---
title: "Vigorous activity and physical function link to better health in long-standing radiographic axial"
id: "plos-one-21-vigorous-physical-activity-and-physical-function-are-strongly-associated-with"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-21-vigorous-physical-activity-and-physical-function-are-strongly-associated-with"
content_type: "clinical_feed_article"
specialty: "Rheumatology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360248"
published_at: "2026-10-13T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Vigorous activity and physical function link to better health in long-standing radiographic axial
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-21-vigorous-physical-activity-and-physical-function-are-strongly-associated-with
- **Specialty:** [Rheumatology](https://medichelpline.com/clinical-feed/rheumatology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360248)
- **Published At:** 2026-10-13T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Cross-sectional analysis of 141 patients with long-standing **radiographic axial spondyloarthritis** assessed physical function, spinal mobility, muscle strength, and self-reported physical activity. - Median disease duration was long (mean 25 years); participants had a mean age of 60 years and 57% were male. - Health status used the **ASAS HI**; HRQoL used **SF36** physical (PCS) and mental (MCS) component scores. - Physical function (BASFI) and **vigorous physical activity** were the strongest, independent determinants of ASAS HI and SF36-PCS in multivariable models. - Models explained ~50% of variability in ASAS HI and SF36-PCS, but only 21% of variability in SF36-MCS. - Muscle tests (Timed Stands Test and Grippit) and spinal mobility (BASMI) showed weaker but meaningful correlations with health status and physical HRQoL. - Compared with age- and sex-matched reference values, 55% had BASFI within cutoff for healthy controls and 45% had BASMI within normal range; 82% and 91% performed within normal ranges for TST and Grippit respectively. - Fifty-one percent reported >1 hour/week of vigorous activity; 77% met WHO recommendations for health-enhancing physical activity. - Sex-stratified models differed: leg strength predicted ASAS HI in men; handgrip strength predicted ASAS HI in women; vigorous activity more consistently associated with outcomes in women for SF36-MCS. - Limitations include cross-sectional design and reliance on self-reported physical activity; the source did not report longitudinal causal inference or specific exercise prescriptions.
## Clinical Analysis & Structured Key Points
Vigorous physical activity and physical function are strongly associated with better health in patients with long-standing radiographic axial spondyloarthritis | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Objectives To evaluate the impact of physical function and level of physical activity on health status and health-related quality of life (HRQoL) in patients with long-standing radiographic axial spondyloarthritis (r-axSpA). Methods In total, 141 patients with long-standing r-axSpA were included in this cross-sectional cohort study. Assessments included physical function (Bath Ankylosing Spondylitis Functional Index (BASFI)), spinal mobility (modified Bath Ankylosing Spondylitis Metrology Index (BASMI)), muscle function for leg strength (Timed Stands Test (TST)) and handgrip force (Grippit), amount of self-reported physical activity (vigorous physical activity, moderate physical activity, sedentary behavior), health status by ASAS Health Index (ASAS HI) and HRQoL with Short Form Survey Instrument 36-Item. Multivariable linear regression was used to analyze associations between health status, HRQoL, physical activity, muscle function, and physical function. Results The mean (SD) age was 60 (12) years, diagnosis duration was 25 (10) years, and 57% were male. Physical function and vigorous physical activity were the strongest determinants of health status and HRQoL. The models explained approximately 50% of the variation in ASAS HI and the physical aspects of HRQoL and 21% of the mental aspects of HRQoL. Participants displayed good health status (62%) by ASAS HI ≤ 5, reached the recommended level of health-enhancing physical activity (77%), had normal muscle function (TST 82% and Grippit 91%), and demonstrated physical function (55%), and spinal mobility (45%) within reference values. Conclusion This study highlights the importance of regular vigorous physical activity in older individuals living with long-standing r-axSpA since it was strongly associated with health status and HRQoL. Citation: 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 21(10): e0360248. https://doi.org/10.1371/journal.pone.0360248 Editor: Wesam Gouda, Prime Hospital LLC, UNITED ARAB EMIRATES Received: June 10, 2025; Accepted: September 24, 2026; Published: October 13, 2026 Copyright: © 2026 Feldthusen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The data contain sensitive personal information and because of the risk of re-identification, disclosure of data would require a secrecy assessment according to Swedish law. Data can be assessed, after secrecy assessment, from the Swedish Ethical Review Board (597–08, 2021-03484), dataskyddsombud@etikprovning.se . Funding: This work was supported by grants from Health and Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Award Number: VGFOUREG-383071, VGFOUREG-564511, VGFOUREG-754661 The Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement Award Number: ALFGBG-938395, ALFGBG-965333 Stiftelsen Konung Gustaf V:s 80-årsfond Award Number: FAI-2017-0454, FAI-2019-0560, FAI-2022-0883 The Swedish Association Against Rheumatism Rune och Ulla Amlövs Stiftelse för Neurologisk och Reumatologisk Forskning The Inger Bendix Foundation for Medical Research The Margareta Rheumatology Research Foundation the Gothenburg Society of medicine The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Introduction Radiographic axial spondyloarthritis (r-axSpA) is a chronic