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Overview of Ankylosing Spondylitis

This systemic inflammatory condition primarily affects the sacroiliac joints and joints of the spine and can also affect peripheral joints. The condition leads to fibrosis and ossification of the involved articulations. The cause of the condition is unknown, although it may have environmental and genetic origins. This condition is usually initiated by an insidious onset of low back or hip pain and stiffness. Severe complications, including spinal stenosis and vertebral fractures, that limit mobility can occur. Individuals with this condition will have limited mobility due to joint stiffness that is particularly severe in the morning. Pain and related fatigue symptoms will limit their ability to initiate exercise and recreational activities.

Comorbidities to Consider

  • Advanced ankylosing spondylitis limits chest wall mobility and leads to respiratory muscle fatigue that will significantly limit exercise tolerance.1

Client Examination

Keys to Examination of Clients

  • This condition is not easily identifiable during its early stages.

  • Consider recommending radiographs, which may show signs of sacroiliitis and inflammation in the spinal articulations.

  • Laboratory tests for the HLA-B27 antigen may assist in identifying this condition.

  • Assess clients' posture, chest expansion, and range of motion of the spine and extremities to determine a baseline for these impairments.

Recommended Baseline Testing of Fitness Levels

  • Exercise tolerance can be assessed by walking or cycle ergometer tests.

  • The Bath Ankylosing Spondylitis Disease Activity Index can be used as a baseline for the patient's symptoms and activity level.2

Exercise Prescription


Type: Walking, biking, postural and pulmonary exercises, and stretching activities3,4,5

Intensity: Low levels to start, aerobic activities at 50%–60% of maximum heart rate3

Duration: Up to 50 minutes of combined activities

Frequency: Three times per week

Getting Started

Clients with this condition have limited spinal mobility and abnormal spinal postures, which increases their risk for sustaining vertebral fractures. Start clients in the exercise program with a warm-up period of stretching and stepping or walking activities. Take the time to individually teach these clients exercises to address their spinal posture, chest wall mobility, and muscle tightness to ensure proper form and tolerance. Avoid excessive exercise intensities or stretching procedures that may worsen the inflammatory process. Exercises that potentially require excessive joint motion, such as rowing or an elliptical trainer, should be avoided when beginning an exercise program. Aquatic therapies have also been recommended for clients with this condition. Supervised and group exercise programs are recommended for clients beginning a program or for those with recent exacerbation of symptoms.6,7 Clients should be encouraged to progress to an independent exercise program to maintain their fitness and mobility.6...

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