Supervised Exercise Most Effective for Managing Axial Spondyloarthritis, Study Finds

6/16/2025

A new study published in Therapeutic Advances in Musculoskeletal Disease highlights the powerful benefits of structured exercise programs in managing axial spondyloarthritis (axSpA).

Doctors often recommend non-drug treatments, called non-pharmacological interventions (NPIs), to be used alongside medications for axSpA. These treatments are especially important because not all patients respond well to medication, and some experience side effects or relapses after reducing their drug dosage. NPIs, particularly physical activity, are generally considered safe and have few side effects, making them a valuable part of long-term treatment plan.

Researchers set out to compare the effectiveness of different types of NPIs, especially exercise-based programs, in improving clinical outcomes for patients with axSpA. They performed a network meta-analysis, a method that allows multiple treatments to be compared at once, even if they haven’t been directly tested against each other in the same studies.

The team reviewed 51 high-quality randomized controlled trials (RCTs) involving 3,457 patients. These studies tested various non-drug interventions such as aerobic exercise, conventional stretching and mobility routines, neuromuscular training, and supervised combined exercise programs.

Key Findings

Two types of exercise stood out:

• Supervised combined exercise programs, which include multiple types of training like strength, flexibility, and aerobic workouts
• Neuromuscular training, which focuses on improving balance, posture, and muscle control

These two interventions were found to be the most effective at improving disease activity, physical function, and spinal mobility—the three core areas affected by axSpA.

Compared to standard care or even conventional exercise routines, patients who followed supervised combined exercise or neuromuscular training experienced:

• Greater reductions in symptom severity (as measured by the BASDAI index)
• Improved ability to perform daily tasks (based on the BASFI index)
• Better spinal flexibility (tracked by the BASMI index)

Both approaches also outperformed unsupervised or standard exercise programs in reducing pain and improving overall physical outcomes.

The study confirms that not all exercise is equally effective for people with axSpA. While general movement is helpful, structured, supervised programs that include neuromuscular training or a mix of different exercises offer more meaningful results.

The authors note that treatment decisions should still consider individual preferences, goals, and physical abilities. For example, some patients may prefer aerobic workouts, while others may benefit more from balance and strength training.

References:

1. Sage Journals – Non-pharmacological interventions for patients with axial spondyloarthritis: a meta-analysis
2. NIH – Underweight and obesity are strong predictors of clinical outcomes in patients with ankylosing spondylitis: data from the Smart-phone SpondyloArthritis Management System
3. SAA – Spondycast Episode 34: Physical Fitness and Spondyloarthritis