- Design
- Systematic review and frequentist network meta-analysis of randomised trials with CINeMA certainty rating
- Population
- 59 trials, 3,404 adults with axial spondyloarthritis
- Primary outcome
- BASDAI, BASFI and BASMI versus usual care
- Effect
- Pilates versus usual care: BASDAI MD -1.72 (95% CI -2.79 to -0.66); BASFI MD -1.65 (-2.74 to -0.56)
A network meta-analysis compared seven exercise types in adults with axial spondyloarthritis: mobility, strength, aerobic, Pilates, Tai Chi, Qigong and yoga. It pooled 59 randomised trials with 3,404 participants, with BASDAI, BASFI and BASMI as co-primary outcomes.
Compared with usual care, Pilates had the largest effects on BASDAI (mean difference -1.72, 95% CI -2.79 to -0.66), BASFI (-1.65, -2.74 to -0.56) and pain on a visual analogue scale (-9.60, -13.81 to -5.38). Yoga also reduced pain (-3.38). Qigong was the only modality linked to lower ESR (-10.71) and CRP (-6.99). No modality significantly improved spinal mobility (BASMI), ASDAS-CRP, six-minute walk or quality of life.
Heterogeneity was moderate to high and certainty was low to moderate for most comparisons, rankings varied by outcome and few modalities differed from each other. The authors conclude that exercise selection should be individualised. The review was registered retrospectively.
- Exercise improved disease activity, function and pain versus usual care.
- Pilates had the largest effect on BASDAI, BASFI and pain.
- Qigong was linked to lower ESR and CRP.
- No modality improved BASMI, ASDAS-CRP or six-minute walk distance.
- Choose the exercise the patient will keep doing.
Why it matters
Exercise is already standard advice, and this tells patients that the exact type matters less than doing it.
Don't overread it
Rankings among exercise types rest on indirect, low-to-moderate certainty evidence, and the review was registered retrospectively.
The statistics, in plain English
A mean difference of -1.72 on BASDAI is a clinically noticeable change on a 0 to 10 scale. Network rankings come from indirect comparisons, so they are weaker than head-to-head trials, and low-to-moderate certainty means the ranking could change with more data.
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