Depending on the areas of your body that are affected, you may find it difficult to use the range of motion that many types of activity require. You may also find that during psoriatic arthritis flares, forms of exercise that normally pose few problems can become painful or physically difficult. Even though it may not always come naturally, staying active is an essential part of managing psoriatic arthritis. While exercising regularly doesn’t directly affect your disease process, it can help keep your joints flexible and your muscles strong — both of which can reduce your perception of psoriatic arthritis symptoms. But while the right kinds of exercise can have a strong beneficial effect, exercising the wrong way can actually make psoriatic arthritis worse. Activities that place excessive stress on your joints, for example, may cause inflammation and lead to even more pain and stiffness. There are a number of exercise considerations — from staying hydrated to getting enough rest — that you should pay extra attention to if you have psoriatic arthritis. Often, there are negative consequences when you don’t. Here are 12 exercise mistakes that can affect psoriatic arthritis, and how to avoid them. “Basically, the stronger your muscles are, the better they can absorb shock and control motion,” he explains, “which ultimately minimizes stress on the actual joint.” A study published in February 2018 in the journal Clinical Rheumatology found that participants with psoriatic arthritis who added strength training two days a week for 12 weeks had improved quality of life and functional fitness versus participants who continued with conventional therapy. It’s important, Dr. Kolba notes, not to start out with too much weight or resistance. Instead, begin at an intensity that doesn’t feel too difficult, and do more repetitions of the exercise than you would at a higher weight.
2. You don’t get enough aerobic activity
As important as strength training is, it’s equally essential to incorporate aerobic exercise into your routine. If you’ve experienced discomfort in your joints while doing moderate-impact aerobic exercises like jogging, Kolba says, you may be tempted to skip cardio altogether. But lower-impact alternatives like elliptical machines, stationary bikes, rowing machines, swimming, or pool exercises can boost your health without overstressing your joints. As an alternative, you can use lighter weights for strength training and do them in a circuit fashion — with short, timed pauses between activities — to get a cardiovascular benefit, Kolba notes.
3. You focus on high-impact exercises
Running and jumping may not be good options if you have psoriatic arthritis, Kolba says, since they can put strain on your joints and accelerate the inflammatory process. Kolba notes that walking puts between 1.5 to 2 times your body weight in stress on your joints, while jogging puts five to eight times your body weight in stress on your joints. “That’s a lot of stress for a joint that’s irritated or inflamed,” he adds. “There’s a tremendous amount of force coming up through the legs and into the spine.” And any type of jumping or rapid form of resistance activity could be even worse for your joints. “Those activities just aren’t going to be tolerable in most people with joint issues,” says Kolba. A study published in June 2018 in the journal Arthritis Care & Research, however, found that high-intensity interval training (HIIT) didn’t worsen disease activity and may help improve fatigue in people with psoriatic arthritis. If you want to incorporate high-impact exercises into your workout routine, talk to your doctor or physical therapist about how to do so safely.
4. You don’t work on your balance
Lack of balance “is typically what leads to falls,” says Kolba, “and a lack of strength is typically what prevents you from catching yourself.” Kolba notes that it’s common to lose strength and balance as you age or as an inflammatory condition such as psoriatic arthritis progresses. But you can take steps to work on improving your strength and balance. This means that to some extent, you can “minimize the progression of whatever arthritic changes you have,” Kolba says. Make sure you include balance exercises in your overall workout plan. Try practicing yoga or tai chi moves along with stretching exercises before a more rigorous workout or on a low-key exercise day. A study published in the journalPLoS One recommends that tai chi should be incorporated into arthritis rehab protocols.
5. You don’t warm up
You should never jump right into a rigorous workout. Instead, get your muscles moving in a more relaxed way for a few minutes — such as by walking or using an elliptical machine — before you increase the intensity. Kolba says many of his clients find that warming up and stretching helps eliminate stiffness and soreness. Not only does this get your muscles ready for a workout, it gives you the energy and motivation to exercise in a way that feels satisfying.
6. You don’t consider motion limitations
When you have joint inflammation, you may not be able to move all of your limbs through the full range of motion that someone without a condition such as psoriatic arthritis could. This is an important consideration when deciding what exercises to do. Particularly when strength training, Kolba says, finding a range of motion that’s pain-free should be your goal. Once you’ve been doing the activity successfully for a while, “then you can eventually slowly start to increase the range of motion that you’re able to move the weight through.”
