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 ) .
The effect of balneotherapy on patients with ankylosing spondylitis
Objective : To compare the effect of balneotherapy on physical activity and quality of life as well as the symptoms of pain and stiffness with exercise alone in ankylosing spondylitis ( AS ) patients . Methods : A total of 60 patients who had a diagnosis of AS according to the modified New York criteria were included in the study . The patients were r and omly assigned to two groups . In Group I ( n = 30 ) the patients received balneotherapy in a therapeutic pool for 30 min once a day for 3 weeks . All patients received instructions on the exercise programme , which they were requested to repeat once a day for 30 min during the study . The patients in this group continued the same exercise programme after the end of the balneotherapy protocol to complete a course of 6 months . In Group II the patients were given the same exercise protocol but did not receive balneotherapy . Patients were evaluated before the start of the study and at 3 weeks and 24 weeks . Evaluation parameters were daily and night pain , morning stiffness , the patient 's global evaluation and the physician 's global evaluation ( according to a scoring system of 1 to 5 ) , the Bath Ankylosing Spondilitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Dougados Functional Index ( DFI ) , tragus – wall distance , chest expansion , modified Shober test ( MST ) , fingertip – fibula head distance , and Nottingham Health Profile ( NHP ) . Results : Evaluations were completed in 54 patients in the two groups . Comparison of the groups showed significantly superior results for Group I for parameters of BASDAI , NHP total , pain , physical activity , tiredness and sleep score , patient 's global evaluation and the physician 's global evaluation at 3 weeks , but only for the parameters of patient 's global evaluation and MST at 24 weeks . Conclusion : Balneotherapy has a supplementary effect on improvement in disease activity and functional parameters in AS patients immediately after the treatment period . However , in the light of our medium‐term evaluation results , we suggest that further research is needed to assess the role of balneotherapy applied for longer duration s in AS patients
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 ) .