Exercise is an essential part of managing ankylosing spondylitis (AS), a chronic inflammatory condition that affects the spine and larger joints of the body. Strengthening exercises keep the muscles around the joints strong, while flexibility exercises increase range of motion.
Regular physical activity reduces pain and stiffness and helps you remain mobile and in an upright posture, says Karena Wu, a board-certified clinical specialist in orthopedic physical therapy at ActiveCare Physical Therapy in New York City and fellow of the American Academy of Orthopaedic Manual Physical Therapists. She suggests aiming for at least three 30-minute workouts per week.
It may seem difficult to fit in exercise between work, school, and household chores, but there’s good news: Breaking up the 30 minutes into snack-sized bites of 5 minutes throughout the day can be just as effective as one longer workout session.
“Any pocket of exercise that will total the amount you are to do in a day helps. It makes it fun and breaks up the routine,” Wu says.
“Breaking up exercise into shorter bouts two or three times each day is especially good for those who are just beginning an exercise routine,” adds Lauren Shroyer, a certified athletic trainer with the American Council on Exercise who specializes in training clients with chronic injuries and conditions.
AS Exercise Dos and Don’ts
Before you get started with any new exercise program, check with your doctor for dos and don’ts. “Each person’s disease progresses differently, and it’s essential to talk to your doctor about which exercises are best,” says Shroyer.
Wu suggests exercises that strengthen your abs and back, even if this area is stiff, to help make your muscles more supportive around the joints most affected by AS. “This can help with decompressing the spinal column and feeling more supported in an upright position,” she says.
Because the lower body supports the lumbar spine, Shroyer and Wu also recommend strengthening exercises for your glutes and hamstrings, such as squats, lunges, and deadlifts. “When the hips are strong, it can give the low back a feeling of support and mobility,” Wu says.
Start with bodyweight exercises; if they’re painful, limit your range of motion. “As you get stronger, you’ll notice the pain-free range will increase,” Shroyer says. Once you can do an exercise in proper form with full range of motion, you can add 5 pounds of weight and increase from there, she adds.
It’s possible to lift heavier weights with AS, as long as you’re doing the exercise properly. “AS can lead to postural changes, which can lead to inefficient movement patterns and potential injury,” Wu says. “If you’re straining or performing the exercise without control or good form, then you might be setting yourself up for injury.”
Not sure your form is correct? Check with a physical therapist or trainer who’s certified in orthopedic exercises and can teach you proper form and exercise variations, Shroyer suggests.
If your spine has fused, you won’t be able to safely move your trunk forward and back through a full range of motion. Instead, Wu recommends dynamic lumbar exercises to strengthen and stabilize your backside.
These low-back exercises are done lying on your stomach or positioned on your hands and knees. For example, try:
- Bird dogs
- Donkey kicks
- Fire hydrants (similar to donkey kicks, but lifting a bent leg to the side)
Throw some stretching exercises into the mix to help maintain mobility in your spine, hips, and knees. “It’s important to make sure the muscles are flexible enough to compensate for the lack of spinal range of motion,” Wu notes.
Finally, don’t forget some cardio to boost your muscle endurance. As an added benefit, “Cardio can really get those feel-good endorphins released,” Wu says.
If you have 15 minutes to spare, Wu recommends the following workout:
- Start with a quick warm-up like marching in place, low-impact high knees, walking, or dynamic stretching.
- Pick two to four exercises you can perform well that alternate muscle groups. For example, do squats, bent-over rows, planks on elbows and toes, and bird dogs.
- Repeat the circuit for three sets.
- Incorporate stretches for your legs, trunk, and even neck and shoulders between circuits or sets as needed.
AS Exercise Safety Tips
Wu says anyone with AS should limit or avoid:
- High-impact exercise Running — and exercises like it — could set you back and irritate your joints if you have an arthritic condition, such as AS, according to Wu.
- Intense bending and twisting If you don’t have full range of motion or good muscle strength and control, activities or exercises that involve a lot of bending and twisting can be dangerous. “They can flare up your joints or cause an injury,” Wu says.
- Forcing movement “Forcing end-of-range bending or twisting in the spine would not be safe if [your spine is] fused and you do not have that range of motion,” Wu notes.
- Exercising during a flare If your AS flares up, you should cut back or stop exercising for a short period of time, so the inflamed joints can calm down, Wu advises.
Also remember that while some discomfort is to be expected when you exercise, pain is never normal. “Pain and fatigue are your body’s warning signals. Listen to them,” says Shroyer. “Your energy level, the number of sets or reps, and the weight you use will vary from day to day. The most important thing is to wake up the day after your workout feeling like you could do it again.”
Quick Workout Ideas?
Ready to get moving? There are many quick and effective ways to work exercise into your day.
Here are a few creative ways you can fit in movement, even if you have only a few minutes to spare. Try one or two of these when you wake up, on your lunch break, or before bed.
