A physician-supervised combined aerobic and yoga-based exercise program may provide additional benefits over aerobic exercise alone in selected clinical and functional outcomes, particularly chest expansion, spinal mobility, and functional capacity in ankylosing spondylitis.
Key Findings
Results
Combined aerobic and yoga-based exercise produced significantly greater improvement in chest expansion compared to aerobic exercise alone in ankylosing spondylitis patients.
Chest expansion delta gain difference between groups was statistically significant (p = 0.002)
This finding remained statistically significant after Holm-Bonferroni-adjusted sensitivity analysis
Group 2 (n = 26) received yoga therapy in combination with aerobic exercises; Group 1 (n = 25) received aerobic exercise therapy only
Both groups received 12 sessions of 30-minute aerobic exercise using a lower extremity ergometer under physician supervision
Results
Combined aerobic and yoga-based exercise produced significantly greater improvement in spinal mobility (BASMI) compared to aerobic exercise alone.
Between-group delta comparison for BASMI favored Group 2 (p = 0.025)
BASMI improvement remained statistically significant after Holm-Bonferroni-adjusted sensitivity analysis
BASMI (Bath Ankylosing Spondylitis Metrology Index) was recorded pre- and post-treatment
The yoga-based component included spinal flexibility, relaxation, breathing, and meditation exercises administered for 30 minutes over 12 sessions
Results
Functional capacity as measured by the 6-Minute Walk Test (6-MWT) was significantly more improved in the combined exercise group than in the aerobic-only group.
Between-group delta comparison for 6-MWT favored Group 2 (p = 0.005)
6-MWT improvement remained statistically significant after Holm-Bonferroni-adjusted sensitivity analysis
The 6-MWT was used to evaluate functional capacity pre- and post-treatment
51 total patients completed the study (27 males, 24 females; mean age 40.7 ± 9.1 years; range 24–57 years)
Results
Combined aerobic and yoga exercise showed significantly greater improvements in handgrip strength and BASFI compared to aerobic exercise alone in unadjusted analyses, but these did not survive correction for multiple comparisons.
Right handgrip strength delta difference between groups was significant (p = 0.023) and left handgrip strength (p = 0.044) in unadjusted analysis
BASFI (Bath Ankylosing Spondylitis Functional Index) delta difference favored Group 2 (p = 0.03) in unadjusted analysis
After Holm-Bonferroni-adjusted sensitivity analysis, handgrip strength and BASFI no longer remained statistically significant
Peripheral muscle strength was recorded pre- and post-treatment alongside SpA-specific clinical measures
Results
Resting systolic blood pressure showed a significantly greater improvement in the combined aerobic and yoga group compared to the aerobic-only group.
Between-group delta comparison for resting systolic blood pressure favored Group 2 (p = 0.012)
This finding was noted among the statistically significant differences in the unadjusted between-group analysis
The Holm-Bonferroni sensitivity analysis results for this outcome were not separately specified as surviving correction in the abstract
Aerobic exercise intensity was determined using Cardiopulmonary Exercise Testing (CPET)
Methods
The study design included aerobic exercise intensity determination via Cardiopulmonary Exercise Testing and monitored supervised sessions for both groups.
Aerobic exercise intensity was individually determined using Cardiopulmonary Exercise Testing (CPET)
Aerobic program was administered for 30 minutes over 12 sessions under physician supervision using a lower extremity ergometer
Respiratory parameters and aerobic capacity levels were recorded using Pulmonary Function Tests (PFT) and CPET
Laboratory measures (ESR and CRP), ASDAS-CRP, ASQoL scale, and fibromyalgia scores were also assessed pre- and post-treatment
What This Means
This research suggests that adding yoga-based exercises to a standard aerobic exercise program provides greater benefits for people with ankylosing spondylitis (AS), a form of inflammatory arthritis that primarily affects the spine, compared to aerobic exercise alone. In a 12-session supervised program, patients who combined yoga (including spinal flexibility, breathing, and relaxation exercises) with aerobic cycling showed significantly more improvement in chest expansion, spinal mobility, and walking distance (6-Minute Walk Test) than those who did aerobic exercise only. These key findings held up even after statistical corrections for multiple comparisons, lending more confidence to the results.
Some additional benefits were seen for hand grip strength and physical function scores (BASFI) in favor of the combined program, but these did not hold up after stricter statistical correction, meaning they should be interpreted cautiously. Resting systolic blood pressure also improved more in the combined group. Neither group showed significant differences in disease activity markers like CRP or ESR, suggesting the exercise additions are more relevant to physical function and mobility than to inflammation levels directly.
This research suggests that yoga-based exercises, when added to a supervised aerobic program tailored by cardiopulmonary exercise testing, could be a useful addition to treatment plans for people with ankylosing spondylitis, particularly to help maintain or improve spinal flexibility and overall physical function. The study was relatively small (51 patients) and short-term (12 sessions), so larger and longer studies would be needed to confirm these benefits over time.
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Önal R, Ordu Gökkaya N, Dizdar D, Korkmaz S, Alemdaroğlu E, Güler T, et al.. (2026). Enhancing spinal mobility and functional capacity through aerobic exercise and yoga in ankylosing spondylitis: a randomized controlled trial.. Rheumatology international. https://doi.org/10.1007/s00296-026-06185-2