7. You overexert yourself
While it may be tempting to give yourself the most rigorous workout possible, this isn’t a good idea if you have an inflammatory condition such as psoriatic arthritis. “The key is to listen to your joints during exercise,” says Kolba. “And more importantly, how does it feel later?” While some level of discomfort after a workout is normal, Kolba says that you shouldn’t ever be above a 4 on a pain scale of 0 to 10, “where 10 is going to the hospital and 0 is no pain at all.” If you’re experiencing anything above a four, he says, you risk aggravating inflammation.
8. You don’t use proper form
Depending on which of your joints experience the most stiffness and pain, you may instinctively change the way your body is positioned during certain types of exercises — particularly with strength training. This is especially true for people with shoulder or knee issues, Kolba says. Since using a “faulty movement pattern” can lead to even more muscle and joint issues, Kolba says, if you have significant joint pain or restricted motion, it’s important to work with a trainer or physical therapist to make sure your form is correct. If you have trouble using the right form for certain exercises, “we would stay away from those based on how you felt and what we saw,” Kolba notes.
9. You don’t take your hands into account
If you have pain or stiffness in your fingers, it may be more difficult to do any number of strength-training exercises — particularly ones that use free weights. In order to use free weights safely, “you have to grip and hold onto them,” Kolba notes. If you have hand problems, you may need to stick to very light weights, he notes. Many exercise machines offer a better alternative, since the handles can’t be dropped and sometimes require only pushing with the inside of your hand instead of gripping with your fingers. Even machines that involve pulling may not require a full-force grip. Another good alternative, Kolba says, is using resistance bands, which can be looped around your wrist or hands. This can help you gradually work on building your grip without the risk of straining the joints in your hands. In any case, Kolba says, you should work on building your grip if that’s an area of impairment. “If you ignore it, it eventually gets worse,” he notes.
10. You don’t rest enough
If you’re sore from a workout you did the previous day, you should take it easy, Kolba says. This doesn’t necessarily mean being sedentary, but it does mean not pushing yourself. “You could definitely take the day off and bring [your pain] down to a two or zero,” says Kolba. But he adds that just warming up and doing some stretches can also do wonders to help reduce stiffness and soreness. You may even want to plan a workout routine that alternates between heavier and lighter workouts, Kolba adds — like doing stretching and balancing exercises the day after an aerobic and strength-training routine. Light biking can also be a good way to keep moving on off-days, he notes. Applying heat or ice to sore muscles can also be a good way to help them recover while you rest. “Anecdotally, my patients report that they prefer heat, and find it better at reducing soreness,” Kolba says. Heat is better for delayed-onset muscle soreness; ice is good immediately following exercise if a joint is swollen or warm.
11. You don’t stay hydrated
When you’re exercising or sweating a lot, or even on days of rest, “lots of water” is the way to go, Kolba says. Aside from replenishing fluids that are lost during a workout, staying hydrated every day helps flush toxins from your body, which in turn helps fight inflammation. What’s more: Drinking enough water can help keep your joints lubricated. While you shouldn’t be drinking water in quantities that feel uncomfortable, it’s generally a good idea to drink water frequently throughout the day. When you feel thirsty or if your mouth is dry, Kolba says, that’s a sign that you’re already dehydrated. The Arthritis Foundation also recommends tea, coffee, milk, and other beverages for people with arthritis.
12. You don’t pay attention to your diet
A healthy, balanced diet is good for overall psoriatic arthritis management, Kolba says. But when you’re working out, your muscles also need a variety of nutrients to move effectively and grow stronger. “Cutting out sugar and processed foods and eating high-quality food in general — fruits and vegetables, lean meats — those are simple strategies that can help minimize inflammation,” Kolba notes. Maintaining a healthy weight is also important for psoriatic arthritis patients as a lower body weight puts less pressure on joints. What’s more, a study published in May 2018 in the journal PLoS ONE found there was a 60 percent greater chance that a class of biologic drugs commonly used to treat psoriatic arthritis, called tumor necrosis factor (TNF) inhibitors, would not work if a patient is obese. If you’re unsure how you should be eating to support your exercise routine and overall health, ask your doctor for a referral to a dietitian or nutritionist.
