Ankylosing spondylitis (AS) can be improved with a healthy body weight and exercise. Ankylosing spondylitis is a type of inflammatory arthritis that mainly affects the spine and can lead to pain, fatigue, and stiffness. But research has shown regular exercise can help improve it.
The American College of Rheumatology (ACR) outlined recommendations for patients with ankylosing spondylitis. Principal investigator Michael Ward said “The ACR’s primary objective was to provide recommendations on optimal treatment for patients with AS and non-radiographic axial SpA [spondyloarthritis] that were based on quality evidence and took into consideration patient values and preferences. While the guideline does not cover all aspects of spondyloarthritis management, it provides a foundation based on the current best-available evidence.”
The guidelines not only discuss the broad spectrum of ankylosing spondylitis treatments. The investigators also included the Grading of Recommendations Assessment, Development, and Evaluation approach (called GRADE), which provides specifications for different patient groups, interventions, competing treatment alternatives and outcomes, grading the quality of evidence used, and basing recommendations on benefits and harm.
Recommendations are placed into one of six categories: recommendations for the treatment of patients with active AS (pharmacologic and rehabilitation), recommendations for the treatment of patients with stable AS (pharmacologic and rehabilitation), recommendations for the treatment of patients with either active or stable AS, recommendations for the treatment of patients with AS and specific impairments or comorbidities (such as advanced hip arthritis, severe kyphosis, acute iritis, and inflammatory bowel disease), education and preventive care recommendations; and recommendations for the treatment of patients with non-radiographic axial SpA.
Each category contains recommendations regarding pharmaceutical and non-pharmaceutical interventions followed by supporting evidence.
Following a healthy diet has been proven to help relieve symptoms associated with ankylosing spondylitis. Here are the foods most beneficial for those with ankylosing spondylitis—and foods that you should avoid in your healthy diet.
Foods rich in omega-3: These include chia seeds, fatty fish (sardines, salmon, and tuna), flaxseeds, and walnuts. A study found that omega-3 supplements reduced disease activity of ankylosing spondylitis in that it could help provide a modest effect on joint pain and inflammation.
Fruits and vegetables: Contains many of the vitamins and minerals necessary for overall health and well-being, they are also low in calories and high in fiber. The National Ankylosing Spondylitis Society (NASS) in the United Kingdom recommend eating fruits and vegetables of all different colors, as they contain many antioxidant compounds that help to protect against the disease.
Eat whole grains: These include brown rice, corn, quinoa, buckwheat, and oatmeal. Known for being high in fiber and nutrients, whole grains may aid in the reduction of inflammation. However, those with gluten sensitivity or intolerance may have triggered symptoms when consuming whole grains. It is advised to speak to a doctor before incorporating whole grains into your diet.
Eat calcium rich foods: Helps to strengthen weak bones, of which ankylosing spondylitis is known to cause. Foods high in calcium include dark leafy greens such as watercress and kale, broccoli, Chinese cabbage, low-fat dairy products, fortified plant milk, almonds, canned sardines with bones, and fortified cereals.
Use more herbs and spices: Garlic is known to have anti-inflammatory and antimicrobial properties. Ginger is known for being a great anti-inflammatory food. Turmeric, commonly used in Asian dishes, has also been shown to reduce inflammation.
Avoid excessive amounts of sugar, sodium, and fat: These tend to be highly processed foods that can lead to the development of inflammation in the body. It is a good idea to limit the amount of food that comes in boxes, bags, and cans whenever possible. Reading labels can give you an idea of what is in your foods. Look for added sugars, high sodium content, saturated fats, trans fats, and preservatives, and do your best to avoid them.
Limit alcohol consumption: Alcohol can interact with medication and cause additional effects. It is best to avoid alcohol altogether. Also, excessive alcohol consumption can lead to damage to the liver, stomach lining, and the small intestine. All of these structures are required for efficient absorption of vitamins and nutrients.
Consider probiotics: Studies suggest that taking a multi-strain probiotic may benefit those with ankylosing spondylitis. This will allow your gut to be filled with good bacteria, which can help fight off bad bacteria along with support a healthy immune system. Certain foods also contain probiotics including yogurt, kefir, and kombucha tea.
