Exercise Prescription for Axial Spondyloarthritis: A Systematic Review and Meta-analysis of randomized controlled trials

Chunhui Yu¹Lina Guo²Xiaoxiao Gao³Xiaojie Shen⁴Xilan Ma⁵Ji Li⁶Weifei Wu^1*Junhao Cai^7*

• ¹Liaoning University of Traditional Chinese Medicine, Shenyang, China
• ²Caoxian People's Hospital, Heze, China
• ³Shanghai Jiading District Zhenxin Community Health Service Center., Shanghai, China
• ⁴Jiading Industrial Zone Community Health Service Center, shanghai, China
• ⁵Liaoning University of Traditional Chinese Medicine Affiliated Second Hospital, Shenyang, China
• ⁶Northeastern University, Shenyang, China
• ⁷Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China

Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic condition that significantly impacts patients' quality of life. Exercise therapy serves as a core non-pharmacological treatment modality, yet its overall efficacy and optimal prescription parameters require further clarification through high-quality evidence. This study aims to systematically evaluate the efficacy of exercise interventions for axSpA patients. Methods: Computerised searches were conducted across databases including PubMed, Embase, Web of Science, and the Cochrane Library, covering the period from inception to September 2025. Randomised controlled trials (RCTs) comparing exercise interventions with conventional treatments for axSpA were included. Two researchers independently performed literature screening, data extraction, and quality assessment. The heterogeneity of the research results was assessed using the I² statistic. Continuous variables were presented as weighted mean differences or standard mean differences, with confidence intervals set at 95%. Stata 15.0 was utilised to conduct a meta-analysis. Results: Fifteen RCTs involving 1,699 patients were included. Meta-analysis revealed that exercise intervention significantly improved disease activity in axSpA patients compared with controls (BASDAI: SMD = −0.75, 95% CI: −1.19 to −0.31; ASDAS: SMD = −0.91, 95% CI: −1.54 to −0.29), physical function (BASFI: SMD = −0.37, 95% CI: −0.47 to −0.26), spinal mobility (BASMI: SMD = −0.26, 95% CI: -0.49 to -0.04), thoracic expansion (SMD = 0.35, 95% CI: 0.04 to 0.65), and fatigue levels (SMD = -0.53, 95% CI: -0.78 to -0.28). Subgroup analyses indicated that different exercise modalities and intervention durations influenced treatment efficacy. Conclusion: This meta-analysis confirms that exercise interventions significantly improve core outcome measures including disease activity, physical function, spinal mobility, and fatigue in patients with axial spondyloarthritis, with statistically significant effects. The findings support the incorporation of individualised exercise prescriptions as a key component of standard axSpA treatment, providing evidence-based guidance for clinical practice. Future research should further optimise exercise prescription parameters and validate their long-term efficacy.