Efficacy of High Intensity Exercise on Disease Activity and Cardiovascular Risk in Active Axial Spondyloarthritis: A Randomized Controlled Pilot Study Exercise and changes in health status in patients with ankylosing spondylitis. Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions Psychometric characteristics of the short form 36 health survey and functional assessment of chronic illness Therapy-Fatigue subscale for patients with ankylosing spondylitis Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity within and outside the home in patients with axial spondyloarthritis, including nonradiographic axial spondyloarthritis and ankylosing spondylitis Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial The limited value of the Health Assessment Questionnaire as an outcome measure in short term exercise trials. Effects of a multimodal exercise program for people with ankylosing spondylitis. Improved Function and Reduced Pain after Swimming and Cycling Training in Patients with Osteoarthritis A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. Evaluation of the effects of Global Postural Reeducation in patients with ankylosing spondylitis Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis. Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices, quality of life and depression Reductions in health-related quality of life in patients with ankylosing spondylitis and improvements with etanercept therapy.
Background Physical therapy is recommended for the management of axial spondyloarthritis ( axSpA ) and flexibility exercises have traditionally been the main focus . Cardiovascular ( CV ) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases . Therefore , the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA. Methods In a single blinded r and omized controlled pilot study the exercise group ( EG ) performed 12 weeks of endurance and strength exercise while the control group ( CG ) received treatment as usual . The primary outcome was the Ankylosing Spondylitis ( AS ) Disease Activity Score ( ASDAS ) . Secondary outcomes included patient reported disease activity ( Bath AS Disease Activity Index [ BASDAI ] ) , physical function ( Bath AS Functional Index [ BASFI ] ) , and CV risk factors measured by arterial stiffness ( Augmentation Index [ Alx ] ) and Pulse Wave Velocity [ PWV ] ) , cardiorespiratory fitness ( VO2 peak ) and body composition . ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences , and Mann Whitney U-test was used for outcomes with skewed residuals . Results Twenty-eight patients were included and 24 ( EG , n = 10 , CG , n = 14 ) completed the study . A mean treatment effect of −0.7 ( 95%CI : −1.4 , 0.1 ) was seen in ASDAS score . Treatment effects were also observed in secondary outcomes ( mean group difference [ 95%CI ] ) : BASDAI : −2.0 ( −3.6 , −0.4 ) , BASFI : −1.4 ( −2.6 , −0.3 ) , arterial stiffness ( estimated median group differences [ 95 % CI ] ) : AIx ( % ) : −5.3 ( −11.0 , −0.5 ) , and for PVW ( m/s ) : −0.3 ( −0.7 , 0.0 ) , VO2 peak ( ml/kg/min ) ( mean group difference [ 95%CI ] : 3.7 ( 2.1 , 5.2 ) and trunk fat ( % ) : −1.8 ( −3.0 , −0.6 ) . No adverse events occurred . Conclusion High intensity exercise  improved disease activity and reduced CV risk factors in patients with active axSpA. These effects will be further explored in a larger trial . Trial Registration Clinical Trials.gov BACKGROUND Although exercise is a commonly recommended treatment for ankylosing spondylitis ( AS ) , little is known about the effectiveness of unsupervised recreational and back exercises . We examined the effects of recreational exercise and back exercises on  patient-reported pain severity , stiffness severity , and functional disability  in a prospect i ve longitudinal study of 220 patients with AS . METHODS Participants provided information on exercise habits and health status every 6 months using mailed question naires ( median follow-up , 4.5 years ) . Pain severity and stiffness severity were measured using visual analog scales , and functional disability was measured using the Health Assessment Question naire ( HAQ ) Disability Index . RESULTS Among all patients , there were no associations between either the number of exercise minutes per week or the number of days of back exercise per week and short-term ( 6-month ) changes in pain , stiffness , or HAQ Disability Index . However , among those who had AS for 15 years or less , pain scores were 0.18 points lower ( on a scale of 0 - 3 ; P = .04 ) , and stiffness scores were 6.4 points lower ( on a scale of 0 - 100 ; P = .005 ) during periods with more than 200 minutes per week of exercise compared with periods with 0 to 30 minutes of exercise per week . Among those who had AS for more than 15 years , pain scores were 0.11 points lower ( on a scale of 0 - 3 ; P = . 