Nonpharmacological interventions are one of the mainstreams of treatment for patients with spondyloarthritis (SpA). They include education, measures regarding joint protection, posture and rest, therapeutic exercise, physical therapy modalities, orthoses, and acupuncture. A key component in the rehabilitation of patients with SpA entities is therapeutic exercise, which can be performed as land-based or water-based. Positive effects of the exercises are manifested in reducing pain, maintaining mobility, improving posture, increasing aerobic capacity and improving quality of life. The best effects can be obtained when exercise is performed under the supervision of a physiotherapist at a health institution. The majority of studies on therapeutic exercise in SpA are related to ankylosing spondylitis (AS), while there is a paucity of studies devoted to other conditions. Although progress has been made in the quantity and quality of research on this topic, there are still issues regarding the quality of studies and considerable variability among them, which makes it difficult to compare different methods and harmonize and develop rehabilitation protocols according to evidence-based medicine.
Khan M. An overview of clinical spectrum and heterogeneity of spondyloarthropathies. Rheum Dis Clin North Am 1992:1–10.
2
Rudwaleit M, Van Der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009:777–83.
3
Grazio S. Classification and diagnosis of axial spondyloarthritides -history, present state and perspectives. Reumatizam 2016;(Suppl 1):1–17.
4
Stolwijk C, Van Onna M, Boonen A, Van Tubergen A. Global prevalence of spondyloarthritis: a systematic review and meta-regression analysis. Arthritis Care Res (Hoboken) 2016:1320–31.
5
Bostan E, Borman P, Bodur H, Barça N. Functional disability and quality of life in patients with ankylosing spondylitis. Rheumatol Int 2003:121–6.
6
Van Echteld I, Cieza A, Boonen A, Stucki G, Zochling J, Braun J, et al. Identification of the most common problems by patients with ankylosing spondylitis using the international classification of functioning, disability and health. J Rheumatol 2006:2475–83.
7
Boonen A, Chorus A, Miedema H, Van Der Heijde D, Van Der Tempel H, Van Der Linden S, et al. work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis 2001:353–8.
8
Gobelet C, Luthi F, Al-Khodairy A, Chamberlain M. Work in inflammatory and degenerative joint diseases. Disabil Rehabil 2007:1331–9.
9
Grazio S, Jajić Z, Nemčić T, Jajić I. Work capacity evaluation in patients with ankylosing spondylitis. Reumatizam 1997:1–5.
10
Husni M, Merola J, Davin. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum 2017:351–60.
11
Wu J, Penfold R, Primatesta P, Fox T, Stewart C, Reddy S, et al. The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis. J Eur Acad Dermatol Venereol 2017:1168–75.
12
Meesters J, Bremander A, Bergman S, Petersson I, Turkiewicz A, Englund M. The risk for depression in patients with ankylosing spondylitis: a populationbased cohort study. Arthritis Res Ther 2014:418.
13
Meesters J, Bergman S, Haglund E, Jacobsson L, Petersson I, Bremander A. Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden. Scand J Rheumatol 2018:185–93.
14
Zochling J. Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies. Arthritis Care Res (Hoboken) 2011;(Suppl 11):47–58.
15
Gladman D, Helliwell P, Mease P, Nash P, Ritchlin C, Taylor W. Assessment of patients with psoriatic arthritis: a review of currently available measures. Arthritis Rheum 2004:24–35.
16
Who. International classification of functioning, disability and health 2001.
17
Stucki G. International Classification of Functioning, Disability, and Health (ICF). Am J Phys Med Rehabil 2005:733–40.
18
Boonen A, Braun J, Van Der H, Bruinsma I, Huang F, Maksymowych W, et al. ASAS/WHO ICF Core Sets for ankylosing spondylitis (AS): how to classify the impact of AS on functioning and health. Ann Rheum Dis 2010:102–7.
19
Van Der Heijde D, Landewé R, Baraliakos R, Van Den Bosch X, Sepriano F, Regel A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017:978–91.
20
Gossec L, Smolen J, Ramiro S, De Wit M, Cutolo M, Dougados M, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis 2016:499–510.
