Feasibility and exploratory outcomes of a multimodal pulmonary rehabilitation program in radiographic axial spondyloarthritis: A prospective single-arm pilot study

Objectives: To assess the feasibility and safety of an 8-week multimodal pulmonary rehabilitation (PR) program in adults with radiographic axial spondyloarthritis (r-axSpA) and to describe exploratory pre- to post-intervention changes in clinical outcomes. Patients and Methods: This prospective, single-center, single-arm pilot feasibility study enrolled 20 adults with stable r-axSpA. The program included two supervised hospital sessions and one structured home session per week for 8 weeks, combining aerobic conditioning, resistance and mobility exercises, and respiratory exercises. Primary outcomes were assessment retention, supervised-session attendance, and adverse events. Clinical measures were exploratory and included 6-minute walk distance (6MWD), dyspnea, spirometry, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index, Hospital Anxiety and Depression Scale, and Turkish 36-Item Short Form Health Survey. Results: Seventeen of 20 participants completed the full week 8 assessment (assessment retention 85%). Median supervised attendance was 14 of 16 planned sessions (87.5%), and no serious adverse events were recorded. The mean 6MWD change was +25.7 m [95% confidence interval (CI): 20.0 to 32.5]. The Borg dyspnea score changed by -0.7 (95% CI: -0.9 to -0.5), and BASDAI changed by -0.41 (95% CI: -0.76 to -0.14). Nominal improvements were also observed in selected spirometric and psychosocial measures. Conclusion: The multimodal PR program was feasible and safely deliverable in this small cohort. Because the study utilized a single-arm design, included participants with low baseline dyspnea, and was not powered to test effectiveness, the observed clinical changes are strictly hypothesis-generating. These findings do not establish clinically meaningful benefit but provide a strong rationale and foundational metrics for designing adequately powered, randomized controlled trials with objective adherence monitoring.