The Do's and Don'ts of Exercising With Psoriatic Arthritis

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Exercising with psoriatic arthritis isn't always the easiest. The autoimmune disorder targets areas where tendons and ligaments connect to bone, causing joint pain, swelling, and stiffness. Exercise, meanwhile, requires those joints to move smoothly and without pain. It’s tempting to think you should minimize movement, but that’s not the case. “Exercise can actually reduce swelling and stiffness, while strengthening the muscles that surround and stabilize the joints,” says Lauren Smith, P.T., a physical therapist at the Hospital for Special Surgery in New York City. Translation: Regular exercise can ease pain associated with psoriatic arthritis—but only if you heed the advice that follows.


Spondylosis seen on x-ray
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Why Modifications Are Key

When you have PsA, some excercise movements are impractical, if not painful, Smith says. Special concerns arise with dactylitis, which is swelling of the fingers and toes, as well as spondylitis—inflammation in the joints between the spine’s vertebrae and between the spine and pelvis. But following a careful, supervised plan can keep your joints safe. Consider the following do's and don't a start.


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Do: Consult Your Doc First

Before beginning any new exercise routine, always get clearance from your rheumatologist or primary care physician, Smith says. They may refer you to a physical or occupational therapist to help you troubleshoot any potential obstacles, such as swelling or limited joint mobility.

They will also recommend specific gear for your unique body, such as shoe inserts, which can change how you distribute stress in your feet and legs to relieve pain, or walking aids, such as a cane, to lessen weight placed on the lower body. A cane can also improve balance during lower-body and single-leg exercises.


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Don't: Glom Onto New

The latest trendy workout, no matter how great it is, may not be ideal for those dealing with psoriatic arthritis, says Julio Aponte, M.D., a Cleveland-based physician and fellow of the American College of Rheumatology. That’s especially true if you are new to exercise or haven’t worked out regularly since developing the condition, Dr. Aponte adds.

Example: HIIT (high-intensity interval training) has been hot for a few years now. But certain exercises common to HIIT—such as jump squats and burpees—could stress already inflamed joints to trigger pain and further mobility issues.


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Do: Embrace Smooth Movements

There are plenty of options for exercising that don’t jolt the body, says Smith. Yoga, Pilates, and cycling can be fun ways to mix things up. Swimming and water aerobics often become go-to fitness choices, since the water removes virtually all stress on the joints, Dr. Aponte says.

When exercising to improve PsA symptoms, focus on total-body exercises—meaning that treading water or swimming laps will be more beneficial than performing calf raises in the pool.


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Don't: Just Focus on Cardio

The best exercise is one you’ll actually do, Dr. Aponte says. But even if you naturally gravitate to the treadmill or stationary bike, cardiovascular exercise alone won’t sufficiently strengthen the muscles surrounding the body’s joints—supporting a full range of motion—to improve symptoms and increase pain-free mobility.

With psoriatic arthritis, it’s common for the muscles to atrophy and the tendons to loosen and weaken, he says. That means you need to... read the next slide!


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Do: Add Strength Training to Your Routine

It’s proven to work: In a 2018 study in Clinical Rheumatology, when people with psoriatic arthritis performed twice-weekly resistance training sessions for 12 weeks, they improved their functional fitness and quality of life more than those who stuck with conventional drug therapies alone.

Apart from strengthening the muscles, says Dr. Aponte, standing strength exercises load the bones, reducing the risk of osteoarthritis that can occur with the disease.


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Do: Add Strength Training (Part 2)

The really good news about strength training with PsA is you can get great benefits without a lot of equipment. Standing bodyweight exercises—like squats, wall sits (in which you hold a squat with your back supported against a wall), and elevated pushups (performing pushups with your hands on an elevated surface such as a countertop, table, or wall)—teach the body to support and stabilize itself, and can make a big impact.


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Don't: Leave the Ground

High-impact exercises likes plyometrics, running, and jumping can overload already stressed joints—why they’re generally not recommended for people with psoriatic arthritis, Dr. Aponte says. This is especially true for those experiencing knee pain or knee-tracking problems. With knee pain, the joint is often not properly supported by surrounding tissues; landing hard can move the joint out of alignment, causing injury.


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Do: Listen Closely When Your Body Is Talking

Exercise is meant to challenge your body, not hurt it. Calibrate your workout to how your joints and energy levels are feeling that day—and don’t hesitate to switch up your approach mid-workout, Smith says. For example, if your knees hurt when performing low squats, feel free to stick with shallower squats.

Focus on staying active in ways that feel good, and only progress to heavier weights or more difficult exercises when you can do so without pain or jeopardizing form.


Don't: Push Through Flare-Ups

“Flare-ups complicate exercise because they increase pain and stiffness,” Smith says. “It’s harder to move and walk.” Grinding through is not the answer. Exercising with pain increases the risk of wear-and-tear on the joints, causes you to compromise form, and raises your risk of injury. It also makes exercising miserable. Which means you’re less likely to do it again.

So take it easy until the flare subsides and start back slowly.