Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials

Objective: To assess the effectiveness of exercise programs on disease activity and function in ankylosing spondylitis (AS) by a systematic review and meta-analysis of randomized controlled trials (RCTs). Data Sources: Medline via PubMed and Cochrane Library. Study Selection: Reports of RCTs examining the effectiveness of exercise programs for AS published up to May 2017. Data Extraction: Outcomes were evolution of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) after the completion of exercise programs. Modalities of exercise were compared and the use of biologic therapy was reported. Data Synthesis: After screening 190 abstracts, we selected 26 reports for detailed evaluation and finally investigated 8 trials that assessed a home-based exercise program (2/8), swimming (1/8), Pilates training (1/8), or supervised exercises (4/8), for a total of 331 patients with AS. Four trials included patients receiving antitumor necrosis factor therapy. All trials except one showed a decrease in BASDAI and BASH with exercise. The weighted mean difference was 0.90 (95% confidence interval, 1.52 to 0.27; I-2=69%; P=.005) for the BASDAI and 0.72 (95% confidence interval, -1.03 to -0.40; I-2=0%; P<00001) for the BASH in favor of exercise programs. Conclusions: Despite the small number of patients and the heterogeneity of exercise programs in the RCTs included in this meta-analysis, its results support the potential of exercise programs to improve disease activity and body function in AS. (C) 2017 by the American Congress of Rehabilitation Medicine