Physical therapy in axial spondyloarthritis: guidelines, evidence and clinical practice

Review written by Jack March info

Key Points

  1. Exercise is a vital component of axial spondyloarthritis management.
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Exercise has long been a key component of treatment for axial spondyloarthritis (AxSpA). Historically though this consisted of low intensity stretching and hydrotherapy. In recent times some well-designed studies have shown that high intensity exercise is a safe and effective alternative. It has also become clear that AxSpA patients are in need of global health improvements as they suffer from increased risk of cardiovascular disease, osteoporosis, obesity, pain levels and depression. All of which can be improved by adhering to a well-designed exercise program.

Physical therapy for AxSpA is also recommended in guidelines such as those from the National Institute of Clinical Excellence (NICE) and European League Against Rheumatism (EULAR) (1,2). This narrative review paper looked at the evidence behind exercise modalities for AxSpA to enhance patient outcomes.

High intensity exercise is safe and effective for people with axial spondyloarthritis.
Patient preference on exercise prescription currently trumps biological reasoning for those with AxSpA.


All types of exercise are necessary to maximise outcomes in AxSpA. Strength, aerobic capacity and flexibility all have an evidence base showing improvements in patients’ function and outcomes. In a condition which has effects on range of motion, fatigue, skeletal

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