Effects of Pulmonary Rehabilitation Exercises on Pain, Respiratory Muscles, Quality of Life, and Disease Activity in Patients With Axial Spondyloarthritis: A Prospective Randomized Single-Blind Controlled Study

This is a single-center, prospective, randomized, single-blind controlled study conducted in patients with axial spondyloarthritis followed at the Physical Medicine and Rehabilitation Clinic of Sisli Hamidiye Etfal Training and Research Hospital.

Participants were randomized into two groups using the National Cancer Institute Clinical Trial Randomization Tool with the Maximally Tolerated Imbalance method. The intervention group received conventional exercises together with a structured pulmonary rehabilitation program. The pulmonary rehabilitation program included breathing exercises, range-of-motion exercises, aerobic exercise, and strengthening exercises.

Participants in the intervention group performed home-based range-of-motion and breathing exercises twice daily for 10 repetitions. Breathing exercises included pursed-lip breathing, diaphragmatic breathing, lateral abdominal breathing, relaxation and breathing control exercises, and neck and shoulder stretching exercises. In addition, participants completed supervised cycle ergometer exercise sessions at the hospital twice weekly for 8 weeks, with each session lasting approximately 30 minutes including warm-up and cool-down periods. Aerobic exercise intensity was prescribed at moderate intensity using the Karvonen method, with the Borg Rating of Perceived Exertion used when appropriate. Upper-extremity and shoulder-girdle strengthening exercises were also included.

The control group received a conventional exercise program.

The primary outcome was pain intensity measured using the Visual Analog Scale (VAS), with the primary endpoint defined as week 12. Secondary assessments included the Six-Minute Walk Test, Ankylosing Spondylitis Quality of Life Questionnaire, Maximal Voluntary Ventilation, pulmonary function tests, chest expansion, modified Schober distance, occiput-to-wall distance, lateral spinal flexion, Bath Ankylosing Spondylitis Disease Activity Index, and C-reactive protein. Assessments were performed at baseline, week 8, and week 12.