Vigorous physical activity and physical function are strongly associated with better health in patients with long-standing radiographic axial spondyloarthritis.
Feldthusen C, Hallström M, et al. • PloS one • 2026
Physical function and vigorous physical activity were the strongest determinants of health status and health-related quality of life in patients with long-standing radiographic axial spondyloarthritis, explaining approximately 50% of the variation in physical health outcomes.
Key Findings
Results
Physical function and vigorous physical activity were the strongest determinants of health status and HRQoL in patients with long-standing r-axSpA.
Multivariable linear regression was used to analyze associations between health status, HRQoL, physical activity, muscle function, and physical function
The models explained approximately 50% of the variation in ASAS HI and the physical aspects of HRQoL
The models explained approximately 21% of the variation in the mental aspects of HRQoL
BASFI (physical function) and vigorous physical activity emerged as the strongest determinants across the models
Results
The majority of participants with long-standing r-axSpA displayed good health status as measured by ASAS Health Index.
62% of participants displayed good health status defined by ASAS HI ≤ 5
The sample had a mean age of 60 (SD 12) years and mean diagnosis duration of 25 (SD 10) years
57% of the 141 participants were male
This finding occurred in a cohort with long-standing disease, suggesting maintained health status is achievable
Results
The majority of participants with long-standing r-axSpA reached recommended levels of health-enhancing physical activity.
77% of participants reached the recommended level of health-enhancing physical activity based on self-reported physical activity measures
Physical activity was assessed via self-report, including vigorous physical activity, moderate physical activity, and sedentary behavior
Vigorous physical activity specifically was identified as strongly associated with health status and HRQoL
Results
Most participants demonstrated normal muscle function despite long-standing disease.
82% of participants had normal muscle function as assessed by the Timed Stands Test (TST) for leg strength
91% of participants had normal handgrip force as assessed by the Grippit instrument
These findings suggest preserved muscle function in the majority of this older cohort with long disease duration
Results
Physical function and spinal mobility were within reference values for approximately half of participants with long-standing r-axSpA.
55% of participants demonstrated physical function within reference values as measured by BASFI (Bath Ankylosing Spondylitis Functional Index)
45% of participants demonstrated spinal mobility within reference values as measured by modified BASMI (Bath Ankylosing Spondylitis Metrology Index)
These two measures were included alongside muscle function tests and physical activity assessments in the multivariable models
Methods
The study population consisted of older patients with long disease duration in a cross-sectional cohort design.
141 patients with long-standing radiographic axial spondyloarthritis (r-axSpA) were included
Mean (SD) age was 60 (12) years
Mean (SD) diagnosis duration was 25 (10) years
57% were male
A cross-sectional cohort study design was used, limiting causal inference
What This Means
This research examined how physical activity levels and physical function relate to overall health and quality of life in 141 people living with long-standing radiographic axial spondyloarthritis (r-axSpA), a form of inflammatory arthritis primarily affecting the spine. The participants were older adults (average age 60) who had been living with the condition for an average of 25 years. The study measured several factors including how well people could perform daily activities, their spinal flexibility, muscle strength, how much vigorous and moderate exercise they did, and their overall health and quality of life.
The study found that vigorous physical activity and physical function were the strongest predictors of better health status and quality of life, together explaining about half of the variation in physical health outcomes among participants. Notably, despite their long disease duration, most participants were doing reasonably well: 62% had good overall health status, 77% met recommended physical activity guidelines, and the majority had normal muscle strength in both their legs and grip. About half had physical function and spinal mobility within normal reference ranges.
This research suggests that staying physically active — particularly engaging in vigorous exercise — may be especially important for older individuals managing long-term inflammatory spinal disease. The findings highlight that many people with long-standing r-axSpA can maintain good health and function, and that physical activity appears to play a meaningful role in supporting that outcome. Because this was a cross-sectional study (a snapshot in time), it cannot prove that exercise directly causes better health, but the strong associations observed support the value of physical activity in this population.
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Feldthusen C, Hallström M, Hulander E, Deminger A, Forsblad-d'Elia H. (2026). Vigorous physical activity and physical function are strongly associated with better health in patients with long-standing radiographic axial spondyloarthritis.. PloS one. https://doi.org/10.1371/journal.pone.0360248