Enhancing spinal mobility and functional capacity through aerobic exercise and yoga in ankylosing spondylitis: a randomized controlled trial.

Objective This study aimed to investigate the effects of yoga-based exercises, combined with aerobic exercises, on spinal mobility, disease activity and functional capacity in Ankylosing spondylitis (AS). Methods A total of 51 patients with AS (27 males, 24 females; mean age: 40.7 ± 9.1 years; range 24-57 years) completed in this prospective, randomized, controlled study. Group 1 (n = 25) received only aerobic exercise therapy, while group 2 (n = 26) received yoga therapy in combination with aerobic exercises. The intensity of the aerobic exercise program were determined using Cardiopulmonary Exercise Testing (CPET). The aerobic program was administered for 30 min over 12 sessions, under physician supervision with monitoring using a lower extremity ergometer. In group 2, in addition to the aerobic program, a yoga-based exercise consisting of spinal flexibility, relaxation, breathing and meditation exercises was administered for 30 min over 12 sessions. Spinal mobility (chest expansion(CE) and BASMI), peripheral muscle strength and laboratory measures (ESR and CRP), were recorded pre- and post-treatment. SpA-specific clinical measures included the ASDAS-CRP, BASFI, ASQoL scale, fibromyalgia scores. Functional capacity was evaluated using the 6-Minute Walk Test (6-MWT). Respiratory parameters and aerobic capacity levels, recorded using Pulmonary Function Tests (PFT) and CPET. Results In the analysis comparing pre- and post-treatment delta gain values between the two groups, statistically significant differences favoring group 2 were found in CE (p = 0.002), BASMI (p = 0.025), right and left handgrip strength (p = 0.023, 0.044), BASFI (p = 0.03), 6-MWT (p = 0.005) and resting systolic blood pressure (p = 0.012). In the Holm-Bonferroni-adjusted sensitivity analysis of between-group delta comparisons, chest expansion, BASMI, and 6-MWT remained statistically significant among clinical and functional secondary outcomes, whereas handgrip strength and BASFI no longer remained statistically significant Conclusion This study showed that a physician-supervised combined aerobic and yoga-based exercise program may provide additional benefits over aerobic exercise alone in selected clinical and functional outcomes, particularly chest expansion, spinal mobility, functional capacity. We suggest that yoga-based exercises combined with aerobic exercise, could be included in the treatment plans of patients with AS.