The below recommendations are based on a new consensus statement published in Rheumatology, which provides the first comprehensive exercise recommendations to guide practitioners treating AS patients:
1) Assessment: Individual yoga prescriptions should be informed by a thorough and reproducible assessment that includes musculoskeletal and psychosocial factors, and AS-specific measures, including objective axial mobility and chest expansion.
2) Monitoring: Sufficient monitoring and feedback should be provided on an individual basis.
3) Safety: Physical changes of AS -- including the amount of bony change, balance and mobility changes, osteoporosis, and cardiorespiratory consequences of the disease -- should be considered throughout all aspects of the yoga exercise prescription, especially for those with more severe or advanced disease.
4) AS-specific exercise -- mobility: Individual yoga prescription with an emphasis on spinal mobility is essential, as is maintaining mobility of peripheral joints. Individual goals should be informed by assessment findings. Balanced yoga sequences that include strengthening, cardiopulmonary, functional fitness (balance, co-ordination, gait, agility and proprioception) and specific stretching are recommended.
5) Physical Activity: Healthcare personnel should encourage regular physical activity outside the yoga program to promote general health, well-being, and functional outcomes.
6) Dosage: Since a precise "one size fits all" dosage is not possible, it's recommended that exercise frequency, intensity, duration, and type be tailored to the person's assessment findings, goals, and lifestyle. For yoga programs (mobility, stretch, and postural exercises), consistency is the most important factor. For other exercise types, national physical activity guidelines may require modification. Disease stage, activity, and progression should be considered while aiming for optimal effectiveness.
7) Adherence: It's important to assess adherence to yoga program (and outside exercise), encourage motivation, and promote self-management.
8) Additional Exercise: Additional exercise outside of yoga should be guided by patient preference, to enhance adherence and optimize positive outcomes.
Millner, J. R., Barron, J. S., Beinke, K. M., Butterworth, R. H., Chasle, B. E., Dutton, L. J., & Zochling, J. (2015, August). Exercise for Ankylosing Spondylitis: an Evidence-Based Consensus Statement. In Seminars in Arthritis and Rheumatism. WB Saunders.