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Exercise in AS — SCE Rheumatology MCQ

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EasySpondyloarthropathyExercise in ASSCE Rheumatology

A 35-year-old man with established axial spondyloarthritis attends a routine review. His disease is clinically stable, and he asks which exercise programme should form part of his long-term management. Which is the most appropriate advice?

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Correct answer: D — An individualised programme combining spinal mobility, stretching, strengthening, postural and aerobic exercises

Option D is correct. NICE recommends referral to a specialist physiotherapist to initiate an individualised, structured programme incorporating stretching, strengthening and postural work, deep breathing, spinal extension and range-of-motion exercises, together with aerobic exercise. ASAS-EULAR similarly recommends regular exercise and consideration of physiotherapy. Hydrotherapy can help pain and function but is an adjunct rather than the only safe modality. Aerobic exercise alone omits important mobility, posture and muscle-strengthening components. Supervised physiotherapy may help tailor the programme but should not preclude regular self-directed exercise. Routine rest or delaying exercise until remission risks greater stiffness and deconditioning; exercise should instead be individualised to disease activity, functional ability and comorbidity.

Reference: National Institute for Health and Care Excellence. Spondyloarthritis in over 16s: diagnosis and management (NG65), recommendation 1.5.1, 2017 (guideline partially updated 2025). https://www.nice.org.uk/guidance/ng65/chapter/Recommendations