Therapeutic Exercise for Ankylosing Spondylitis: Recommendation for Clinical Application

Abstract

Background

Ankylosing spondylitis(AS) as one of rheumatic diseases is primarily an inflammatory arthritis of the back, affecting the sacroiliac and apophysial joints. No intervention could alter the causing mechanism in AS which need long-term management. Current available conventional treatments are twofold, consisting of medication and therapeutic exercise. Therapeutic exercises consisted of strengthening and stretching exercises are performed to maintain mobility of affected joints, to enhance or maintain posture and to achieve general fitness. The therapeutic exercises combined the medication with physical exercises are applied to managing and reducing the symptoms. However, this approach is widely used in practice without reliably structured study for clinical application. There have been no recent systematic reviews on therapeutic exercise for AS patients. The improvement of physical function or quality of life are an important outcome. The objective of this systematic review was to answer the question: In AS patients, which therapeutic exercise are associated with best level of physical function or quality of life, short term therapy and long term therapy? Which therapeutic exercise is appropriated for improvement of quality of life on the symptomatic stage of AS patients?

Purposes The aims of this study are to present recent information of therapeutic exercise, explain the method of physical exercise structured specifically for AS through systemic review, and provide the recommendations for clinical application of therapeutic exercise.

Methods

The authors searched Medline, EMBASE, and Cochrane Controlled Trial Register from January 1, 1990 to May 31, 2004. Terms and text words used for specific search of this study were AS, therapeutic exercise, training, and physical therapy. For clinical evidences and practical reasons, only randomized controlled clinical trials published in English were included. The literature search identified 15 articles. 6 Of these met the inclusion criteria. Two reviewers extracted data using predetermined forms.

Results

Therapeutic exercise in AS patients has an important role in maintaining and improving mobility of the spine and peripheral joints, strengthening the muscles of the trunk, legs and back, and the abdomen, stretching the back and improving fitness by general conditioning exercises and sporting activities and relaxing of the body and improving mobility by hydrotherapy. Recent reviews and randomized clinical trials indicate that physical exercise is effective for improving pain, function, and psychological aspect of AS patients. Also, combination of spa therapy and group exercise may be more effective than exercise performed individually at reducing symptom and impairment associated with AS.

Recommendations for Therapeutic Exercise:

Regularly exercise - Stretching and strengthening exercises - 5 or more days/week, 1-2 times/day, and 20-30 minutes/time Stop exercising if pain, heat and swelling are occurred in the joint, and apply an ice Do not take a forward posture Avoid taking a prolonged position Frequently take a break to do not have a fatigue Avoid aggressive activities Contact sports are not recommended in patients with cervical spine involvement Breath deeply and adequately using diaphragm Encourage to attend various activities Provide psychological support and facilitate motivation to treatment

Conclusion

Given the overall safety and likely benefits of exercise, physical intervention such as therapeutic exercise and functional training should be necessarily included in the overall treatment of patients with AS in order to long-term management and improvement of a quality of life and physical function. Therefore, a proper guideline for the clinical application of therapeutic exercise should be provided to perform an effective and safe exercise.