03 ) , and HAQ Disability Indexes were 0.08 points lower ( on a scale of 0 - 3 ; P<.001 ) during periods with 5 to 7 days per week of back exercise compared with periods when back exercises were not performed . Less intense levels of exercise were not associated with improvements in health status . CONCLUSIONS Unsupervised recreational exercise improves pain and stiffness , and back exercise improves pain and function in patients with AS , but these effects differ with the duration of AS . Health status is improved when patients perform recreational exercise at least 30 minutes per day and back exercises at least 5 days per week . Arch Intern Med . 2000;160:2969 - Abstract Ankylosing spondylitis ( AS ) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability . Aquatic ( water-based ) exercise may have a beneficial effect in various musculoskeletal conditions . The aim of this study was to compare the effectiveness of aquatic exercise interventions with l and -based exercises ( home-based exercise ) in the treatment of AS . Patients with AS were r and omly assigned to receive either home-based exercise or aquatic exercise treatment protocol . Home-based exercise program was demonstrated by a physiotherapist on one occasion and then , exercise manual booklet was given to all patients in this group . Aquatic exercise program consisted of 20 sessions , 5 × per week for 4 weeks in a swimming pool at 32–33 ° C . All the patients in both groups were assessed for pain , spinal mobility , disease activity , disability , and quality of life . Evaluations were performed before treatment ( week 0 ) and after treatment ( week 4 and week 12 ) . The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t test . Paired t test was used for comparison of pre- and posttreatment values within groups . A total of 69 patients with AS were included in this study . We observed significant improvements for all parameters [ pain score ( VAS ) visual analog scale , lumbar flexion/extension , modified Schober test , chest expansion , bath AS functional index , bath AS metrology index , bath AS disease activity index , and short form-36 ( SF-36 ) ] in both groups after treatment at week 4 and week 12 ( p < 0.05 ) . Comparison of the percentage changes of parameters both at week 4 and week 12 relative to pretreatment values showed that improvement in VAS ( p < 0.001 ) and bodily pain ( p < 0.001 ) , general health ( p < 0.001 ) , vitality ( p < 0.001 ) , social functioning ( p < 0.001 ) , role limitations due to emotional problems ( p < 0.001 ) , and general mental health ( p < 0.001 ) subparts of SF-36 were better in aquatic exercise group . It is concluded that a water-based exercises produced better improvement in pain score and quality of life of the patients with AS compared with home-based exercise We investigated the effects of home-based daily exercise on joint mobility , functional capacity , pain , and depression in patients with ankylosing spondylitis ( AS ) . The patients were r and omly assigned to a wait-list control group or to an exercise-therapy group . The exercise-therapy group performed a 20-min exercise program once per day for 8 consecutive weeks . After 8 weeks , compared with the control group , the exercise group showed improvements in joint mobility ( cervical flexion , extension , shoulder flexion , abduction , hip abduction , and knee flexion ) , finger – floor distance , and functional capacity . Pain and depression scores were significantly lower after the exercise program in the exercise group than in the control group . These findings indicate that exercise therapy increases joint mobility and functional capacity , and decreases pain and depression in patients with AS .  Home-based exercise , which is easily accessible to patients , might be an effective intervention for AS The home-based exercise therapy recommended to the patients with ankylosing spondylitis ( AS ) is a simply applicable and cheap method . The aim of this study was to investigate the effects of home-based exercise therapy on pain , mobility , function , disease activity , quality of life , and respiratory functions in patients with AS . Eighty patients diagnosed with AS according to the modified New York criteria were included in the study .  