Riding a bike with psoriatic arthritis
Credit: Tatiana Ayazo

We get it. When your joints feel stiff and achy (and you are too wiped to get off the couch), the last thing you probably want to do is lace up your sneakers and exercise. Many people even believe that exercise worsens rheumatic conditions like psoriatic arthritis (PsA); but that’s a myth. It’s quite the opposite: People with PsA who exercise regularly report less pain and fatigue and a better quality of life, according to a review published in the journal Clinical Rheumatology.

Here, we take a closer look at how exercise can help your psoriatic arthritis — and what you need to know to get started. Of course, you’ll want to get the okay from your health care provider first and start slowly with a routine that feels right for your fitness and energy. Exercising when you have psoriatic arthritis may require some modifications to help you avoid injuries.

Why Exercise Is Important for Psoriatic Arthritis

You can exercise with PsA, and you really should, says Kathryn Dao, MD, Associate Professor, Division of Rheumatology, Department of Internal Medicine at University of Texas Southwestern in Dallas. “One of the non-pharmacological [non-drug] treatments for PsA that is written into ACR (ACR (American College of Rheumatology)/NPF (National Psoriasis Foundation) guidelines is exercise.”

The list of benefits is long: “Exercise improves strength, reduces pain, improves range of motion, and provides other health benefits,” says Dr. Dao. Here are a few more to consider:

Fewer disease flares

A systematic review of more than 13 studies published in the journal Clinical Rheumatology found that regular exercise reduced disease activity in patients with psoriatic arthritis.

Although not directly linked to PsA, researchers at the University of California San Diego School of Medicine found that one 20-minute session of moderate exercise can stimulate the immune system and produce an anti-inflammatory response.

Reduced fatigue

“Additionally, multiple studies have demonstrated that exercise reduces fatigue, a major issue for many patients with psoriatic arthritis,” says Dr. Dao, adding that fatigue is often a legitimate reason people feel like they are unable to exercise.

It sounds counterintuitive that if you have too much fatigue to exercise, physical activity can help reduce your fatigue, but it may be a matter of starting slowly and building up.

“A lot of people say that when they first start exercising, they get extraordinarily fatigued and they have more pain,” rheumatologist Alexis Ogdie, MD, shared in a recent audio guide about healthy lifestyle changes for PsA. “You’ve got to make it over that fence and then regular exercise will actually help keep your functional status up,” she added.

Lauren Scholl, a personal trainer and competitive physique athlete diagnosed with PsA five years ago, agrees, noting that moving around and doing some low-impact exercise helps her fatigue, which typically sets in around 3 p.m. Taking the dogs out for a walk or getting out for a stroll provides a nice pick-me-up, she says. Learn more about Lauren’s journey with PsA in The Psoriatic Arthritis Club podcast.

A healthier weight

When combined with a sensible nutrition plan, exercise can also help you lose excess pounds or maintain a healthy weight. Being overweight or obese can lead to inflammation and greater disease activity, says Dr. Dao.

A study published in the Annals of the Rheumatic Diseases found that people with PsA who were overweight or obese were more likely to have more psoriasis, joint pain, and inflammation than those who were at a healthy weight. Bonus: Shedding unhealthy pounds may also help your PsA medication work better, according to another study published in the Annals of the Rheumatic Diseases.

The study looked at the effect of biologic therapy in more than 100 patients with PsA who were overweight or obsess. After losing weight —either via a low-calorie diet or just by following dietary guidelines — participants were able to achieve minimal disease activity.

Stronger bones and muscles

PsA has been associated with lower bone mineral density, according to a Chinese study of almost 5,000 people with psoriasis and nearly 900 people with PsA. Strength training, in particular, can help prevent bone loss and may even help build new bone so you’re less likely to experience debilitating fractures. Plus, you’ll get stronger muscles, which protect your joints.

A lower risk of other health problems

That’s important, since people with PsA are more likely to develop conditions such as cardiovascular disease (including heart attack, stroke, and heart failure), obesity, diabetes, high blood pressure, abnormal cholesterol levels, high blood sugar, and mood disorders. Read more about psoriatic arthritis comorbidities.

Better sleep

Regular exercise can promote not just more sleep, but deeper, more restorative sleep, says Dr. Dao. And joint pain due to PsA can disrupt your sleep and contribute to fatigue and mood problems, according to a study in Arthritis Research & Therapy.

If joint pain is keeping you up, be sure to talk to your doctor about it. Lifestyle changes and even a change in your treatment plan may help.

A greater sense of well-being

“Sometimes patients who have psoriasis have poor self-esteem and end up with depression,” says Dr. Dao. “Exercise can help mental health and decrease depression.”

“Personally, exercise has helped make me feel mentally stronger,” says Scholl. “When I exercise, I feel like I am no different than anyone else and that I can work toward fitness goals the same way people who don’t suffer from PsA do.”