1. Stretch your morning routine
Perform easy stretches while lying in bed or between bites of breakfast. A few ideas that can strengthen and stretch areas of your back:
- Seated figure-four stretch: Sit on the edge of your bed or on a shower bench, with both feet on the ground, and then place one ankle on your opposite knee. If you want more of a stretch, lean forward while keeping your back straight. Repeat with the other leg.
- Lying quadriceps stretch: Lying on your stomach, bend one knee and place a towel around the back of your foot. With either side of the towel in each hand, gently pull the towel toward your shoulder. Repeat with the other leg.
- Prone lying: Lying on your stomach, place your forearms on the ground with your elbows under your shoulders. Try to straighten your arms out in front of you and hold for 10 to 20 seconds; rest and repeat.
- Thoracic extension: Sit in a chair, with your feet on the floor, and place your hands behind your head, with your elbows out to the side. Keeping your elbows wide and chest open, lean back into the chair while arching your back up.
- Wall stands: Standing with your feet under your hips and your butt and heels touching the wall, squeeze your shoulder blades together for 5 to 10 seconds. Release, relax, and repeat.
2. Do a Tabata-Style Workout
A Tabata is a form of high-intensity interval training that consists of eight reps of 20 seconds of intense exercise followed by 10 seconds of rest, over a total of four minutes, according to the American Council on Exercise. A review published in April 2019 in The Journal of Physiological Sciences found that cardiovascular benefits from this method are similar to the ones you’d get from a traditional, steady-state cardio workout, such as jogging around the block for 30 minutes.
A few Tabata-style workout ideas:
- Mountain climbers
- Reverse lunges
Skip high-impact exercises, such as jumping jacks or jumping rope, which may put too much stress on your joints if you have AS.
3. Download a bite-sized-workout app
Many apps offer at-home fitness routines, often in 5- to 30-minute increments. A few favorites from the American Council on Exercise:
- Sworkit’s workout library consists of more than 400 exercises you can do in just five minutes.
- FitOn has no membership commitment and allows you to browse by length of workout and part of your body you’d like to work out.
- Melissa Wood Health offers high-intensity, low-impact body-weight workouts of 5 minutes and up based on Pilates and yoga principles.
- The Sculpt Society is celebrity trainer Megan Roup’s accessible fitness app, with workouts from 5 to 50 minutes.
- Sweat offers a variety of female-led workouts you can do anywhere, anytime.
4. Choose compound exercises
Compound exercises work out multiple joints — and, therefore, multiple muscle groups — at the same time. You’ll improve coordination, bump up your heart rate, and gain flexibility in less time than with single-joint isolation exercises.
Use hand weights or simply your own body weight for any of the following exercises:
- Lunges to biceps curls: From a standing position, step one foot forward and lower into lunge position. Stand back up and lift your back leg into the air, with the knee bent to hip height, and then perform a biceps curl with dumbbells. If you can’t lift your knee up in the latter portion of the exercise, keep it on the ground.
- Squats to shoulder presses (dumbbell thrusters): With dumbbells in your hands at shoulder height, hands facing each other, sit down into squat position. As you stand up, push your hands up, and then sit back down, bringing your hands back to your shoulders.
- Renegade rows: Start in push-up position with your hands holding dumbbells. Do a push-up, and then pull one dumbbell from the ground up toward the same shoulder, keeping your arm and elbow close to the side of your body. Return to starting position, engaging your core so your hips don’t sway. Do the same with the other arm, then repeat from the beginning.
5. Sneak in exercise during daily tasks
Multitasking can include simple exercises. The American Council on Exercise recommends blending lunges, squats, calf raises, push-ups, or planks into tasks that involve waiting. For example:
- Sit in chair position on the wall while brushing your teeth. Your thighs should be parallel to the ground, with your knees in line with your ankles.
- Do calf raises while washing the dishes.
- Lunge as you sweep or vacuum.
- Do a modified plank while you’re waiting for water to boil. Place your hands on the kitchen counter and walk your feet back as far as possible, holding for up to 2 minutes.
- Do knee lifts while you wait for your coffee to brew or your lunch to heat up.
6. Work in a walk
Find any moment throughout the day where you could add movement:
- Walk around the block a few times while you’re waiting for a doctor appointment.
- Take the office stairs a few times or go for walk during your lunch break.
- Stroll around the block while on work calls or in phone meetings.
7. Mix exercise and pleasure
The American Council on Exercise recommends adding a simple exercise to your evening unwinding routine:
- Dance around: Make a playlist with a few of your favorite fun songs and have a mini dance party.
- Work out while watching TV: Use the couch and floor to do triceps dips, glute bridges, or Pilates leg exercises while binge-watching your favorite show.
- Engage your core while reading: Get into plank position, on your forearms or hands, while reading before bed. Be sure to place the book so your head stays in line with your shoulders and hips, and keep your abs engaged. If you can’t keep your back from sagging, do a modified plank with your hands on a desk or countertop and your feet on the ground.