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Introduction: Exercise is a key non-pharmacological component in axial spondyloarthritis (axSpA) [1]. Evidence for yoga as a mind-body intervention, and direct comparison with physiotherapy and healthy individuals, remains limited. Our objective was to assess the effects of an 8-week yoga program on mobility, function, disease activity, activity-related competences, and psychological outcomes in axSpA compared with standard physiotherapy and healthy individuals performing the same yoga protocol.

Methods: Prospective controlled, non-randomized study (Erlangen, 05/2021–01/2024). axSpA patients participated either in weekly yoga sessions for 8 weeks (≈60 min; live via Zoom or video; optional repetition) or received standard individual physiotherapy (≥30 min/week). A healthy comparison group completed the same yoga program. Outcomes at baseline and follow-up (0-8 weeks) included BASMI, BASFI, BASDAI, physical activity (BSA), physical-activity-related-health competency (PAHCO,) SF-36, and kinesiophobia (TSK-II). Changes were analyzed using linear mixed-effects models (random intercept), estimated marginal means, and within-group change scores (Δ=FU–BL).

Results: Seventy-six participants were included (axSpA yoga n=24; axSpA physiotherapy n=24; healthy yoga n=28). Baseline age, sex, and BMI did not differ between axSpA groups; BASMI and BASFI were comparable, while work-related BSA was higher in physiotherapy. In axSpA, yoga improved spinal mobility (BASMI Δ −0.31; p=0.004), whereas physiotherapy showed worsening (Δ +0.29; p=0.006). BASFI remained stable in both groups. In the yoga group, PAHCO improved (control competence Δ +1.10; p=0.001; self-regulation Δ +0.72; p=0.021); no relevant PAHCO changes were observed with physiotherapy. BSA subdomains showed no significant changes. Psychological outcomes favored yoga: SF-36 mental component improved (Δ +6.62; p<0.001) and kinesiophobia decreased (TSK-II Δ −3.25; p=0.011); physiotherapy showed no meaningful changes. BASDAI decreased in both groups and approached significance in the yoga group (Δ −0.44; p=0.055). Healthy individuals showed similar directional changes with smaller, mostly non-significant effects, consistent with lower baseline burden; BASMI interpretation in healthy participants was limited by missing data (available n=14).

Conclusion: An 8-week yoga intervention was associated with superior mobility and psychological outcomes compared with physiotherapy for axSpA and additionally improved activity-related competences. Findings support yoga as a complementary therapy addressing both physical and psychological dimensions of axSpA. Larger randomized trials with complete mobility data and longer follow-up are warranted.

Disclosures: The authors thank all participating patients and the whole team of Medizinische Klinik 3 for their support of this project. The present work was performed in fulfillment of the requirements for obtaining the degree Dr. med for the first author, this work was partially supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – SFB 1483 – Project-ID 442419336 and the Horizon Health 2022 project SPIDeRR (project code 101080711).

References

[1] Ortolan A, Webers C, Sepriano A, Falzon L, Baraliakos X, Landewé RB, Ramiro S, van der Heijde D, Nikiphorou E. Efficacy and safety of non-pharmacological and non-biological interventions: a systematic literature review informing the 2022 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. Ann Rheum Dis. 2023 Jan;82(1):142-152. DOI: 10.1136/ard-2022-223297