Background: Axial spondyloarthritis (AS) causes reduced spinal mobility, functional limitations, and a decreased quality of life. The pupose of this study was to assess patient satisfaction and identify evidence-based improvements in supervised group exercise for axial spondyloarthritis. Aim of the study: The aim of this study was to evaluate patient satisfaction and identify evidence-based improvements in supervised group exercise for axial spondyloarthritis. Methods: This prospective, comparative study was conducted outdoors at the Rheumatology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2022 to June 2022, involving 40 patients with axial spondyloarthritis randomized into supervised or home-based exercise groups. The supervised group attended physiotherapist-led sessions at the Department of Physical Medicine and Rehabilitation, BSMMU, while the home-based group followed a guided regimen with weekly check-ins. Outcomes (BASDAI, ASQoL, BASFI, and adherence) were assessed at baseline and 12 weeks. Statistical analysis used t-tests, chi-square tests, and ANCOVA (p < 0.05, SPSS v25). Results: In this study of 40 patients with axial spondyloarthritis, the supervised exercise group showed significantly greater improvements in disease activity (-27.27%, p < 0.0001), quality of life (-48.80%, p < 0.0001), and functional outcomes (-52.38%, p < 0.0001) compared to the home-based group. Exercise adherence was higher in the supervised group (85% vs. 55%, p = 0.03). Satisfaction was also greater in the supervised group, with 95% reporting satisfaction versus 65% in the home-based group (p = 0.011). Conclusion: Supervised exercise significantly improves patient satisfaction, functional outcomes, and well-being in axial spondyloarthritis, highlighting the value of structured supervision.