Taekwondo for Axial Spondyloarthritis

This study is designed as a single-blind, parallel-group, exploratory pilot randomized controlled trial to evaluate the efficacy and safety of a 12-week Taekwondo training program in patients with ankylosing spondylitis and axial spondyloarthritis.

• Total Taekwondo Intervention Period: 24 Weeks

• Initial 12 weeks: Comparison between the Taekwondo training group and the control group in an RCT.
• Post-RCT 12 weeks: The control group receives the same Taekwondo training, allowing for a pre- and post-intervention comparison.

• Assessment Time Points

• Baseline (Pre-Intervention): Within 2 weeks before the start of the 12-week Taekwondo training.
• End of RCT (Post-Intervention): Within 1 week after completing the initial 12-week Taekwondo training.

The primary effects of the intervention will be assessed through comparisons between the Taekwondo training group and the control group.

• End of Control Group Intervention: Within 1 week after completing the 12-week Taekwondo training in the control group.

Pre- and post-intervention comparisons will be conducted for the control group. 3) Group Composition

• Taekwondo Training Group: Participates in a structured 12-week Taekwondo training program during the RCT period.
• Control Group: Maintains usual daily activities for the initial 12 weeks, followed by participation in the same 12-week Taekwondo training program.

• Blinding Procedure

• Evaluator Blinding: The assessors conducting the outcome evaluations will remain blinded to the intervention status of participants to ensure unbiased assessments. All evaluations will be performed in a neutral setting.
• Role of the Treating Physician: The treating physician will be responsible for managing participants' medication and medical history but will not be involved in any part of the patient evaluation process, including the assessment of the intervention's effects.

• Randomization Method

• Participants meeting the inclusion and exclusion criteria will undergo stratified randomization to ensure balanced distribution.
• Stratification factors may include gender, age (below 40 years vs. 40 years and older), or disease severity (presence vs. absence of syndesmophytes on X-ray imaging). Final stratification factors will be determined based on the characteristics of enrolled participants.
• Randomization will be performed by a designated research team member using Microsoft Excel's random function or other randomization software to allocate participants into the Taekwondo training group and the control group.

Inclusion criteria

• Diagnosed with axial spondyloarthritis (axSpA) according to the ASAS classification criteria.
• Age: Between 19 and 59 years old.
• Stable medication or non-medication treatment:

• Patients whose medication regimen has remained stable for at least the past 3 months.
• Patients who have not taken medication for axSpA for at least the past 3 months.

Exclusion criteria

Participants will be excluded from the study if they meet any of the following conditions:

• History of orthopedic surgery or fractures within the past 12 months.
• History of cardiovascular diseases, including ischemic heart disease, cardiomyopathy, heart failure, or stroke.
• Advanced ankylosis in ankylosing spondylitis, as confirmed by radiographic or CT imaging:

• Complete ankylosis of at least two regions of the cervical, lumbar, or thoracic spine (i.e., continuous syndesmophyte formation or complete ossification between vertebral bodies).
• Presence of other musculoskeletal abnormalities or conditions that may limit exercise performance.
• Diagnosis of cancer within the past 5 years
• Pregnancy
• Regular exercise participation within the past 6 months (defined as exercising for at least 60 minutes per session, three or more times per week).
• Major changes in medication for axial spondyloarthritis during the study period, including:

• Initiation or discontinuation of biologic agents or targeted therapies.
• Significant changes in the continued use of NSAIDs or sulfasalazine.
• Significant changes in the continued use of systemic glucocorticoids.