Exercise for psoriatic arthritis can be a complex subject. The inflammatory autoimmune condition causes painful, stiff, and swollen joints, in addition to fatigue1—all very understandable reasons to avoid working out.
But if you have psoriatic arthritis, maintaining a consistent exercise routine can actually be one aspect of your care plan—as long as you don’t push yourself too hard, according to Joshua Bilsborrow2, M.D., MHS, instructor of rheumatology at Yale School of Medicine. (Overdoing it can create not just the muscle soreness you’d expect from a challenging workout, but it can also increase symptoms like joint pain and swelling.) Although your exact workout routine should be based on your abilities and interests, Dr. Bilsborrow recommends stretching, cardio, and strength training as part of any well-rounded program for people with psoriatic arthritis.
Although you probably often hear that it’s a good idea to listen to your body, it can be confusing for a person with chronic pain to figure out the best way to do that when working out, since exercise often includes some level of discomfort naturally. Here’s how experts say you can safely exercise for psoriatic arthritis.
1. Work with a physical therapist if you can.
If you have this condition, we don’t have to tell you how tricky it can be to exercise for psoriatic arthritis. Dr. Bilsborrow says working with someone who understands what you’re dealing with can be really beneficial. A certified personal trainer may have the skills to safely coach someone without psoriatic arthritis, but they typically aren’t trained in the pathology of different conditions and may not know what’s best for you, according to Maura Iversen3, DPT, MPH, who is dean of the College of Health Professions and professor of physical therapy, movement science, and public health at Sacred Heart University in Fairfield, Connecticut. Physical therapy can be expensive and may not be an option for everyone. If you have insurance, you can check with your provider to see if your plan covers it.
If working with a physical therapist is an option for you, consider asking your doctor for recommendations of clinicians familiar with psoriatic arthritis, since even some physical therapists may not have the advanced training or experience to fully understand how it can affect your ability to work out. Otherwise, your physician may be able to recommend specific workouts, online resources, or even support groups in your area that can help.
2. Work out at times when you feel your best.
You might try to schedule your workouts first thing in the morning before life has a chance to interfere with your plans. But working out when you feel your best is usually more doable when you have psoriatic arthritis, according to Dr. Iversen.
For many people, exercising is easier later in the afternoon because they’re too sore and stiff in the morning, Dr. Iversen says. You may be more motivated to exercise when your body feels its best, plus you can focus on your form when you’re not distracted by any (or as much) pain. Some individuals find that light movement in the morning, such as stretching, can help ease tightness. Dr. Iversen suggests doing some gentle movements before you even get out of bed, then doing a little more while you’re standing under warm water if you shower in the morning.
3. Prioritize proper form.
The experts we spoke with emphasized the importance of paying attention to proper form when doing any activity, whether it’s lifting, running, swimming, or anything else. Doing so will lower your risk of injury and help you get more out of each movement by properly engaging your muscles.
If you’re able to, working with a specialist like a physical therapist can help you learn proper techniques. However, that’s not always possible, and there are many videos and articles explaining how to do exercises correctly. You can browse through SELF’s fitness section for tutorials or the American Council on Exercise database. Beyond that, performing movements slowly and focusing on how you’re moving can help you with form.
4. Try low-impact cardio if you’re new to working out.
Michael Humphrey, CSCS and physical therapist at Northwestern Medicine in Illinois, says cardio is a great entry point for people who are just starting a fitness program or are jumping back into one after a hiatus. Beginning with a short, gentle, low-impact workout that you can consistently complete may help you build momentum.
Humphrey suggests choosing activities like walking, swimming, water aerobics, or the elliptical to elevate your heart rate without pounding your joints. Biking can be a great low-impact activity if you don’t have psoriatic-arthritis-related sacroiliac joint pain, according to Dr. Iversen. (The sacroiliac joints connect the lowest part of your spine with the two sides of your pelvis.) If you need something gentler, she recommends yoga or tai chi.