Home-based exercise program including range of motion , stretching , strengthening , posture , and respiratory exercises was practically demonstrated by a physiotherapist . A training and exercise manual booklet was given to all patients . Patients following home-based exercise program five times a week at least 30 min per session ( exercise group ) for 3 months were compared with those exercising less than five times a week ( control group ) . Visual analog scale pain ( VASp ) values at baseline were significantly higher in the exercise group . The exercise group showed improvements in VASp , tragus – wall distance , morning stiffness , finger – floor distance , modified Schober 's test , chest expansion , the Bath Ankylosing Spondylitis Disease Activity Index , the Bath Ankylosing Spondylitis Functional Index , Ankylosing Spondylitis Quality of Life Question naire ( ASQoL ) , forced expiratory volume in first second , and forced vital capacity at third month . There was significant difference in ASQoL scores between the two groups in favor of the exercise group at third month . Regular home-based exercise therapy should be a part of main therapy in patients with AS . Physicians should recommend that patients with AS do exercise at least five times a week at least 30 min per session Background We evaluated the psychometric characteristics of the Short Form 36 ( SF-36 ) Health Survey and the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue subscale in patients with ankylosing spondylitis ( AS ) . Methods We analyzed clinical and patient-reported outcome ( PRO ) data collected during 12-week , double-blind , placebo-controlled periods of two r and omized controlled trials comparing adalimumab and placebo for the treatment of active AS . The Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Functional Index , and other clinical measures were collected during the clinical trial . We evaluated internal consistency/reliability , construct validity , and responsiveness to change for the SF-36 and FACIT-Fatigue . Results The SF-36 ( Cronbach alpha , 0.74 - 0.92 ) and FACIT-Fatigue ( Cronbach alpha , 0.82 - 0.86 ) both had good internal consistency/reliability . At baseline , SF-36 and FACIT-Fatigue scores correlated significantly with Ankylosing Spondylitis Quality of Life scores ( r = -0.36 to -0.66 and r = -0.70 , respectively ; all p < 0.0001 ) . SF-36 scores varied by indicators of clinical severity , with greater impairment observed for more severe degrees of clinical activity ( all p < 0.0001 ) . FACIT-Fatigue scores correlated significantly with SF-36 scores ( r = 0.42 to 0.74 ; all p < 0.0001 ) and varied by clinical severity ( p < 0.05 to p < 0.0001 ) . Conclusions The SF-36 is a reliable , valid , and responsive measure of health-related quality of life and the FACIT-Fatigue is a brief and psychometrically sound measure of the effects of fatigue on patients with AS . These PROs may be useful in evaluating effectiveness of new treatments for AS.Trial Registration Clinical Trials.gov : NCT00085644 and Introduction The arthritis-specific Work Productivity Survey ( WPS ) was developed to evaluate productivity limitations associated with arthritis within and outside the home . There is an unmet need for an instrument assessing similar productivity limitations in axial spondyloarthritis ( axSpA ) , including nonradiographic axSpA and ankylosing spondylitis . Following its validation in rheumatoid and psoriatic arthritis , we aim ed to assess psychometric properties of WPS in adult-onset active axSpA in this analysis . Methods Psychometric properties were assessed using data from the RAPID-axSpA trial ( NCT01087762 ) in which research ers investigated certolizumab pegol efficacy and safety in axSpA. WPS was completed at baseline and every 4 weeks until week 24 . Validity was evaluated at study baseline via known-groups defined by the first and third quartile cutoffs of patient scores to Ankylosing Spondylitis Disease Activity Score ( ASDAS ) , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , back pain , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Short Form 36 health survey ( SF-36 ) and Ankylosing Spondylitis Quality of Life Scale ( ASQoL ) . Responsiveness and reliability were assessed by comparing WPS mean changes in ASAS 20 % improvement criteria ( ASAS20 ) , BASDAI50 , ASDAS clinical ly important improvement/major improvement ( CII/MI ) and BASFI minimum clinical ly important difference ( MCID ) responders versus nonresponders at week 12 . All comparisons were conducted on observed cases in the r and omized set using a nonparametric bootstrap-t method . Results The results confirmed the psychometric properties of WPS . AxSpA patients with a worse health state had significantly more days of household work lost , household work with reduced productivity , social activities missed and outside help hired , as well as a higher interference rate of arthritis , than patients with a better health state . Similarly , employed patients with a worse health state had significantly more work days lost or with productivity reduced , and a higher interference of arthritis on work productivity . Similar findings were also observed in the nonradiographic ( nr ) axSpA and AS sub population s. The WPS was responsive to clinical changes , with responders reporting larger improvements at week 12 in WPS scores versus