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Muscle Strength And Walking Performance In Ankylosing Spondylitis Improved By Swiss Ball

A new study presented at EULAR 2013, the Annual Congress of the European League Against Rheumatism, demonstrates that using a is effective in improving and walking performance in patients with (AS).

Patients randomised to the showed statistically significant improvements in muscle strength with no worsening of disease activity; in addition these patients reported greater satisfaction with their treatment than those in the control group.

AS is a chronic inflammatory rheumatic disease affecting the spine and joints in the lower back and pelvis. 0.1-2% of the population suffers from AS, with the highest prevalence in northern European countries.2 Initial symptoms are chronic pain and stiffness in the middle and lower part of the spine, which is worse at rest and eased by exercise. However, many patients find their mobility to be significantly restricted, impacting their ability to exercise.

According to lead author Mr Marcelo de Souza physiotherapist of the Rheumatology Division, Federal University of Sao Paulo, Brazil, “exercises are recommended in the management of patients with AS, yet the benefits of specific exercise programmes are not as well defined.”

“Our study has confirmed that a progressive muscle strengthening programme using a Swiss ball significantly improves functional capacity, muscle strength, and mobility in patients with AS, with no harmful effects on disease activity,” Mr de Souza concluded.

There was a statistically significant improvement in strength in the intervention (exercise) group, compared to the control group, for the muscles used in the exercises: abdominal (p =0.003), rowing exercises (p=0.02), squat (p=0.01), triceps (p=0.021) and reverse fly (p=0.02). The intervention group also improved the 6-minute walk test* (p=0.005) at week 16.

There was also a statistically significant difference between the two groups in terms of treatment satisfaction at all times (p <0.001), measured using a Likert scale.†

60 clinically and demographically similar patients were randomized to either the intervention group or the control group, with 30 patients in each. Eight exercises were completed by the intervention group with free weights on a Swiss ball, twice a week for 16 weeks. Loads were reassessed and increased every 4 weeks. The control group remained on a waiting list, receiving drug therapy but without any exercise.


*6-minute walk test, test of exercise tolerance; furthest distance an individual can walk over a total six minutes

†Likert scale: psychometric scale commonly employed in questionnaires and comprised of statements requiring subjective evaluation, e.g. strongly disagree, disagree, neither agree nor disagree, agree, strongly agree

1.Souza et al., Benefits of progressive muscle strengthening using a Swiss ball in patients with ankylosing spondylitis: a randomised controlled trial [abstract]. EULAR Annual European Congress of Rheumatology; 12-15 June 2013; Madrid, Spain. Abstract nr. OP0096-HPR.

2.Ankylosing Spondylitis. Patient UK. Available from: http://www.patient.co.uk/doctor/ankylosing-spondylitis. Last accessed: May 2013.

European League Against Rheumatism