Improving exercise adherence in ankylosing spondylitis through individualized education and follow-up: a pilot randomized trial

This study aimed to investigate the effects of individualized patient education and structured follow-up on exercise adherence and functional outcomes in biologic-naïve patients with ankylosing spondylitis (AS). In this prospective randomized pilot study, 40 AS patients meeting the modified New York criteria were enrolled. Participants were randomized into an intervention group (n = 20) receiving individualized education based on the National Ankylosing Spondylitis Society (NASS) booklet with monthly follow-up visits, or a control group (n = 20) evaluated only at baseline and month 6. Patients on biologic therapies were excluded. All patients received a standardized home-based exercise program. Clinical outcomes included spinal mobility (BASMI, fingertip-to-floor distance, occiput-to-wall distance), functional status (BASFI, Dougados Functional Index), disease activity (BASDAI), and pain (VAS). Exercise adherence was tracked for six months using patient logs. Thirty-two patients completed the study (17 intervention, 15 control). The intervention group demonstrated significant within-group improvements in fingertip-to-floor distance (p = 0.005), lateral flexion (p = 0.040), occiput-to-wall distance (p = 0.042), BASMI (p = 0.004), and Dougados Functional Index (p = 0.021). Exercise adherence was maintained in the intervention group (p = 0.407) but declined sharply in controls (p < 0.001). Between-group differences in change scores were not statistically significant. Regular patient education and structured follow-up may improve exercise adherence and functional outcomes in biologic-naïve AS patients. Integrating such approaches into routine care could strengthen non-pharmacological management. This study is one of the first randomized pilot studies in AS to focus on biologic-naïve patients, isolating the impact of educational and behavioral strategies independent of pharmacologic therapy. The blended model of individualized education with monthly reinforcement may offer a scalable, low-cost framework for enhancing adherence in clinical practice. This pilot randomized study evaluated whether individualized patient education combined with structured follow-up improves exercise adherence in biologic-naïve patients with ankylosing spondylitis. Patients receiving education and monthly follow-up maintained significantly higher exercise adherence over six months, while adherence declined markedly in the control group. The intervention group demonstrated significant within-group improvements in spinal mobility and functional outcomes despite the absence of biologic therapy. Education-based, low-cost interventions may represent a feasible strategy to strengthen non-pharmacological management in routine clinical practice.