How to Start Exercising with PsA

Exercise guidelines from the U.S. Centers for Disease Control and Prevention (CDC) suggest 150 minutes of moderate-intensity aerobic exercise and at least two strength training workouts a week for the general population. Some people meet the cardio recommendation with five 30-minute sessions a week. But you can break that down into three 10-minute bouts throughout the day, says Dr. Dao, which can be easier to squeeze into busy days. You also do not need a lot of equipment to exercise.

Of course, these are only guidelines, and you know your body best. Do what you can on those days you’re experiencing a lot of joint pain or fatigue. Build slowly: Even a moderate-paced walk around the block is better than nothing.

First, get your doctor’s okay

If you’re not a seasoned exerciser, it’s a good idea to talk to your doctor before getting started with a new regimen if you have a chronic pain condition like PsA, recommends Dr. Dao. “Patients need to let their health care providers know they want to start exercising and find out the best way to start.”

Your doctor may prescribe physical therapy first to assess what you can and cannot do; some activities may not be recommended based on your health and PsA symptoms. For example, if you have a lot of foot or ankle pain, which is common in PsA because of enthesitis, your doctor may recommend you use a stationary bike rather than something higher impact, like jogging or walking a long distance. This can help reduce the risk of injury, especially when you first start exercising.

Decide when to exercise

Schedule exercise at a time that works with your schedule. “If you’re able keep to a routine, you’ll be able to exercise consistently,” says Dr. Dao. “A lot of my patients find a morning workout loosens them up, and they feel good throughout the day.”

It may be best to avoid vigorous exercises right before bed. “It can hype you up and can interfere with sleep” in some patients, says Dr. Dao.

Also consider when you feel your best, says Scholl, who suggests tracking patterns in your PsA symptoms. “Mornings — about an hour to two hours after waking — are when I feel my best, so that is when I schedule my workouts, both cardio and strength training.”

Consider aerobic exercise

Generally, low-impact activities such as swimming and cycling — either outdoors or on an exercise bike — are easiest on the joints. Though higher-intensity workouts won’t be appropriate for everyone, some people whose symptoms are well-managed may be able to tolerate more rigorous exercise, such as running and high-intensity interval training (or HIIT, which alternates periods of high-intensity exercise with lower intensity exercise in a single workout).

According to a study published in the journal Arthritis Research & Care, patients with PsA who performed high-intensity interval training (HIIT) for 11 weeks reported meaningfully less fatigue, with no worsening of their joint pain.

Ask your doctor what’s appropriate for you. If you have sore toe joints or enthesitis (inflammation where tendons and ligaments meet bone), walking on a treadmill or track provides more cushion, “rebound,” and less impact than walking on concrete or uneven ground.

Add resistance training

Exercise that involves movements using weights, weight machines, weight cuffs (worn around the ankles and wrists), resistance bands, or bodyweight alone are effective. And it doesn’t take a bodybuilder’s routine or even that much time to realize the benefit. People with psoriatic arthritis who performed resistance exercise twice a week for 12 weeks experienced improvements in functional capacity, disease activity, and quality of life, according to a study reported in Clinical Rheumatology.

Scholl traded a cardio-heavy regimen for one more focused on strength training, which she says has been kinder to her joints. She does four strength workouts a week, dividing them into lower-body and upper-body days — a schedule that provides a few days of rest before she exercises the same parts of her body again.

Incorporate flexibility exercises

Exercises that promote flexibility can help ease joint stiffness, strengthen muscles, and prevent injury during your daily activities. A review of studies published in Biological Research for Nursing found that the combination of yoga postures, slow-breathing techniques, and higher doses of yoga practice may be particularly helpful in reducing inflammation in chronic conditions such as PsA.

Focus on balance

Since PsA is associated with bone loss, building better balance now can guard against falls and fractures. The mind-body practices yoga, Pilates, Qi Gong, and tai chi employ gentle, flowing movements, helping with balance and flexibility, says Dr. Dao.

While there are no specific studies on tai chi and balance in people with PsA, a 12-week tai chi program resulted in improvements in pain, stiffness, and physical function, according to a review of seven studies involving 348 people with osteoarthritis reported in the journal Plos One.

Tips and Strategies for Getting Started with Exercise

Once you make the decision to add exercise to your overall psoriatic arthritis management plan, a few helpful hints and simple modifications can ensure your workout plan is safe and effective.

Learn what to avoid

Knowing the exercises your body doesn’t like can help you figure out a workout plan that you can do consistently and comfortably. Expect to experiment and to assess yourself daily. “I avoid high-impact exercise and training at maximum capacity,” says Scholl, who finds jumping movements, sprinting, long-distance running, heavy weightlifting, and fast-paced workouts aggravate her PsA.

Make exercise regular

Exercise that you perform consistently yields the greatest benefits. And, yes, you can do it even when you’re feeling stiff, says Scholl. “Those times, go light with the weights and work through the range of motion to the best of your ability.”

