Physical activity is always recommended in case of back pain, especially if it is disabling as the case of ankylosing spondylitis – explains Dr. Lara Castagnetti, osteopath and specialist in Physical Medicine and Rehabilitation of Humanitas. However, regular physical activity and column specific exercises, in the case of this inflammatory spine disease that predominantly affects young males aged 20 to 40 years, and causes changes to the spine sometimes as severe as “merging” into a single structure, should be recommended. As published scientific evidence shows, regular, moderate intensity physical activity, adapted to the degree of the disease, initial or advanced, should be done for about 2-4 hours per week. Exercising for at least 200 minutes per week, combined with 5 days of spine exercises per week, helps reduce pain, improve spine function, and also reduce the rate of disability progression by up to 5 years. Moreover, spondylitis, also called the disease of “the man who cannot look at the sky”, not only affects the spine but also causes a decrease in lung function, increased risk of cardiovascular disease and myocardial infarction, as well as osteoporosis, risk of vertebral fractures, changes in balance and defense mechanisms from falls or sudden events. Therefore, physical activity should be included within a multidisciplinary approach that together with a balanced rehabilitation program such as stretching, muscle strengthening, adequate cardiorespiratory fitness, also takes into account therapy with biological drugs, since ankylosing spondylitis is part of a larger family of chronic inflammatory diseases called spondylarthritis that also includes cases associated with psoriasis or chronic inflammatory diseases of the intestine.