OBJECTIVE: This study aimed to assess the effectiveness of exercise therapy for Axial spondyloarthritis (axSpA) patients. DATA SOURCES: From the database inception to March 2024, we searched PubMed (via Medline), Cochrane Library, Embase, Web of Science, Scopus, and SPORTDiscus for all relevant publications without any language restriction. STUDY SELECTION: We included randomized controlled trials (RCTs) for axSpA patients in which at least one group received exercise therapy. DATA EXTRACTION: Two independent reviewers assessed the quality of the literature using the Cochrane Collaboration Risk of Bias Tool 2.0. The outcomes were ankylosing spondylitis (AS) disease activity score (ASDAS), Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index (BASMI), 6-minute walk distance (6MWT), Chest expansion capacity, Peak oxygen consumption (VO2peak), pain, fatigue, C-reactive protein (CRP), and Eythrocyte sedimentation rate (ESR). DATA SYNTHESIS: A total of 20 RCTs, including 1,670 patients, were included in this study. Compared with the control group, exercise therapy improved BASFI (weighted mean difference (WMD) -0.49, 95% confidence interval (CI) -0.65 to -0.32, I2 3.4%, p = 0.414), BASMI (WMD -0.49, 95% CI -0.87 to -0.11, I2 71.9%, p = 0.679), BASDAI (WMD -0.78, 95% CI -1.08 to -0.47, I2 55.9%, p = 0.021), ASDAS (WMD -0.44, 95% CI -0.64 to -0.24, I2 0.0%, p = 0.424), VO2peak (WMD 3.16, 95% CI 1.37 to 4.94, I2 0.0%, p = 0.873), 6MWT (WMD 27.64, 95% CI 12.04 to 43.24, I2 0.0%, p = 0.922), Pain (standardized mean difference (SMD) -0.47, 95% CI -0.74 to -0.21, I2 66.0%, p = 0.046) and Fatigue (SMD -0.49, 95% CI -0.71 to -0.27, I2 0.0%, p = 0.446). However, no significant benefit was found in Chest expansion, CRP, and ESR outcomes. CONCLUSIONS: Exercise therapy is an effective strategy for improving disease control and symptom relief in axSpA.

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