To move or not to move: the paradoxical effect of physical exercise in axial spondyloarthritis

Review written by Jack March info

Key Points

  1. Exercise of all types remains safe and effective as a component of management for people with axial spondyloarthritis in the short-term (symptom reduction) and long-term (general health maintenance).
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Axial spondyloarthritis (AxSpA) is an autoinflammatory disorder primarily presenting with inflammatory type chronic back pain but also with high proportions of insertional tendon symptoms in the periphery. AxSpA is a disease of the entheses causing inflammatory reactions at the point where ligaments (spine and sacroiliac joints) and tendons attach to bone (1). If left untreated these enthesis locations can ossify, leading to fusion in the spine and SIJs and bony encroachment in the peripheral tendons. Several factors increase the risk of these bony changes – disease duration, being male, HLA-B27 positivity, and smoking (2).

Exercise increases load, stress and possibly the inflammatory process at these entheses, but AxSpA symptoms are often better with activity and exercise is important to maintain many general health benefits in this disease. This leads to a paradox – exercise being beneficial but also potentially detrimental. This paper aimed to explore the effect of exercise in AxSpA.

Axial spondyloarthritis often presents with high proportions of insertional tendon symptoms in the periphery.
Our best approach is to be guided by the individual's preferences, ability and symptom reactions to exercise.


This was a review article which pulled together various studies looking at the implications of inflammation at the enthesis, genetic factors, osteoimmunological factors and pathways that would lead to these bony changes. This combination lays the framework for why people

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