Getting on the Ball for Spinal Arthritis

Ankylosing spondylitis patients may benefit from Swiss ball exercises

(RxWiki News) Exercise is a key part of managing arthritis of the spine. But exercise comes in many forms. So, for patients with spinal arthritis, what are the benefits of different types of exercise?

Researchers recently tested one exercise program involving a Swiss ball on patients with ankylosing spondylitis, a form of arthritis that mainly affects the spine.

Swiss balls, or stability balls, are large inflatable balls used to help people focus on balance and posture while exercising. Good posture can have an impact on the way a person with ankylosing spondylitis looks and feels.

From their study, the researchers found that the Swiss ball exercise program improved muscle strength and walking performance in patients with ankylosing spondylitis.

"Make time for daily exercise."

This study was conducted by Marcelo de Souza and fellow researchers from the Rheumatology Division of the Federal University of Sao Paulo in Brazil.

According to de Souza and colleagues, "Exercises are recommended to the management of patients with ankylosing spondylitis, although the benefits of specific exercise programs are not yet well defined."

Therefore, the researchers set out to see if a progressive muscle strengthening program using a Swiss ball could improve the functional capacity (ability to do typically simple activities), muscle strength, disease activity and quality of life of patients with ankylosing spondylitis.

Swiss balls are commonly used in a variety of exercise programs, including physical therapy and athletic training. Some people sit on Swiss balls in place of an office chair in order to maintain a healthy posture while working.

This study included 60 patients with ankylosing spondylitis who were randomly assigned to either the Swiss ball exercise program or to a comparison group that did not exercise but continued treatment with medications.

The exercise group did exercises with free weights on a Swiss ball twice per week for 16 weeks. The program was progressive, in that weight loads were increased every four weeks.

At the beginning of the study, both groups had similar disease characteristics. By the end, patients in the exercise group had greater improvement in muscle strength as measured by the one-repetition maximum test, which is the maximum amount of weight than a person can lift in one repetition. 

More specifically, the exercise program patients showed greater improvement in the strength of muscles used in abdominal exercises, rowing exercises, squats, tricep exercises and reverse fly (a weightlifting exercise that works the upper back muscles).

Results also showed that patients in the exercise program had greater improvement in their walking capacity as shown by the six-minute walk test, which measures how far a person can walk in a total of six minutes.

Furthermore, the exercise group appeared to be more satisfied with their treatment than the comparison group was.

The researchers also measured a number of other characteristics using a variety of questionnaires and lab tests. However, they found no other differences between the groups according to these measures.

In addition, disease activity did not worsen in patients who participated in the exercise program.

According to de Souza, "Our study has confirmed that a progressive muscle strengthening program using a Swiss ball significantly improves functional capacity, muscle strength and mobility in patients with ankylosing spondylitis, with no harmful effects on disease activity."

Jim Crowell, owner and head trainer at Integrated Fitness in Pittsburgh, Pennsylvania, also sees the benefits of exercising with a Swiss ball.

"I'm a big believer in training my clients from head to toe. I think that increasing strength will have a very positive benefit on their health in the long run. Paramount to this idea is to train their stomachs and low backs," said Crowell, who was not involved in this study.

"With the lack of activity that most people get, I see many people come into my gym with terrible posture and very weak abs. It's only a matter of time before somebody takes all of that 'bad posture tension' into their back and that brings with it back pain or worse," Crowell said.

"A great workout tool that can help train your core is a Swiss ball. It allows you to fit your body onto a giving surface while also turning your abs on because the surface is unstable," he said. "You can also turn over and train your lower back, specifically with hip and back extensions on top of the ball. In my experience, those people who train both their abs and their low back in particular feel considerably less pain in their backs. "

Crowell continued, "I do believe that somebody needs strength all of the way through their body so doing ab and lower back work isn't enough by itself. But, when you combine core work with upper and lower body work, you will get in much better shape. While I do like to use other equipment on top of a Swiss ball because you can get better and different results elsewhere, you could utilize a Swiss ball for most exercises."

The findings from this study were presented in June at the Annual Congress of the European League Against Rheumatism (EULAR 2013). The study has yet to be published in a peer-reviewed journal.

The authors declared no conflicts of interest.

Review Date: 
June 18, 2013