Avoid long (or painful) workouts

“From 30 to 45 minutes should be sufficient,” says Scholl. “If exercise is causing an increase in pain, stop what you’re doing and move to a low-impact, low-intensity form of exercise, such as an easy bike ride, leisurely walk, or swim.”

Include a variety of movements

Doing the same movements over and over again can put constant stress on the joints and muscles and lead to injury. Include a variety of movements and space workouts apart so each muscle group has adequate time to recover from exertion.

For example, alternate between upper and lower body exercises. Scholl does a leg workout twice a week, spacing them days apart so her leg and glute muscles have time to recover.

Suit up smartly

Wear comfortable clothing that doesn’t restrict your movement and provides the necessary support. Choose moisture-wicking fabric that helps avoid irritating the skin and aggravating psoriasis patches. Opt for footwear that suits your feet and the activity you’re doing; ask your doctor for suggestions if your toes or other parts of your foot tend to become painful or inflexible. Insoles, orthotics, or a different type of shoe might be useful.

Use good form

Twisting your body or limbs to avoid discomfort or accommodate stiff joints can ultimately cause muscle or joint injuries. Consider working with a physical therapist or personal trainer knowledgeable about psoriatic arthritis who will help you develop a safe and effective workout plan that’s appropriate for you. The American Council on Exercise database provides videos and descriptions to help you learn proper exercise form.

Get your rest

Getting to bed by 9 p.m. gives Scholl the energy she needs to stay active. It also makes an early wakeup (4:15 a.m!) possible so she can take time to loosen up her joints before her own workout.

Warm up and cool down

“Always warm up before exercising to wake up your muscles, work through stiffness, and prevent injury. After a workout, cool down to prevent stiffening with a slow-paced walk or some light stretching,” says Scholl.

Pay attention to tempo

When training with weights, use slow and controlled movements. “I like to think, three counts up, three counts down,” says Scholl. Rest briefly between sets and exercises and avoid rushing through workouts.

Make a plan for flares

“My rule of thumb during a flare-up or when my pain is higher than a five (on a scale of one to 10) is to take it easy and allow my body to get the recovery time it needs,” says Scholl. Having a plan keeps you feeling in control, so you’re less likely to throw in the towel and stop exercising altogether after needed downtime.

Modify when necessary

Being flexible with your workouts and willing to modify them can help you stay consistent with your exercise program.

Perform exercises while seated if standing is difficult. Pick a different route if the hilly path you normally take is aggravating your PsA. Use gym machines or wrist and ankle weights instead of free weights (dumbbells, kettlebells, and barbells). Scholl says lifting straps take the stress off her grip and allow her to focus better on the muscle she’s targeting when weight training.

Develop a recovery strategy

Take adequate rest days after working inflammation-prone areas. “I usually take one full rest day (no working out at all) after a day where I perform only leg exercises,” says Scholl.

Keep an exercise diary

“Pay attention to your symptoms after a workout and jot down how you’re feeling,” says Scholl. “You may notice a pattern and realize something doesn’t work well for your body.”

If you feel that you have an exercise-induced injury, allow the joint to rest and ice it; consider calling your doctor if the pain persists. Exercise diaries are also helpful in tracking your progress and keeping you motivated to achieve more.

Progress slowly

Think of exercise as a long-term commitment. Go at your own pace and resist overreaching — pushing yourself to perform at a level that is more advanced than your abilities — which can lead to flares, pain, and injuries.

The bottom line: Exercise is an important tool to manage your PsA and live your best life. “It boils down to this: If you exercise regularly, your joints will do better and you’ll live a longer, healthier life,” says Dr. Dao. “There is no reason to not exercise. Any barrier to exercise can be overcome.” The key is to find a regimen that works for you and your lifestyle and makes you feel good and healthy.

American College of Rheumatology. 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. https://www.rheumatology.org/Portals/0/Files/PsA-Guideline-2018.pdf.

Centers for Disease Control and Prevention. How much exercise do adults need? https://www.cdc.gov/physicalactivity/basics/adults/index.htm.

Di Minno M, et al. Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers. Annals of the Rheumatic Diseases. doi: https://doi.org/10.1136/annrheumdis-2012-202812.

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Interview with Kathryn Dao, MD, Associate Professor, Division of Rheumatology, Department of Internal Medicine at University of Texas Southwestern in Dallas.

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UC San Diego Health. Exercise … it does a body good: 20 minutes can act as anti-Inflammatory. https://health.ucsd.edu/news/releases/pages/2017-01-12-exercise-can-act-as-anti-inflammatory.aspx.

Yan Jung-Hon, et al. Efficacy of Tai Chi on Pain, Stiffness and Function in Patients with Osteoarthritis: A Meta-Analysis. Plos One. April. 2013. doi: https://doi.org/10.1371/journal.pone.0061672.

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