Rheumatol Int. 2025 Aug 1;45(8):178. doi: 10.1007/s00296-025-05912-5.ABSTRACTTo investigate the effects of a Tai Chi (TC) programme (hospital-based or remote) on total physical activity (PA) time in patients with axial spondyloarthritis (axSpA ). Between January 2019 and July 2021, patients with stable AS (BASDAI ≤ 40/100 or symptoms at an acceptable level, within the last six months) were enrolled in a four-month parallel, two-arm pilot study. Participants were randomised to either the immediate Tai Chi group (ITG), starting face-to-face TC immediately after enrolment for a duration of 4 months, or to the waiting list control group (WLCG), which started a 2 month face-to-face TC programme 2 months after enrolment. Due to COVID-19 pandemic, courses were delivered remotely using the same protocol after a lockdown period. Total enrolment was 40, including 20 in the hospital-based TC and 20 in the remote TC sub-study. Intention-to-treat analysis of all population demonstrated a significantly higher level of PA at month 2 in the ITG compared to the WLCG including hospital-based and remote TC (effect size: 0.19, 95% CI: 0.01 to 0.37, p = 0.04). These results were maintained at month 4. Patient Global Assessment (PGA) was improved at month 2 in both ITG (p < 0.05). There were no significant between-group differences in physical, psychological, and clinical outcomes. However, within-group analyses showed that TC had beneficial effects on endurance, lower limb strength, leg balance, shoulder and wrist mobility, PGA, and coping. There was no significant difference in total PA between remote and hospital-based TC at month 2. Both remote and hospital-based TC increased total PA in patients with axSpA.Trial registration: The study was registered on ClinicalTrials.gov ( https://clinicaltrials.gov/study/NCT04700150 ) prior to starting enrolment.PMID:40748484 | DOI:10.1007/s00296-025-05912-5