Exercise as a Core Component of Axial Spondyloarthritis Management: Translating Evidence into Clinical Practice

PURPOSE: Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease associated with impaired physical function, reduced cardiorespiratory fitness, sarcopenia, and increased cardiometabolic comorbidity. Although exercise is consistently recommended within international management guidelines, implementation in routine clinical practice remains inconsistent. The purpose of this review was to examine the role of exercise as a therapeutic co-intervention in axSpA and to explore practical approaches for translating evidence into clinical care. METHODS: A narrative review was performed using evidence identified from guideline documents, systematic reviews, randomized controlled trials, and translational literature relating to exercise, physical activity, rehabilitation, cardiorespiratory fitness, multimorbidity, and sarcopenia in axSpA. FINDINGS: Exercise interventions, including aerobic, resistance, and combined training approaches, consistently improve disease activity, physical function, spinal mobility, fatigue, and health-related quality of life in axSpA. Emerging evidence also suggests beneficial effects on cardiovascular risk factors, body composition, and muscle health, with moderate- to high-intensity exercise demonstrating a favorable safety profile when appropriately prescribed and supervised. Physical inactivity and sedentary behavior contribute substantially to long-term disease burden and may exacerbate deconditioning, reduced cardiorespiratory fitness, and sarcopenia. Despite strong endorsement from international guidelines, exercise prescription in routine care is frequently delivered as nonspecific advice rather than as a structured and progressive therapeutic intervention. IMPLICATIONS: Exercise should be considered a core component of long-term axSpA management rather than an optional lifestyle adjunct. Greater emphasis on structured assessment, individualized prescription, progression, and multidisciplinary support may improve implementation of exercise-based interventions and help address the broader functional and cardiometabolic burden of axSpA.