Ankylosing spondylitis (AS), previously known as Bechterew’s disease (or syndrome) and Marie-Strümpell disease, is a chronic inflammatory disease of the axial skeleton, with variable involvement of peripheral joints and nonarticular structures. Ankylosing spondylitis is a member of the group of the spondyloarthropathies, with a strong genetic predisposition. It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine. Complete fusion results in a complete rigidity of the spine, a condition known as “bamboo spine”. Ankylosing spondylitis causes significant pain and disability.
Physical activity is one of the most effective non-medical treatments of the management of ankylosing spondylitis. Exercise can help to reduce pain, strengthen muscles that support the spine, maintain or improve posture, keep the spine more mobile and improve flexibility.
It is best to exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath). The weight of the water helps improve circulation (blood flow), relieve pain and relax muscles. Aquatic (water-based) exercise may have beneficial effect in various musculoskeletal conditions.
The aim of this study was to compare the effectiveness of aquatic exercise interventions with land-based exercises (home-based exercise) in the treatment of Ankylosing Spondylitis. Patients with Ankylosing Spondylitis were randomly assigned to receive either home-based exercise or aquatic exercise treatment protocol.
Home-based exercise program was demonstrated by a physiotherapist on one occasion and then, exercise manual booklet was given to all patients in this group.
Aquatic exercise program consisted of 20 sessions, 5 times per week for 4 weeks in a swimming pool at 32-33°C.
All the patients in both groups were assessed for:
Evaluations were performed before treatment and after treatment (week 4 and week 12). The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t-test. Paired t-test was used for comparison of pre and post treatment values within groups.
A total of 69 patients with Ankylosing Spondylitis were included in this study.
We observed significant improvements for all parameters:
In both groups after treatment at week 4 and week 12 (p < 0.05). Comparison of the percentage changes of parameters both at week 4 and week 12 relative to pretreatment values showed that improvement in VAS (p < 0.001) and bodily pain (p < 0.001), general health (p < 0.001), vitality (p < 0.001), social functioning (p < 0.001), role limitations due to emotional problems (p < 0.001), and general mental health (p < 0.001) subparts of SF-36 were better in aquatic exercise group.
Based on this study it is concluded that a water-based exercises produced better improvement in pain score and quality of life for patients with ankylosing spondylitis.