Is personalized exercise therapy cost-effective for people with axial spondyloarthritis?

For people with axial spondyloarthritis (axSpA) who have severe functional limitations, long-term personalized exercise therapy may be a cost-effective option. A 2026 randomized controlled trial found that while the therapy costs more upfront than usual care, it leads to modest gains in quality of life that may justify the expense. However, the evidence is based on one trial, and real-world implementation faces barriers.

What the research says

A 2026 randomized controlled trial compared long-term personalized exercise therapy to usual care in 214 people with axSpA and severe functional limitations ²⁷. The intervention group received an average of 41 supervised sessions over one year, with mean direct costs of €1,515 per participant ²⁷. Total physiotherapy costs were higher in the intervention group (€1,967 vs. €514), and total societal costs were also higher by €657, though this difference was not statistically significant ²⁷. Quality of life, measured as quality-adjusted life years (QALYs), improved slightly more in the exercise group ²⁷. Cost-effectiveness analyses suggest the therapy may be worth the extra cost, but the trial's one-year follow-up limits conclusions about long-term value ²⁷.

Barriers to implementing this therapy in routine care include unclear referral processes, limited access to trained physiotherapists, and financial uncertainties ⁸. Facilitators include strong evidence of effectiveness and consistent messaging among stakeholders ⁸.

What to ask your doctor

• Given my level of functional limitation, could personalized exercise therapy be a good option for me?
• Are there physiotherapists in my area who are trained to deliver this type of program?
• What would the out-of-pocket costs be, and does my insurance cover any of it?
• How many sessions per week would be recommended, and for how long?
• What are the expected benefits in terms of pain, mobility, and quality of life?