21
Coates L, Kavanaugh A, Mease P, Soriano E, Acosta-Felquer L, Armstrong M, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment recommendations for psoriatic arthritis. Arthritis Rheumatol 2016:1060–71.
22
Vlieland T, Van Den Ende C, Pinheiro J. EULAR Compendium on Rheumatic Diseases 2009:590–600.
23
Ehlebracht-Konig I, Bonisch A. Patient education in the early treatment of ankylosing spondylitis and related forms of spondyloarthritis. Wien Med Wochenschr 2008:213–7.
24
Leung Y, Tam L, Lee K, Leung M, Kun E, Li E. Involvement, satisfaction and unmet health care needs in patients with psoriatic arthritis. Rheumatology (Oxford) 2009:53–6.
25
Franović A. The long-term positive effects of educational-motivational care of patients with ankylosing spondylitis. Reumatizam 1985:10–6.
26
Grubišić F, Grazio S, Znika M. Sport and recreation activities as the form of functional treatment of patients with ankylosing spondylitis. Acta Med Croat 2007;(Supl 1):57–61.
27
Feldtkeller E, Hammel L, Brenneis C, Song I, Rudwaleit M. Advice for patients diagnosed with ankylosing spondylitis: results of a representative patient survey in Germany. Z Rheumatol 2011:431–7.
28
Poddubnyy D, Haibel H, Listing J, Märker-Hermann E, Zeidler H, Braun J, et al. Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum 2012:1388–98.
29
Chung H, Machado P, Van Der Heijde D, Agostino D, Dougados M, M. Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Ann Rheum Dis 2012:809–16.
30
Warsi A, Wang P, Lavalley M, Avorn J. Solomon DH. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med 2004:1641–9.
31
Hammond A, Bryan J, Hardy A. Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial. Rheumatology (Oxford) 2008:1712–8.
32
Williams B, Pace A. Problem based learning in chronic disease management: a review of the research. Patient Educ Couns 2009:14–9.
33
Steultjens E, Dekker J, Bouter L, Van Schaardenburg D, Van Kuyk M, Van Den Ende C. Occupational therapy for rheumatoid arthritis: a systematic review. Arthritis Rheum 2002;(6):672–85.
34
Masiero S, Boniolo A, Wassermann L, Machiedo H, Volante D, Punzi L. Effects of an educational-behavioral joint protection program on people with moderate to severe rheumatoid arthritis: a randomized controlled trial. Clin Rheumatol 2007:2043–50.
35
Durmus B, Altay Z, Esoy Y, Baysal O, Dogan E. Postural stability in patients with ankylosing spondylitis. Disabil Rehabil 2010:1156–62.
36
Swann J. Ankylosing spondylitis: living with the condition. Br J Healthcare Assistants (BJHA) 2009:235–7.
37
Grazio S, Znika M. A Guide to safe exercise for people with rheumatic diseases. 1st ed. Zagreb: Croatian League Against Rheumatism 2004:1–112.
38
Roberts C, Hevener A, Barnard R. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol 2013:1–58.
39
Stewart K, Bacher A, Turner K, Lim J, Hees P, Shapiro E, et al. Exercise and risk factors associated with metabolic syndrome in older adults. Am J Prev Med 2005:9–18.
40
Lautenschlager N, Cox K, Flicker L, Foster J, Van Bockxmeer F, Greenop X, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. J Am Med Assoc 2008:1027–37.
41
Rubenstein L, Josephson K, Trueblood P, Loy S, Harker J, Pietruszka F, et al. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. J Gerontol A Biol Sci Med Sci 2000:317–21.
42
Franco M, Pereira L, Ferreira P. Exercise interventions for preventing falls in older people living in the community. Br J Sports Med 2014:867–8.
43
Harding A, Beck B. Exercise, Osteoporosis, and Bone Geometry. Sports (Basel) 2017.
44
Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas 2017:48–56.
45
Pedersen B. Muscle as a secretory organ. Compr Physiol 2013:1337–62.
