Exercise prescription for axial spondyloarthritis: a systematic review and meta-analysis of randomized controlled trials

Background Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic condition that significantly impacts patients’ quality of life. Exercise therapy serves as a core non-pharmacological treatment modality, yet its overall efficacy and optimal prescription parameters require further clarification through high-quality evidence. This study aims to systematically evaluate the efficacy of exercise interventions for axSpA patients. Methods Computerized searches were conducted across databases including PubMed, Embase, Web of Science, and the Cochrane Library, covering the period from inception to September 2025. Randomized controlled trials (RCTs) comparing exercise interventions with conventional treatments for axSpA were included. Two researchers independently performed literature screening, data extraction, and quality assessment. The heterogeneity of the research results was assessed using the I 2 statistic. Continuous variables were presented as weighted mean differences or standard mean differences, with confidence intervals set at 95%. Stata 15.0 was utilized to conduct a meta-analysis. Results Fifteen RCTs involving 1,699 patients were included. Meta-analysis revealed that exercise intervention significantly improved disease activity in axSpA patients compared with controls (BASDAI: SMD = –0.75, 95% CI: –1.19 to –0.31; ASDAS: SMD = –0.91, 95% CI: –1.54 to –0.29), physical function (BASFI: SMD = –0.37, 95% CI: –0.47 to –0.26), spinal mobility (BASMI: SMD = –0.26, 95% CI: –0.49 to –0.04), thoracic expansion (SMD = 0.35, 95% CI: 0.04–0.65), and fatigue levels (SMD = –0.53, 95% CI: –0.78 to –0.28). Subgroup analyses indicated that different exercise modalities and intervention durations influenced treatment efficacy. Conclusion This meta-analysis confirms that exercise interventions significantly improve core outcome measures including disease activity, physical function, spinal mobility, and fatigue in patients with axial spondyloarthritis, with statistically significant effects. The findings support the incorporation of individualized exercise prescriptions as a key component of standard axSpA treatment, providing evidence-based guidance for clinical practice. Future research should further optimize exercise prescription parameters and validate their long-term efficacy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251144518 , identifier CRD420251144518.