nonresponders . Effect sizes in responders were generally moderate to large ( st and ardized response mean > 0.5 ) . Conclusions These analyses demonstrate that WPS is a valid , responsive and reliable instrument for the measurement of productivity within and outside the home in adult-onset axSpA , as well as the in sub population s of AS and The optimal management of ankylosis spondylitis ( AS ) involves a combination of nonpharmacologic and pharmacologic treatment aim ing to maximize health-related quality of life . The primary objective of our study was to demonstrate the benefits of an original multimodal exercise program combining Pilates , McKenzie and Heckscher techniques on pulmonary function in patients with AS , while secondary objectives were to demonstrate the benefits of the same program on function and disease activity . This is a r and omized controlled study on ninety-six consecutive patients with AS ( axial disease subset ) , assigned on a 1:1 rationale into two groups based on their participation in the Pilates , McKenzie and Heckscher ( group I ) or in the classical kinetic program ( group II ) . The exercise program consisted of 50-min sessions performed 3 times weekly for 48 weeks . St and ard assessment s were done at week 0 and 48 and included pain , modified Schober test ( mST ) and finger – floor distance ( FFD ) , chest expansion ( CE ) and vital capacity ( VC ) , as well as disease activity Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , functional Bath Ankylosing Spondylitis Functional Index ( BASFI ) and metrology index Bath Ankylosing Spondylitis Metrology Index ( BASMI ) . Groups were comparable at baseline ; we demonstrated significant improvement between baseline and after 48 weeks of regular kinetic training for all AS-related parameters in both groups . However , significant improvement was found in pain , lumbar spine motility ( mST , FFD ) , BASFI , BASDAI and BASMI in AS performing the specific multimodal exercise program at the end of study ( p = 0.001 ) . Although there were significant improvements in CE in both groups as compared to baseline ( group I , p = 0.001 ; group II , p = 0.002 ) , this parameter increased significantly only in group I ( p = 0.001 ) . VC measurements were not significantly changed at the end of the study ( group I , p = 0.127 ; group II , p = 0.997 ) , but we found significant differences within groups ( p = 0.011 ) . A multimodal training combining Pilates , McKenzie and Heckscher exercises performed regularly should be included in the routine management of patients with AS for better control of function , disease activity and pulmonary function OBJECTIVE To examine the value of the  Health Assessment Question naire ( HAQ ) as an outcome measure in short term exercise trials . We studied the association of the objectives of exercise , namely joint mobility , muscle strength , and physical condition , with the HAQ . METHODS Data for 100 patients with rheumatoid arthritis ( RA ) included in a study to examine the effect of exercise therapy were used for secondary analysis . Disease activity was determined by the disease activity score ( DAS3 ) , pain was scored on a visual analog scale ( VAS ) , and depression was measured by the Dutch Arthritis Impact Measurement Scale . Aerobic capacity ( VO2max ) estimated from a submaximal ergometer test , grip strength ( kPa ) ,  isokinetic muscle strength of the knee  ( Nm/kg ) , and the  Escola Paulista de Medicina range of motion ( EPM-ROM ) score , a measure of general flexibility , were used as indicators for physical impairments . All variables were entered in a forward multiple regression analysis with the HAQ as dependent variable . RESULTS The HAQ was significantly correlated with the DAS3 score ( r = 0.53 ) , pain ( r = 0.51 ) , depression ( r = 0.40 ) , joint mobility ( r = 0.27 ) , quadriceps strength ( r = -0.35 ) , and grip strength ( r = -0.50 ) , but not with physical condition . The DAS3 score was first entered in the multiple regression analysis model , followed by pain , quadriceps strength , and grip strength ( R2 = 0.45 ) . After 12 weeks of exercise therapy changes in the HAQ were significantly correlated with changes in pain ( r = 0.41 ) , in depression ( r = 0.33 ) , and in quadriceps strength ( r = -0.25 ) , but not with changes in joint mobility or physical condition . CONCLUSION Physical impairments are weakly associated with the HAQ .  The HAQ is not an appropriate instrument to detect changes in physical impairments due to short term exercise therapy BACKGROUND AND PURPOSE Few r and omized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis ( AS ) . This study investigated the effects of a 12-week , multimodal exercise program in patients with AS . SUBJECTS A convenience sample of 30 patients with AS ( 18 male , 12 female ) , with a mean age of 34.9 years ( SD=6.28 ) , participated in the study . Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria . METHODS This study was a r and omized controlled trial . Subjects were assigned to either a group that received an exercise program or to a control group . The exercise program consisted of 50 minutes of multimodal exercise , including aerobic , stretching , and pulmonary exercises , 3 times a week for 3 months . Subjects in both groups received medical treatment for AS , but the exercise group received the exercise program in addition to the medical treatment . All subjects received a physical examination at baseline and at 12 weeks . The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods : clinical measurements ( chin-to-chest distance , Modified Schober Flexion Test , occiput-to-wall distance , finger-to-floor distance , and chest expansion ) and inclinometer measurements ( gross hip flexion , gross lumbar flexion , and gross thoracic flexion ) . In addition , vital capacity was measured by a physiologist , and physical work capacity was evaluated by a doctorally prepared exercise instructor . RESULTS The measurements of the exercise group for chest expansion , chin-to-chest distance , Modified Schober Flexion Test , and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period . The spinal movements of the exercise group improved significantly at the end of exercise program , but those of the control group showed no significant change . In addition , the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group . Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group . DISCUSSION AND CONCLUSION In this study , a multimodal exercise program including aerobic , stretching , and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility , work capacity , and chest expansion Objective . Arthritis and its associated joint pain act as significant barriers for adults attempting to perform l and -based physical activity . Swimming can be an ideal form of exercise for patients with arthritis . Yet there is no information on the efficacy of regular swimming exercise involving patients with arthritis . The effect of a swimming exercise intervention on joint pain , stiffness , and physical function was evaluated in patients with osteoarthritis ( OA ) . Methods . Using a r and omized study design , 48 sedentary middle-aged and older adults with OA underwent 3 months of either swimming or cycling exercise training . Supervised exercise training was performed for 45 min/day , 3 days/week at 60–70 % heart rate reserve for 12 weeks . The Western Ontario and McMaster Universities Arthritis Index was used to measure joint pain , stiffness , and physical limitation . Results . After the exercise interventions , there were significant reductions in joint pain , stiffness , and physical limitation accompanied by increases in quality of life in both groups ( all p < 0.05 ) . Functional capacity as assessed by maximal h and grip strength , isokinetic knee extension and flexion power ( 15–30 % increases ) , and the distance covered in the 6-min walk test increased ( all p < 0.05 ) in both exercise groups . No differences were observed in the magnitude of improvements between swimming and cycling training . Conclusion . Regular swimming exercise reduced joint pain and stiffness associated with OA and improved muscle strength and functional capacity in middle-aged and older adults with OA . Additionally , the benefits of swimming exercise were similar to the more frequently prescribed l and -based cycling training . Trial registration : clinical trials.gov NCT01836380 OBJECTIVE To evaluate the mean overall effects over a 1-year period of a multidisciplinary in-patient rehabilitation programme for patients with ankylosing spondylitis . DESIGN Observer-blinded , r and omized controlled trial , with assessment s made after 4 and 12 months . PATIENTS Forty-six patients received a 3-week in-patient rehabilitation programme and 49 patients received treatment as usual .  METHODS Primary outcomes were disease activity measured with the Bath Ankylosing Spondylitis Disease Activity Scale ( BASDAI ) , and function measured with the Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Secondary outcomes included well-being , spinal and hip mobility , and health-related quality of life measured with the Medical Outcome Study Short Form-36 . Overall treatment effects were estimated with Mixed models repeated measures analyses . RESULTS Significant overall treatment effects in favour of the rehabilitation group were found in the BASDAI score ( mean difference over the 1-year period -10.0 , 95 % confidence interval : -3.7 to -16.3 ) , in well-being ( -7.3 , 95 % confidence interval : -1.0 to -14.7 ) , and in the Medical Outcome Study Short Form-36 variables social