Dr. Bilsborrow says you may be able to run or do other high-impact workouts if you enjoy them and your symptoms are well-controlled. It’s safest to consult a physical therapist or rheumatologist first to discuss whether these may be harmful to your joints, Dr. Iversen says.
5. Consider adding resistance training.
You may worry about putting any sort of weight on joints that can already be painful. However, strength training is a good way to build muscle (which helps support your joints) and reduce your arthritis pain—as long as your form is good and you’re not exacerbating your symptoms, according to Dr. Bilsborrow. To develop a strength-training routine that won’t put too much strain on your joints, all the experts we spoke to suggested working closely with a professional if you are able to.
To avoid injuries, it’s really important to consider your particular situation when adding weights. According to Dr. Iversen, psoriatic arthritis often affects the DIP joints (the small finger joints, closest to your nail beds), which can make it really difficult to safely lift a heavy barbell. In that case, you may want to lift lighter dumbbells if you can tolerate them, or use weighted resistance cuffs that encircle your ankles and wrists, Dr. Iversen says. (The Fragraim Ankle Weights are one popular option on Amazon, $21.)
If you experience a lot of fatigue, Humphrey recommends being strategic with your workout by focusing on compound exercises that involve using multiple joints. These target multiple muscle groups at once, offering more bang for your buck.
6. Stretch throughout the day (including before and after strength training).
Dr. Iversen encourages people to stretch and move throughout the day because that can help with joint stiffness, especially if your lifestyle involves sitting at a computer for hours every day. “Studies have shown that it’s very important to change position often, meaning every hour or so if you can, whether it’s to get up and get a glass of water or change your position at your desk,” Dr. Iversen says.
Even if you’re active throughout the day, it’s really important to stretch and warm up if you’re going to do strength training, Dr. Iversen says. She explains that when you have joint pain, you tend to flex your joints by default. The problem is, this creates tightness in your extensor muscles (such as triceps, quads, and back extensors), which can impact your form and increase your risk of injury. The specific stretches she recommends vary from person to person. “I tend to have people focus on what’s bothering them the most,” Dr. Iversen says.
For instance, you might start by doing 10 minutes of gentle cardio for your warm-up followed by a few yoga poses for tight hips if they feel stiff. After that, you can start your strength-training session.
7. Listen to your body and scale back when you need to.
“Paying careful attention to your body’s signs and symptoms is critical,” Dr. Iversen says. Overexercising can result in tendon inflammation, or enthesitis, a condition associated with psoriatic arthritis. Using a perceived exertion scale to measure your effort can help you determine how difficult your workout feels, according to the Centers for Disease Control and Prevention5. If you’re using a 0–10 scale to do this, working out at a 5 or below will help keep you from overtraining, according to Dr. Iversen.
Keeping a workout diary to track how you feel after your workouts can also be helpful, according to Dr. Bilsborrow. For example, if you notice that you experience any pain that’s worse on one side of your body or a sharp increase in joint pain or swelling during a particular workout, that’s a good sign you need to slow down or try something new, Humphrey says.
Dr. Iversen recommends avoiding high-impact or very strenuous workouts if you have a flare-up of symptoms. “You could still do some light aerobic exercise such as walking, aquatics, or walking in the pool, just to keep things going,” she says.
8. Use cold therapy post-workout if you can handle it.
After a workout, Dr. Bilsborrow suggests icing your joints affected by psoriatic arthritis for up to 20 minutes if you can tolerate it. (It helps to wrap your ice pack in a towel to protect your skin.) Cold therapy can help reduce pain and joint swelling, according to the Mayo Clinic4. Although icing is generally considered safe, Dr. Iverson says some people find it makes their bodies feel stiff; if that’s the case for you, you may want to skip it.
Finding a routine that works for you can take some time, but regular workouts can help you manage your condition and move with less pain.