46
Pedersen B. Muscles and their myokines. J Exp Biol 2011:337–46.
47
Pedersen B, Febbraio M. Muscle as an endocrine organ: focus on muscle-derived interleukin-6. Physiol Rev 2008:1379–406.
48
Pedersen B, Saltin B. Exercise as medicine -evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015;(Suppl 3):1–72.
49
Osthoff R, Niedermann A, Braun K, Adams J, Brodin J, Dagfinrud N, et al. EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018:1251–60.
50
O’hea J, Barlow J. Physiotherapy management of ankylosing spondylitis 2008:519–39.
51
Vlieland V, Li T, L. Rehabilitation in rheumatoid arthritis and ankylosing spondylitis: difference and similarities. Clin Exp Rheumatol 2009:171–8.
52
Costa D, Dritsa D, Ring M, Fitzcharles A, M. Mental health status and leisure-time physical activity contribute to fatigue intensity in patients with spondyloarthropathy. Arthritis Rheum 2004:1004–8.
53
Pécourneau V, Degboé Y, Barnetche T, Cantagrel A, Constantin A, Ruyssen-Witrand A. Effectiveness of exercise programs in ankylosing spondylitis: a metaanalysis of randomized Controlled Trials. Arch Phys Med Rehabil 2018:383–9.
54
Aytekin E, Caglar N, Ozgonenel L, Tutun S, Demiryontar D, Demir S. Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions. Clin Rheumatol 2012:91–7.
55
Liang H, Zhang H, Ji H, Wang C. Effects of homebased exercise intervention on health-related quality of life for patients with ankylosing spondylitis: a meta-analysis. Clin Rheumatol 2015:1737–44.
56
Braun J, Van Den Berg R, Baraliakos X, Boehm H, Vargas B-, R. n.d.
57
Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011:896–904.
58
Dagfinrud H, Kvien T, Hagen K. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev 2008;(1).
59
Viitanen J, Lehtinen K, Suni J, Kautiainen H. Fifteen months’ follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis. Clin Rheumatol 1995:413–9.
60
Hidding A, Van Der Linden S, Witte D, L. Therapeutic effects on individual physical therapy in ankylosing spondylitis related to duration of disease. Clin Rheumatol 1993:334–40.
61
Levitova A, Hulejova H, Spiritovic M, Pavelka K, Senolt L, Husakova M. Clinical improvement and reduction in serum calprotectin levels after an intensive exercise programme for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis. Arthritis Res Ther 2016:275.
62
Cameron M. Physical agents in rehabilitation: from research to practice. 2nd ed 2003:261–306.
63
Bulstrode S, Barefoot J, Harrison R, Clarcke A. The role of passive stretching in the treatment of ankylosing spondylitis. Br J Rheumatol 1987:40–2.
64
Ortancil O, Sarikaya S, Sapmaz P, Basaran A. Ozdolap S. The effect(s) of a six-week home-based exercise program on the respiratory muscle and functional status in ankylosing spondylitis. J Clin Rheumatol 2009:68–70.
65
Calik B, B, Kabul G, Taskın E, H, Atalay T, et al. The efficiency of inspiratory muscle training in patients with ankylosing spondylitis. Rheumatol Int 2018:1713–20.
66
Baker J, Feldt V, Mostoufi-Moab J, Noaiseh S, Taratuta G, Kim E, et al. Deficits in muscle mass, muscle density, and modified associations with fat in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2014:1612–8.
67
Ekdahl C, Broman G. Muscle strength, endurance, and aerobic capacity in rheumatoid arthritis: a comparative study with healthy subjects. Ann Rheum Dis 1992:35–40.
68
Hsieh L, Watson C, Mao H. Physical medicine and rehabilitation 2015:665–84.
69
Demontis A, Trainito S, Felice D, Masiero A, S. Favorable effect of rehabilitation on balance in ankylosing spondylitis: a quasi-randomized controlled clinical trial. Rheumatol Int 2016:333–9.