functioning , role physical , role mental and bodily pain ( mean differences ranging from 5.8 ( pain ) to 10.7 ( role physical ) ) . CONCLUSION A 3-week in-patient rehabilitation programme had positive overall effects on disease activity , pain , function and well-being , and should be considered an important complement to medical disease management in persons with ankylosing spondylitis The objective of this study is to assess the effects of Global Postural Reeducation ( GPR ) in patients with ankylosing spondylitis and compare GPR with group conventional segmental self-stretching and breathing exercises . This is a controlled interventional study of 38 patients divided into 2 groups : a GPR group ( n = 22 ) and a control group ( n = 16 ) . Both groups were treated for more than 4 months . With the GPR group patients , positions that stretched the shortened muscle chains were used . With the control group patients , conventional segmental self-stretching and breathing exercises were performed . The variables analyzed were pain intensity , morning stiffness , spine mobility , chest expansion , functional capacity ( Health Assessment Question naire – Spondyloarthropathies – HAQ-S ) , quality of life ( Medical Outcome Study Short Form 36 Healthy Survey – SF-36 ) , and disease activity ( Bath Ankylosing Spondylitis Disease Activity Index – BASDAI ) . Statistical analysis was used with a significance level of P < 0.05 . There was a statistically significant improvement for all the parameters analyzed between pre- and post-treatment in both groups . In the intergroup comparison , the GPR group showed a significantly greater improvement in morning stiffness ( P = 0.013 ) , spine mobility parameters , except finger-floor distance ( P = 0.118 ) , in chest expansion ( P = 0.028 ) , and in the physical aspect component of the SF-36 ( P = 0.001 ) . The results of this study showed that individual treatment with GPR ( overall stretching ) seems to have better clinical outcomes than group treatment with conventional segmental self-stretching and breathing exercises for patients with ankylosing spondylitis BACKGROUND Exercise therapy is an effective component of fibromyalgia ( FM ) treatment . However , it is important to know the effects and specificities of the different types of exercise : muscle stretching and resistance training . AIM To verify and compare the effectiveness of muscle stretching exercise and resistance training for symptoms and quality of life in FM patients . DESIGN R and omized controlled trial . SETTING Physical therapy service , FM outpatient clinic . POPULATION Forty-four women with FM ( 79 screened ) . METHODS Patients were r and omly allocated into a stretching group ( N.=14 ) , resistance group ( N.=16 ) , and control group ( N.=14 ) . Pain was assessed using the visual analog scale , pain threshold using a Fischer dolorimeter , FM symptoms using the Fibromyalgia Impact Question naire ( FIQ ) , and quality of life using the Medical Outcomes Study 36-item Short-Form Health Survey ( SF-36 ) . The three intervention groups continued with usual medical treatment . In addition , the stretching and resistance groups performed two different exercise programs twice a week for 12 weeks . RESULTS After treatment , the stretching group showed the highest SF-36 physical functioning score ( P=0.01 ) and the lowest bodily pain score ( P=0.01 ) . The resistance group had the lowest FIQ depression score ( P=0.02 ) . The control group had the highest score for FIQ morning tiredness and stiffness , and the lowest score for SF-36 vitality . In clinical analyses , the stretching group had significant improvement in quality of life for all SF-36 domains , and the resistance group had significant improvement in FM symptoms and in quality of life for SF-36 domains of physical functioning , vitality , social function , emotional role , and mental health . CONCLUSIONS Muscle stretching exercise was the most effective modality in improving quality of life , especially with regard to physical functioning and pain , and resistance training was the most effective modality in reducing depression . CLINICAL REHABILITATION IMPACT The trial included a control group and two intervention groups , both of which received exercise programs created specifically for patients with FM . In clinical practice , we suggest including both modalities in an exercise therapy program for FM OBJECTIVES To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis . PATIENTS AND METHODS Fifty patients with knee osteoarthritis were r and omly recruited . They underwent a comprehensive spa therapy program for 21 days . Forty-six patients completed the study . The results were evaluated with Medical Outcomes Study 36-Item Short Form-36 ( SF-36 ) and Arthritis Impact Measurement Scale 2 ( AIMS 2 ) . RESULTS