How to Exercise with Ankylosing Spondylitis

Reviewed by: HU Medical Review Board | Last reviewed: June 2022 | Last updated: July 2022

Ankylosing spondylitis (AS) causes pain and stiffness to affected joints in the spine, and some people also experience AS in their peripheral joints like the hips or shoulders. If the disease progresses, it can cause fusion of the joints, which can limit a person’s mobility and flexibility. Treatment for AS aims to reduce symptoms, maintain the individual’s flexibility and quality of life, and delay or prevent structural damage and possible complications of the disease.1,2 In addition to medication, a critical part of managing AS is exercise and physical therapy.3

Guidelines for exercise in people with ankylosing spondylitis

Although exercise has been recommended for people living with AS for many years, until recently, there were no guidelines on how best to incorporate exercise for symptom relief and management of the disease. In 2016, a group of Australian physical therapists and a rheumatologist reviewed the relevant clinical evidence and created 10 recommendations3:

  1. The exercise you do should depend on your flexibility, how much you can breathe into your chest, and how AS impacts your quality of life.
  2. You should be looked after by a doctor or physical therapist regularly. This can help you gain confidence in the exercise you choose and get better at it in a way that keeps you safe. This can also help you add in or remove exercises that feel good or bad.
  3. The physical changes of AS like stiffening joints, fusing joints, osteoporosis, changes in your balance, should all be carefully monitored throughout exercising.
  4. People who are receiving treatment with a TNF (tumor necrosis factor) inhibitor should continue with regular exercise, as exercise adds an additional benefit than TNF inhibitors alone.
  5. The exercise program should have an emphasis on spinal mobility and should maintain mobility of joints for the best management of AS.
  6. A balanced exercise program should include stretching, strengthening, cardio, and functional fitness components.
  7. Regular physical activity should be encouraged to promote general health, well-being, and functional outcomes.
  8. The frequency, intensity, duration, and type of exercise must be tailored to the individual’s assessment, goals, and lifestyle.
  9. Adherence to exercise should be assessed and encouraged.
  10. The individual’s preference on the type of exercise should be prioritized to help you stick with it and have the most positive outcomes.

Good exercises for people with AS

Some good exercises for people with AS may include (but are not limited to):

  • Pilates
  • Tai chi
  • Posture exercises
  • Yoga
  • Warm-water exercise
  • Stretching
  • Cardio exercise, such as brisk walking, cycling, or swimming

Exercise don’ts for people with AS

Most types of exercise are safe for the majority of people with AS. However, some exercises may not be safe in certain advanced cases of AS, such as3:

  • High impact exercises, like contact sports, martial arts, four-wheel driving, boating in rough seas, fairground rides
  • Fast movement or exercise with lots of resistance, especially those which have you move your midsection a lot
  • Exercises which really challenge balance, ability to stay stable, or breathing function
  • Exercises which require lots of spinal or joint mobility in a person with ankylosis in that area
  • Certain exercises after a total hip replacement

Each individual should work with their doctor and physical therapist to determine which exercises are appropriate and safe for their unique situation. And, as the guidelines suggest, the recommended and safe exercises may change over time as a person’s disease progresses.

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