Foods to avoid with AS: You will want to avoid foods that trigger inflammation. These foods include sugar, salt and high-sodium foods, red meat, high-fat foods, starchy foods, wheat and gluten, and alcohol. You will also want to keep track of your own food triggers as each person is different. You can uncover your own food triggers by keeping a food diary and documenting your reaction and symptoms associated with eating certain foods. Certain diets may aggravate AS including diets that contain alfalfa, copper, zinc, low-calorie, low-fat, and low-protein diets. Consult your doctor about what the best diet for you and your condition is.
For many ailments, resting in bed is generally the go-to recommendation. But for those living with ankylosing spondylitis, laying still in bed and resting can worsen symptoms. Therefore, it’s important to exercise and keep moving.
Exercises should focus on the back, chest, and limbs. but be mindful and know your limits – overdoing it can cause more pain. Here are some useful exercises for those with ankylosing spondylitis:
Stand with your back flat against the wall. Slowly put your head onto the wall, but do not tilt it forward. Hold for five seconds, release, and repeat.
Stand with feet shoulder-width apart and place your hands on your waist. Turn your upper body as if you are looking to the side, but your feet are still pointing ahead. Hold this position, release, and repeat. Make sure you do this on both sides and focus on your breathing.
Lay on your back, knees bent, feet flat on the ground. Place your hands on your ribs and breathe deeply so your ribs are pushing against your hands. Then place your hands on your chest and repeat.
Lay on your stomach, looking straight ahead, hands by your side. Raise one leg up with your opposite arm up out in front of you at the same time and hold.
Release. Switch arms and legs and repeat. When you’re lying on your stomach with hands by your side, attempt to raise your chest, shoulders, and head, but keep the legs on the ground.
On your hands and knees, lift your opposite leg and arm and extend out. Hold this position, release, and switch sides.
Standing posture: It may be easier to perform this exercise in front of a mirror. By standing on your heels about four inches away from the wall, keep your shoulders and buttocks as close to the wall as possible without hurting yourself. Hold for five seconds, and repeat 10 times.
Lying posture: Performed on a firm surface like a bare floor, lie face down for 15 to 20 minutes. You can keep your head facing downward, or turn it to either side if it is more comfortable.
Swimming: By performing the breaststroke swimming technique, you can build and maintain chest expansion. It is also a great way to increase the flexibility of the spine, neck, shoulders, and hips.
Deep breathing: Can help increase and maintain lung capacity as well as keep the rib cage flexible. Breathing slowly through the nose or mouth while keeping one hand on the abdomen helps you gauge the rise and fall of inhaled and exhaled breaths.
Yoga: May help ease pain and increase flexibility. It may also help with reducing stress and tension, promoting restful sleep. Yoga may be difficult to perform alone, so it is recommended to join a class or friends, as it will aid you in increasing your range of motion and help you advance to higher levels.
Walking posture: Keeping the spine as straight as possible while walking helps improve posture muscles.
Sitting posture: Something we do most of the day—it is important that you are not sitting incorrectly. Having a well-designed chair that doesn’t encourage slumping or a stooped position will help. Sitting with the spine straight or in an ergonomic position with the shoulders squared is most optimal.
Sleeping posture: It is recommended to sleep with your spine straight as much as possible. By getting a firm mattress, this can be achieved easier. Not using a pillow while you sleep on your stomach, or using a thin pillow while sleeping on your back can promote a straight spine.
Although exercise can benefit patients with ankylosing spondylitis, some exercises should be avoided as they can cause more harm than good. Such activities include step aerobics, running, heavy weight lifting, kickboxing, burpees, cross training, jumping, sit-ups, and leg lifts. These types of exercises put stress on the back and spine, which can worsen symptoms and increase your risk of injury.
Speak with your doctor prior to starting a workout routine to ensure it is safe for you. You may also want to begin with a visit to a physiotherapist to get a good idea of how to perform certain movements. Lastly, let your body be your guide—if it doesn’t feel right, discontinue the exercise.