all" dosage is not possible, it's recommended that exercise frequency, intensity, duration, and type be tailored to the person's assessment findings, goals, and lifestyle. For mobility, stretch, and postural exercises, consistency is the most important factor. For other exercise types, national physical activity guidelines may require modification. Disease stage, activity, and progression should be considered while aiming for optimal effectiveness. (EBR Grade C)

9) Adherence: It's important to assess adherence to regular exercise, encourage motivation, and promote self-management. (EBR Grade B)

10) Exercise setting: Patient preference in exercise choice should be a priority to enhance adherence and optimize positive outcomes. (CBR)

Patients with AS experience pain and stiffness that mainly affect the axial skeleton (spine, hips, and shoulders). AS can affect muscle strength, balance, and cardiopulmonary function.
The new consensus statement provides the first comprehensive exercise recommendations to guide practitioners treating AS patients was developed by a group of 11 physiotherapist members of an AS special interest group in Australia and a rheumatologist .
Because the research in some areas was of relatively low quality, the panel took an approach that targeted individual therapeutic goals. The recommendations are specific enough to be "clinically useful, but flexible for adaptation" to the needs of individuals, said the authors.

Source:  http://www.medpagetoday.com/Rheumatology/Arthritis/53636