The Facts About Ankylosing Spondylitis and Exercise

M.A., Health Writer
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Ankylosing spondylitis (AS) is a systemic inflammatory disease that targets the sacroiliac or pelvic and axial or skeleton joints. It may cause fatigue, malaise, sarcopenia (a term that refers to loss of muscle tissue), and inflammation of tendons or enthesitis, leading to significant movement restrictions. And there's more you should know.


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More about AS symptoms

Over time, and with persistent inflammation, the spinal column can fuse, limiting trunk motion and rib cage expansion, says Maura Daly Iversen, PT, DPT, SD, MPH, FNAP, FAPTA of Bouve College of Health Sciences, Northeastern University in Boston. In a telephone interview, Dr. Iversen, a physical therapy, movement, and rehabilitation expert, told HealthCentral that AS may also involve hip and shoulder joints, and the disease can affect the heart and lungs.


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This is how heart and lungs are affected

Typical heart manifestations include poor functioning of the ventricle, one of the heart's chambers, and aortic insufficiency due to inversion and inflammation of the aorta. When coupled with spine and rib cage restrictions, AS can markedly reduce aerobic capacity — it can become harder to breath if ribs cannot move normally, which is up and out as you inhale. Body movement is, however, essential to prevent progression of AS.


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Get help to do it right

You can certainly exercise on your own, and this slideshow may help you do that, but before you do, be sure to ask your doctor or physical therapist (PT) first. A PT is specifically trained to tailor a movement program especially for you and your condition, and to ensure you not only do your exercises, but that you do them correctly to avoid injury, and progress the way you desire.


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Move this way

Movement should include aerobic conditioning or cardio, flexibility exercises and postural strengthening, at a sensible pace. Tendons and ligaments can be inflamed in heel cords or in the patella or kneecap. Stretch before you run for cardio, and if heel cords remain tight, try walking, biking or non-weight-bearing swimming instead of running. Try to incorporate extension or back-bending daily. Deep breathing exercises help maintain natural motion of the rib cage during breathing.


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Don't fear exercise

You won't have the same symptoms every day. AS exacerbates and remits — flares up, then quiets down — like other rheumatic conditions, or you may have fatigue. With a flare, tendons may swell and your spine can hurt. With medication or natural remission, symptoms subside. Listen to your body, then do something that keeps you moving because you'll generally feel better when you move, versus feeling stiff and painful. Don't "push through" severe pain. Your body is telling you something important.


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Start smart

If your AS is controlled with medication, ease into exercise gradually, maybe twice a week. Alternate your activity: Please don’t do high-intensity interval training (HIIT) five days a week, with its wear-and-tear on joints. Research shows that high impact can cause progression of existing joint deformity. You could risk tearing a muscle or tendon if you're not conditioned. Alternating exercise provides better balance and allows you to do those three types of movement — and you don't get bored.


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Know core is more

Aim to build strength in muscles around your abdomen, back, and shoulders. Planks do this and keep your spine flexible and strong. We all sit leaning over at our desks, in a slightly flexed position. Your spine will fuse that way if you don't extend or bend your back. Incorporate activities with extension in everyday life. So, lie on your belly on the floor and prop onto your elbows to play with your child or pet. Pull shoulders together and tighten stomach muscles when showering or shaving.


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Make this part of your life

Dr. Iversen likes for you to integrate movement into your daily activities. You hear so much about sitting being the new smoking. Anything you do too much, in one position, isn't good for you. Get a standing desk and stand sometimes, then sit sometimes. Position your computer screen at eye level so you're not leaning over. It may seem like effort at first, but these changes will help you in so many ways.


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Don’t forget to breathe

You breathe deeply during cardio and that helps you increase and maintain lung capacity. Try to do breathing exercises at other times — take a deep breath and hold for a few seconds, and then let it out. Your PT can share specific breathing exercises to help your chest wall expand and contract better. The earlier you start exercises after diagnosis, the better. Also, please don’t smoke. A 2017 systematic review of research shows that smoking AS patients have more problems than non-smokers.


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Try yoga, Pilates and tai chi

For people with or without AS, low-impact yoga, Pilates, and tai chi are great choices for better flexibility, says Dr. Iversen. Yoga aids balance, alignment, strength, flexibility, and breath control and awareness. Pilates can benefit your postural strength and alignment, plus core stability, as you firm up muscles around your spine. Exercises are performed lying down or sitting. Tai chi, an ancient martial art, also helps posture, balance, breathing, and mental calmness.