70
Gunay S, Keser I, Bicer Z. The effects of balance and postural stability exercises on spa based rehabilitation programme in patients with ankylosing spondylitis. J Back Musculoskelet Rehabil 2018:337–46.
71
Souchard P. Global posture reeducation method 1998.
72
Fernandez-De-Las-Penas C, Blanco A, Morales-Cabezas C, M, Page M, J. Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil 2005:407–19.
73
Fernández-De-Las-Peñas C, Blanco A, Alguacil-Diego C, I, Page M, J. One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial. Am J Phys Med Rehabil 2006:559–67.
74
Durmuş D, Alayli G, Uzun O, Tander B, Cantürk F, Bek Y, et al. Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis. Joint Bone Spine 2009:150–5.
75
Karapolat H, Eyigor S, Zoghi M, Akkoc Y, Kirazli Y, Keser G. Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study. Eur J Phys Rehabil Med 2009:449–57.
76
Jennings F, Oliveira H, De Souza M, Vda C, Natour G, J. Effects of Aerobic Training in Patients with Ankylosing Spondylitis. J Rheumatol 2015:2347–53.
77
Papagoras C, Voulgari P, Drosos A. Atherosclerosis and cardiovascular disease in the spondyloarthritides, particularly ankylosing spondylitis and psoriatic arthritis. Clin Exp Rheumatol 2013:612–20.
78
Altan L, Korkmaz N, Dizdar M, Yurtkuran M. Effect of Pilates training on people with ankylosing spondylitis. Rheumatol Int 2012:2093–9.
79
Roşu M, Ţopa I, Chirieac R, Ancuta C. Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial. Rheumatol Int 2014:367–72.
80
Lee E, Kim Y, Chung W, Lee M. Tai chi for disease activity and flexibility in patients with ankylosing spondylitis--a controlled clinical trial. Evid Based Complement Alternat Med 2008:457–62.
81
Akyuz G, Kenis-Coskun O. The efficacy of Tai Chi and Yoga in rheumatoid arthritis and spondyloarthropathies: a narrative biomedical review. Rheumatol Int 2018:321–30.
82
Danve A, Deodhar A. Complementary medicine for axial spondyloarthritis: is there any scientific evidence? Curr Opin Rheumatol 2018:310–8.
83
Liang H, Li W, Zhang H, Tian X, Wei W, Wang C. Concurrent intervention with exercises and stabilized tumor necrosis factor inhibitor therapy reduced the disease activity in patients with ankylosing spondylitis: a meta-analysis. Medicine (Baltimore) 2015:2254.
84
Lubrano E, Spadaro A, Parsons W. Rehabilitation in psoriatic arthritis. J Rheumatol Suppl 2009:81–2.
85
Roger-Silva D, Natour J, Moreira E, Jennings F. A resistance exercise program improves functional capacity of patients with psoriatic arthritis: a randomized controlled trial. Clin Rheumatol 2018:389–95.
86
Medina-Mirapeix F, Escolar-Reina P, Gascon-Canovas J, Montilla-Herrador J, Collins S. Personal characteristics influencing patients’ adherence to home exercise during chronic pain: a qualitative study. J Rehabil Med 2009:347–52.
87
Iversen M, Ayers K, Palmsten A, Wang H, Daltroy L. Predictors of exercise behavior at six months in patients with rheumatoid arthritis. Phys Ther 2004:706–16.
88
Falkenbach A. Disability motivates patients with ankylosing spondylitis for more frequent physical exercise. Arch Phys Med Rehabil 2003:382–3.
89
Barlow J. Understanding exercise in the context of chronic disease: an exploratory investigation of selfefficacy. Percept Mot Skills 1998:439–46.
90
Swinnen T, Vlaeyen J, Dankaerts W, Westhovens R, De Vlam K. Activity Limitations in patients with axial spondyloarthritis: a role for fear of movement and (re)injury beliefs. J Rheumatol 2018:357–66.
91
Santos H, Brophy S, Calin A. Exercise in ankylosing spondylitis: How much is optimum? J Rheumatol 1998:2156–60.
