Background The ASAS/EULAR guidelines recommend that patients with ankylosing spondylitis (AS) should be managed by a combination of pharmacological and non-pharmacological therapy. The non-pharmacological arm encompasses education, exercise, and physiotherapy. In particular, exercise seems to play an important role in the management of AS, particularly when performed in a supervised outpatient group setting, intensively with inpatients, spa-based exercise, or swimming exercise (1-2). However, some AS patients find that it is difficult to follow the recommendations because of lack of time, economic issues, and patient social status.

An incentive spirometer is a device that is designed to achieve and sustain maximal inspiration. It is inexpensive and simple to use, patients do not require supervision once trained in its use, and there are no known side effects.

Objectives We hypothesized that combining incentive spirometer exercise (ISE) with conventional exercise (CE) may improve the efficacy of a rehabilitation program, resulting in better functional capacity and pulmonary function. In the present study, the effects of combination treatment (ISE and CE) were compared to those of CE alone in patients whose AS had been stabilized by tumor necrosis factor (TNF) inhibitor therapy.

Methods This was a 16-week randomized open label case-control single center study. Forty-six patients (44 men, two women) were randomized to the combination (ISE plus CE) group (n=23) or the CE group (n=23). The CE regimen of both groups consisted of 20 exercises performed for 30 minutes once a day. In addition to CE, patients in combination treatment group were instructed how to use the incentive spirometer and performed 30 minutes of CE and 30 minutes ISE once a day for 16 weeks. Patients were assessed before and at the end of treatment by measuring the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), chest expansion, finger to floor distance, pulmonary function parameters, and 6-min walk distance.

Results Both groups improved significantly in terms of chest expansion (p<0.01), finger to floor distance (p<0.01), and BASFI (p<0.05) after completing the exercise program. However, only the combination group showed significant improvements in the forced vital capacity (p<0.05), total lung capacity (p<0.01), and vital capacity (p<0.05). Although there was no significant difference, the combination group was mildly superior to the CE alone group in terms of functional disability and pulmonary function parameters.

Conclusions Combining ISE with a CE can provide positive results in patients whose AS has been clinically stabilized by TNF inhibitor therapy.

1. Braun J, van den Berg R, Baraliakos X, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011;70:896-904.

2. Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev 2008:CD002822.

Disclosure of Interest None Declared