Exercise as it relates to Disease/Ankylosing Spondylitis and Exercise

Background
Ankylosing spondylitis (AS) is an chronic, rheumatic disease part of a group of diseases known as spondyloarthropathier (SpA). Ankylosing spondylitis is a result of inflammation in the spine affecting the synovial tissue, ligament insertions and invertebral discs affecting the spine as well as the hips, knees and shoulders. Inflammation of these areas causes trunk stiffness and pain. Additional calcification to these structures leads to mobility loss throughout the spine and over time can progress to spinal deformity and loss of flexibility.

Symptoms/Diagnosis


Symptoms of ankylosing spondylitis can begin as early in the late teens, affecting males at a rate of 3:1 compared to females. Males tend to have the spine affected to greater severity, where females have greater peripheral involvement. AS is characterised by:
 * Lower back or buttocks pain, radiating between sides
 * Persistent symptoms for >3months
 * Reduction of stiffness with exercises
 * Stiffness in morning or with inactivity

Progression: As the inflammation continues new bone builds around the affected area causing increased fusing of the vertebrae

Diagnosis is regarded as having the above symptoms. Other diagnostic tools that can be used include:
 * Radiology – to grade severity of AS
 * Laboratory tests – it is thought that the HLA-B27 gene influences AS

Treatment/Management
There is no cure for ankylosing spondylitis, however treatment is designed to: Methods of management of AS include:
 * delay the progression of the disease
 * relieve pain
 * minimise inflammation
 * maintain function
 * improve quality of life
 * education and counselling
 * physiotherapy and chiropractic - to correct deformity and minimise spinal joint restriction
 * pharmaceutical - non-steroidal anti-inflammatory drugs (NSAIDs) or disease-modifying anti-rheumatoid drugs (DMARDs)
 * exercise and stretching

Exercise and Stretching as management of ankylosing spondylitis
Exercise preserves mobility and prevents further deterioration in those with AS. Exercise programs should include a variety of the following types of exercises:

Home exercise programs should be designed to fit into daily routines and not all exercises need to be completed in one session. It is recommended that you complete exercise when feels appropriate, e.g. if morning stiffness of hips occurs, stretch hips in the morning.

Recommendation

 * Those with severe AS complications should have an exercise tolerance test conducted before starting a fitness program
 * Exercise at least 30 minutes per day
 * Complete back extension exercises minimum 5 days per week
 * Exercising in the water decreases the load on the body, so AS patients can exercise longer and more vigorously

Recommended Readings
Exercises - world arthritis day

Exercises - Arthritis Research UK

Fact sheet - Arthritis Australia