“Get up and get moving” has become a widespread health mantra, and physical activity is especially important if you have ankylosing spondylitis (AS). Experts tend to agree that medication alone isn’t enough to manage the disease.
“For all forms of arthritis, if you don’t stay active, you become deconditioned and lose muscle, which leads to less support for the joints and increased pain,” says John Andrew Flynn, MD, a professor of medicine at the Johns Hopkins School of Education in Baltimore. People with any type of arthritis, Dr. Flynn says — including AS — should get as much physical activity as possible.
Here are seven ways that exercise can help with ankylosing spondylitis symptoms.
Improves Posture
Many people with AS experience back pain that is somewhat relieved by changing their posture, but this relief is inevitably temporary — and postural changes can end up causing even more pain, according to the Spondylitis Association of America (SAA).
“When you’re in pain, you bend forward to relieve yourself,” says Janice McInnes, MPH, a physical therapist at the center for adults with pediatric rheumatic illness at Brigham and Women’s Hospital in Boston. “Over long periods of time, you can lose your posture.”
Swimming is an ideal exercise for maintaining good posture, McInnes says. And any exercise that strengthens your core muscles (the abdominal and back muscles that help support the spine), such as Pilates, can make it easier to maintain good posture, according to the SAA.
Provides Pain Relief and Better Quality of Life
Exercise is a key element of pain relief for ankylosing spondylitis, according to the SAA. That’s because strong muscles ease pressure on the joints in your spine that are affected by AS, while range-of-motion exercises help relax muscles that have tightened due to inflamed joints, releasing some of the pain.
A meta-analysis from 2020 looked at 10 studies on exercise programs for AS involving a total of 534 participants. The researchers found that people in the exercise intervention groups saw significant improvements in pain scores compared with people in nonexercise groups.
The benefits of exercise on pain were seen in studies that looked at home-based exercise programs, not just in those that involved supervised exercise. Exercise was also linked to lower disease activity and better daily functioning.
Increases Flexibility and Range of Motion
Range-of-motion or stretching exercises can reduce stiffness and ensure that your muscles and joints maintain as close to their full range of motion as possible, according to the SAA. They’re critical for ankylosing spondylitis, because people tend to limit movement in areas where there is swelling or pain, which can lead to loss of mobility and increases the risk that joints will fuse.
If you maintain your flexibility, you’ll find it’s easier to perform other forms of exercise that help with AS symptoms, such as aerobic exercise and strength training.
“Stiffness makes you not want to move,” McInnes emphasizes. “If you don’t move, you lose flexibility.”
Builds Strength and Fitness
Strengthening exercises, such as weight training, can help build muscles that will support and protect your joints, Flynn says. Aerobic or endurance exercises, on the other hand, like biking or running, can help you maintain a healthy body weight, ensuring that your joints don’t carry any more weight than they need to.
In a study from 2020 of 105 people with ankylosing spondylitis, researchers found that obesity was linked to greater inflammation and disease activity than was seen in participants who weren’t obese. They were also at greater risk for structural damage related to AS, as seen on imaging scans. Excess abdominal fat, in particular, was linked to greater AS disease activity.
Reduces Fatigue
Fatigue is a common problem for people with ankylosing spondylitis. It can interfere with many aspects of daily life and impair your cognitive function, according to the SAA.
Fatigue is strongly linked to greater disease activity in AS, and may also be related to depression or sleep disturbances in people with AS.
Exercise can help you reduce fatigue and boost your endurance, which can help make your daily routine easier to manage, McInnes says — a claim that is backed up by some research.
In a study from 2018, researchers found that in a group of 60 people with AS, those who were assigned to either a “postural reeducation” or a conventional exercise program — and who also took a biologic therapy — had lower fatigue scores than a third control group.
Both exercise-plus-biologic groups also showed similar improvements in disease activity, sleep quality, and depression scores.
Creates Greater Lung Capacity
Some people with ankylosing spondylitis lose flexibility in their spine. In severe cases, where two or more vertebrae fuse together, the movement of the rib cage and the lungs may be restricted.
“Every time you breathe, the ribs move forward as the diaphragm moves down,” Flynn says. “With ankylosing spondylitis, those movements forward can become limited with time. This can prevent the lungs from expanding fully to take in oxygen, increasing the risk for restrictive lung disease.”
Deep-breathing exercises and aerobic exercise, such as walking or jogging, may help you maintain flexibility in your chest and breathing function, according to the SAA.
Enhances the Effectiveness of Medication
Exercise combined with a biologic therapy for ankylosing spondylitis known as tumor necrosis factor (TNF) inhibitors may have a synergistic effect, according to a review from 2015.
Researchers looked at data from 13 studies that investigated the combined effectiveness of a rehabilitation program with this type of medication, and compared it with just the drug treatment.
They found that TNF inhibitor therapy may be more effective when coupled with regular exercise. People with AS who took the drug and participated in the rehab program reported reductions in the severity of their symptoms, disease activity, and disability, as well as an improvement in their quality of life.
Additional reporting by Quinn Phillips.