Efficacy and safety of mind-body exercise for patients with axial spondyloarthritis: a systematic review and meta-analysis

Objective To evaluate the efficacy and safety of mind-body exercise (MBE) interventions, including Tai Chi, Yoga, Pilates, and Qigong, in patients with axial spondyloarthritis (axSpA), a systematic review and meta-analysis was conducted. Methods Eight electronic databases were searched from their inception to May 2024. RevMan 5.4 and Stata 16.0 software were used for statistical analysis. Outcome measures included Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analog Scale (VAS), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQoL) Scale, and adverse events. The methodological quality of the included studies was evaluated using the Cochrane risk of bias (RoB) tool (2.0). The certainty of evidence for each outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results Of the 330 studies retrieved, 15 studies satisfied the criteria for meta-analysis. Compared with the controls, MBE interventions significantly improved physical function (measured by BASFI, MD = -0.76, 95% CI: -1.01 to -0.50, P < 0.00001), disease activity (measured by BASDAI, MD = -0.76, 95% CI: -0.94 to -0.57, P < 0.00001), pain intensity (measured by VAS, MD = -0.89, 95% CI: -1.21 to -0.57, P < 0.00001), spinal mobility (measured by BASMI, MD = -0.44, 95% CI: -0.70 to -0.19, P = 0.0006), and quality of life (measured by ASQoL, MD = -2.14, 95% CI: -3.54 to -0.75, P = 0.003). Subgroup analyses revealed that Tai Chi appeared to demonstrate a more pronounced effect on pain reduction when compared to Qigong (test for subgroup difference: P = 0.005). The quality of evidence for these outcomes was estimated as moderate to low. Additionally, no serious adverse events related to MBE were identified among the included studies. Conclusions Overall, MBE may be a promising non-pharmacological treatment to improve physical function, disease activity, pain intensity, spinal mobility, and quality of life in patients with axSpA. To enhance the certainty of the evidence, additional rigorous studies are needed to verify these findings.