Statistically significant improvement was observed in all subscales of SF-36 . All subscales of AIMS 2 improved too , but only half of them were significant . Correlation between matching subscales of each test was also significant , except physical activity . CONCLUSION Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term The objective of this non-r and omised controlled trial was to evaluate the impact of group-based exercise programme and a home-based exercise programme on Bath Ankylosing Spondylitis Indices , depression and quality of life in patients with ankylosing spondylitis ( AS ) . Approximately 41 patients in a rehabilitation unit were divided into two groups , either group- or home-based exercise programme . Exercise sessions were performed three times a week for a period of 6 weeks . The patients were compared before and after the rehabilitation programme , with respect to Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Disease Assessment Index ( BASDAI ) , Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , Beck Depression Inventory ( BDI ) and The Nottingham Health Profile ( NHP ) . A statistically significant improvement was observed on BASDAI , BASMI and energy , pain , reaction of emotional and sleep subscores of NHP in both exercise groups after the exercise programme ( p < 0.05 ) . No statistically significant changes were detected in BASFI , BDI and social and mobility subscores of NHP in both exercise groups ( p > 0.05 ) . No statistically significant differences were found between the two exercise programmes ( p > 0.05 ) . Group and home-based exercise programmes are efficient in improving symptoms and mobility and had an important effect on quality of life in patients with AS . Home-based exercise programme , as it is cheaper , more easily performed and efficient , may be preferable for the management programme in AS OBJECTIVE To assess the impact of ankylosing spondylitis ( AS ) on patient health-related quality of life ( HRQOL ) relative to both the general US and chronically-ill population s , and to evaluate whether etanercept therapy can reverse impairments in HRQOL due to AS . METHODS Two AS patient population s were evaluated : patients with AS from a US clinical trial who were r and omized to receive either etanercept ( n = 20 ) or placebo ( n = 20 ) for 16 weeks , and placebo-treated patients from a multinational sample who subsequently received etanercept ( n = 129 ) during a 48-week , open-label extension study . A sample from the US general population and patients with other medical conditions derived from the National Survey of Functional Health Status were used as comparators to evaluate the relative impact of active AS on HRQOL , as measured by the Short Form 36 ( SF-36 ) question naire . RESULTS At baseline , patients with AS in both the US and multinational sample s had significantly lower scores than the US general population on all 8 SF-36 scales . Compared with patients with other medical conditions , patients with AS had the lowest scores in the physical domains -- Physical Functioning , Role Physical , and Bodily Pain . Impairments in SF-36 scores for psychosocial domains , such as Social Functioning , Role Emotional , and Mental Health , were somewhat less pronounced in patients with AS . Treatment with etanercept significantly improved the HRQOL of patients with AS on all 8 SF-36 scales , especially in the same physical domains that showed the greatest impairments prior to treatment ( Physical Functioning , Role Physical , and Bodily Pain ) . CONCLUSION Patients with active AS despite conventional therapy have significantly reduced HRQOL across a wide range of domains . These reductions are most pronounced in the physical domains and exceed those seen in many other chronic diseases . Etanercept therapy significantly improves patient HRQOL , indicating that decrements in HRQOL due to AS may be at least partly reversible
Moderate evidence supports exercise interventions in improving physical function , disease activity and chest expansion compared to controls ; there is low-level evidence of improved pain , stiffness , spinal mobility and cardiorespiratory function .
Supervised group exercise yields better outcomes than unsupervised home exercise .
The addition of aerobic components to flexibility programmes  improves cardiorespiratory outcomes , but not cardiovascular risk factors .
The most effective exercise protocol remains unclear .
Current evidence suggests that therapeutic exercises are beneficial for adults with ankylosing spondylitis ; effects on other SpA subtypes are unknown
To evaluate the effects of therapeutic exercise on pain , stiffness , quality of life , physical function , disease activity , health-related fitness and cardiovascular risk factors in adults with spondyloarthritis ( SpA ) .