Physical Therapy in the Management of Axial Spondyloarthritis: A Narrative Review

Abstract

Background. Axial spondyloarthritis (axSpA) is a chronic immune-mediated rheumatic disease in which genetic susceptibility interacts with tissue-specific inflammatory processes. The disease can impair spinal mobility, physical function, cardiorespiratory fitness, participation, and quality of life. Exercise and patient education are recommended alongside pharmacological treatment, but the comparative value of specific exercise modalities and delivery models remains uncertain.

Aim. To synthesize current evidence on exercise therapy and adjunct physical therapy interventions in axSpA, with emphasis on clinical outcomes, programme content, supervision, home and technology-supported delivery, adherence, psychosocial factors, and limitations of the evidence.

Material and methods. PubMed/MEDLINE, Scopus, and Web of Science were searched for English-language publications from 2009 through June 2026 concerning axSpA epidemiology, genetic susceptibility, pathophysiology, physical therapy, and exercise.

Results. Structured exercise is associated with modest short-term improvements in self-reported disease activity, physical function, pain, fatigue, and cardiorespiratory fitness.

Conclusions. Regular exercise is a recommended core component of axSpA management. Programmes can be individualized to functional goals, symptoms, comorbidities, safety, access, and patient preference; physiotherapist input may be used for assessment, instruction, progression, and adherence support. Current evidence supports symptom and function management, not disease modification, and does not define a single optimal protocol.