rheumatic inflammatory disease that results in long-lasting back pain and stiffness [ 1 – 3 ]. The disease is characterized by inflammation in the axial skeleton, enthesitis, and sometimes peripheral arthritis, as well as, to a varying degree, extra-musculoskeletal manifestations (EMMs): anterior uveitis, inflammatory bowel disease, and psoriasis. In addition to pain and stiffness, the impact on physical function and spinal mobility are crucial for patients with r-axSpA, as well as the impact on muscle function, especially muscle strength in the lower extremities [ 4 ]. Health-related outcomes and quality of life are negatively affected [ 5 ], and we recently found that both physical and mental health-related quality of life (HRQoL) were reduced in individuals with r-axSpA compared to controls from the general population [ 6 ]. Since the disease starts in early adulthood, its lifelong impact on physical function and health can be significant [ 2 , 7 ]. There is generally a decline in spinal mobility over time and a continuation of decrease even after 10 years of disease duration [ 8 ]. The continuous progress of structural damage in the spine is observed, according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS), especially in male patients [ 9 , 10 ]. Regular physical activity and exercise are a cornerstone in the management of r-axSpA [ 11 ]. Physical exercise programs have been shown to have a positive impact on physical function, spinal mobility, muscle function, and quality of life [ 12 , 13 ]. Vigorous high-intensity exercise has also shown effects on disease activity and inflammation [ 14 – 16 ]. However, these results are based on younger patient populations and less is known about the impact of vigorous physical activity on quality of life in older patients with long-standing disease. Furthermore, studies show that people with axSpA participate less in health-enhancing physical activity than population controls, especially vigorous physical activity [ 17 , 18 ]. Thus, little is known about the connection between different levels of physical activity, physical function, and quality of life in older patients with long-standing r-axSpA, and if there are differences between sexes. To develop and provide appropriate rehabilitation interventions for this group of patients, more data about this topic is needed. The aim of this study was therefore to evaluate physical function, spinal mobility, muscle function, and the amount of different levels of physical activity to determine their influence on health status and HRQoL in patients with long-standing r-axSpA overall and stratified by sex. The secondary aims were to compare physical function, spinal mobility, muscle function, and physical activity in patients with r-axSpA compared to reference values from the general population to put the result into a broader context. Methods Study design Cross-sectional cohort study. Participants Patients in western Sweden were initially recruited to a cohort study in 2009 which has been previously described [ 19 ]. Inclusion criteria were diagnosis of r-axSpA according to the Modified New York Criteria (mNY) for ankylosing spondylitis (AS) [ 1 ] and age > 18 years. Exclusion criteria were psoriasis, inflammatory bowel disease, dementia, pregnancy, and difficulties in understanding Swedish language. The patients enrolled in 2009 were subsequently invited to follow-up examinations after 5-years in 2014 and 13-years in 2022–2023, as part of the Long-term Outcome Ankylosing Spondylitis (LOAS)-study. The present study focuses on the results from the 13-year follow-up in a cross-sectional manner. Out of originally 210 patients, 141 patients were included in the 13-year follow-up study from 05/01/2022 to 01/02/2023, see flowchart in ( S1 Fig ). Written informed consent was obtained from all patients, and the study was approved by the Swedish Ethical Review Board (597–08, 2021–03484). The study was performed in compliance with the Declaration of Helsinki. Outcome measures Analyzed data included socio-demographic factors (age, sex, disease duration, education (ranging from 1; 9-year compulsory school to 4; college/university), working status), medication, pain, and fatigue registered on Visual Analogue Scales (VAS) (0–100 mm) [ 20 , 21 ], and disease activity using Ankylosing Spondylitis Disease Activity Score (ASDAS) [ 22 , 23 ]. Health status was assessed with ASAS Health Index (ASAS HI) [ 24 , 25 ] ranging from 0 to 17, with a lower score indicating better health status, cut-off values ≤5 for good health, > 5 to 0.7 or r 12). No statistically significant differences between sexes could be seen for either health outcome, but a non-significant trend was seen for SF36-MSC in which female participants reported poorer (lower scores 1 hour/week. According to the WHO guidelines, 77% of the participants reached the recommendations for health-enhancing physical activity. Download: PNG larger image TIFF original image Fig 1. Physical activity behavior. The distribution of regular vigorous physical activity (running, gymnastics, sports, etc.), moderate physical activity (brisk walks, gardening, bicycling, etc.), and sedentary behavior apart from sleep (i.e., sitting). https://doi.org/10.1371/journal.pone.0360248.g001 Discussion The majority of the participants with long-standing r-axSpA displayed good health status assessed by ASAS HI. Physical function and vigorous physical activity were found to be strongly related to health status and the physical component of HRQoL. The models were able to explain approximately 50% of its variation while about 21% of the mental aspects of HRQoL in this study with older patients with r-axSpA. Physical activity is first-line treatment in the management of axSpA [ 11 ] and the result of our study corresponds to the results of another recent study showing associations between physical activity at a moderate level or above and health status in younger patients with axSpA [ 37 ]. However, adherence to phys
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