92
Passalent L, Soever L, Shea O, Inman F, R. Exercise in ankylosing spondylitis: discrepancies between recommendations and reality. J Rheumatol 2010:835–41.
93
Roberts V, B. Ankylosing spondylitis: Pathology 1998:181–6.
94
Sukenik S, Abu-Shakra M, Flusser D. Balneotherapy in autoimmune disease. Isr J Med Sci 1997:258–61.
95
Altan L, Bingöl U, Aslan M, Yurtkuran M. The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol 2006:283–9.
96
Oláh M, Koncz A, Fehér J, Kálmánczhey J, Oláh C, Balogh S, et al. The effect of balneotherapy on C-reactive protein, serum cholesterol, triglyceride, total antioxidant status and HSP-60 levels. Int J Biometeorol 2010:249–54.
97
Françon A, Forestier R. Spa therapy in rheumatology. Indications based on the clinical guidelines of the French National Authority for health and the European League Against Rheumatism, and the results of 19 randomized clinical trials. Bull Acad Natl Med 2009:1345–56.
98
Ciprian L, Nigro L, Rizzo A, Gava M, Ramonda A, Punzi R, et al. The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors. Rheumatol Int 2013:241–5.
99
Mustur D, Vujasinović-Stupar N, Ille T. Influence of physical treatment on disease activity and health status of patients with chronic arthritis. Srp Arh Celok Lek 2008:104–9.
100
Ozgocmen S, Akgul O, Altay Z, Altindag O, Baysal O, Calis M, et al. Anatolian Group for the Assessment in Rheumatic Diseases. Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis. Int J Rheum Dis 2012:229–38.
101
Gemignani G, Olivieri I, Ruju G, Pasero G. Transcutaneous electrical nerve stimulation in ankylosing spondylitis: a double-blind study. Arthritis Rheum 1991:788–9.
102
Chen F, Jin Z, Wang D. A retrospective study of transcutaneous electrical nerve stimulation for chronic pain following ankylosing spondylitis. Medicine (Baltimore) 2018:11265.
103
Turan Y, Bayraktar K, Kahvecioglu F, Tastaban E, Aydin E, Omurlu K, et al. Is magnetotherapy applied to bilateral hips effective in ankylosing spondylitis patients? A randomized, double-blind, controlled study. Rheumatol Int 2014:357–65.
104
Karamanlioglu D, Aktas I, Ozkan F, Kaysin M, Girgin N. Effectiveness of ultrasound treatment applied with exercise therapy on patients with ankylosing spondylitis: a double-blind, randomized, placebo-controlled trial. Rheumatol Int 2016:653–61.
105
Oosterveld F, Rasker J, Floors M, Landkroon R, Van Rennes B, Zwijnenberg J, et al. Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects. Clin Rheumatol 2009:29–34.
106
Straburzyńska-Lupa A, Kasprzak M, Romanowski M, Kwaśniewska A, Romanowski W, Iskra M, et al. The effect of whole-body cryotherapy at different temperatures on proinflammatory cytokines, oxidative stress parameters, and disease activity in patients with ankylosing spondylitis. Oxid Med Cell Longev 2018:2157496.
107
Clark H, Rome K, Plant M, Hare O, Gray K, J. A critical review of foot orthoses in the rheumatoid arthritic foot. Rheumatology (Oxford) 2006:139–45.
108
Farrow S, Kingsley G, Scott D. Interventions for foot disease in rheumatoid arthritis: a systematic review. Arthritis Rheum 2005:593–602.
109
Widberg K, Karimi H, Hafstrom I. Self-and manual mobilization improves spine mobility in men with ankylosing spondylitis: a randomized study. Clin Rehabil 2009:599–601.
110
Urruela A, Suarez-Almazor M, M. Acupuncture in the treatment of rheumatic diseases. Curr Rheumatol Rep 2012:589–97.
111
Lv Z, Zhou X, Chen A. Acupuncture therapy versus disease-modifying antirheumatic drugs for the treatment of ankylosing spondylitis-a meta-analysis. Forsch Komplementmed 2015:395–402.
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