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The effectiveness of different exercise mode interventions in improving disease activity in patients with ankylosing spondylitis: a network and dose-dependent meta-analysis

Ye G, Gao L, Liu C, Huang J, Zheng X, Gao Y, Wang H, Wang H

Frontiers in physiology, 2025

1,757 participants

Abstract

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease that impairs physical function, reduces quality of life, and is associated with psychological burdens such as anxiety and depression. While non-steroidal anti-inflammatory drugs (NSAIDs) and biologic therapies are standard treatments, exercise therapy is crucial for maintaining mobility and function. This study aimed to comprehensively compare the effects of 12 exercise interventions on AS patients' disease activity and chest expansion (CE) via network meta-analysis (NMA) and dose-response meta-analysis, and explore dose-dependent effects to inform personalized exercise prescriptions.

Methodology: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, randomized controlled trials (RCTs) were searched from PubMed, Cochrane Library, Embase, and Web of Science until December 31, 2024. Eligible studies included adults with American College of Rheumatology/European League Against Rheumatism (ACR/EULAR)-diagnosed AS, comparing exercise with conventional treatment/placebo/no intervention, with outcomes of Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and CE. Two reviewers screened literature, extracted data, and assessed bias using the Cochrane Handbook. NMA and dose-response analysis (expressed as metabolic equivalents of task (MET)…

How strong is the evidence?

Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,757 participants or records.

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