Higher levels of physical activity, particularly recreational activities, correlate with improved global and physical functioning independent of disease activity in patients with axial spondyloarthritis (axSpA), according to findings published in Seminars in Arthritis and Rheumatism.

Researchers conducted an analysis of data obtained from an ongoing, prospective, observational, cohort study — the Incheon Saint Mary’s Axial Spondyloarthritis Study (ISAXSPA) — between January 2020 and February 2021.

During this period, 185 patients with axSpA completed questionnaires that assessed function and physical activity, including the Ankylosing Spondylitis Disease Activity Score (ASDAS), the Bath Axial Spondyloarthritis Functional Index (BASFI), the Assessment of Spondyloarthritis International Society Health Index (ASAS HI), and the Global Physical Activity Questionnaire (GPAQ).

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Using the GPAQ, the researchers categorized physical activity levels as low, moderate, or high based on estimated metabolic equivalent of task (MET) values for various activities, as well as the duration, intensity, and frequency of activity per week.

A trained radiologist evaluated the number of syndesmophytes on x-rays of the cervical and lumbar spine using the modified Stoke Ankylosing Spondylitis Spinal Score. This radiologist also screened for sacroiliitis on anterior-posterior x-ray views of the pelvis for each patient.

Of the 185 patients with axSpA, 46 (25%), 63 (34%), and 76 (41%) participated in low, moderate, and high levels of physical activity on the GPAQ, respectively. Patients with lower physical activity scored higher on the BASFI (P =.015). Moderate physical activity level significantly correlated with improved global functioning (odds ratio [OR], 2.82; 95% CI, 1.02-7.86; P =.047), while high physical activity levels correlated independently with global functioning after adjusting for other disease-related variables (P =.006).

No differences were observed between the low, moderate, and high physical activity groups regarding disease activity on the ASDAS or the x-rays. There was no correlation between physical activity level and the ASAS HI.

Following analysis of the subtypes of physical activity, the researchers found that recreational activity impacted global functioning more than work and transport-related physical activity in patients with axSpA.

Limitations of the study include the cross-sectional design, the potential for patients to overestimate self-reported physical activity levels, and difficulty in accurately estimating physical activity levels using MET values.

“Our data showed that physical activity is significantly associated with both physical and global functioning in axSpA,” the study authors conclude. “This highlights the importance of maintaining a moderate level of physical activity to preserve global functioning in daily life.”


Kim MY, Hong YS, Park SH, Kang KY. Physical activity is associated with physical and global function in patients with axial spondyloarthritis, independent of disease activity. Semin Arthritis Rheum. 2022;56:152067. doi:10.1016/j.semarthrit.2022.152067