People living with psoriasis and psoriatic arthritis probably know the prescription: Take a dose of healthy changes and add them to your lifestyle to reduce disease flares and the risk of the other health conditions linked with psoriatic skin and joints.
However, undertaking major lifestyle changes can make for a pretty big pill to swallow all at once. Our advice? Take it one day at a time, and be proud of the effort you're putting in to be a happier, healthier you.
Here, experts break down steps for better stress management, exercise, nutrition and quitting smoking.
For about 60 percent of people with psoriasis, stress is a major trigger for flares or worsening disease, according to a 2013 British Journal of Dermatology review. Scientists believe about the same percentage of people with psoriatic arthritis are "stress reactors." To combat stress:
Schedule time to consciously destress — every day. "Take a 10-minute break to do whatever helps you unwind," said Dr. Jana Martin, a psychologist in Rockville, Maryland. Breathing is one of the simplest, best techniques for relaxing. Inhale slowly and deeply through your nose, then exhale slowly through your mouth. Two to three cycles immediately lower heart rate and blood pressure.
Quit lying awake. At night, worry and anxiety can gather force and carry on throughout the next day, leaving you even more vulnerable to stress, said Dr. Stevan Hobfoll, professor and chair of the Department of Behavioral Sciences at Rush University Medical Center in Chicago. "Try remembering a positive event — a special trip or family gathering — in specific detail. Going over and over these details means your mind can't keep running through negative patterns," he said.
Counter pessimism. Understand whether you're simply prone to pessimism or whether you are catastrophizing — the tendency to always expect an outcome that you feel will be not just negative but catastrophic. Martin suggests countering every negative thought with a positive or neutral one. "You owe it to yourself to also think of how things could go right," she said.
Consider counseling. If stress is taking over your life, Hobfoll and Martin recommend seeing a professional who can offer tools for dealing with anxiety. Therapy doesn't need to be long-term; many people get relief in eight to 20 sessions, said Hobfoll.
Even though it doesn't come in a pill, exercise is serious medicine, said Chris Schumann, a clinical exercise physiologist at the University of Alabama at Birmingham.
"Exercise reduces stress and depression, improves cardiovascular health, lowers blood pressure and cholesterol, and helps manage and reduce weight," he said.
Start modestly. If you're new to exercise, aim for 30 minutes day of moderate aerobic activity five days a week.
"Walking is very easy to incorporate," he said. "Try starting with three 10-minute sessions. When you're comfortable going for 30 minutes, gradually add extra time, intensity or both."
Protect joints. Yoga, Pilates, stationary biking and water aerobics all improve strength or cardiovascular health while sparing joints. However, joint issues don't necessarily rule out jogging if it's what you love, said Schumann. "Discomfort comes along with exercise, and it's not always bad. But if joints are sore or swollen the next day, it's a sign you need to try something gentler."
Aim for the exercise trifecta. Combine aerobics, resistance training and flexibility work for the most benefit. Once you've established your 30-minute routine, add a few days of light-to-moderate weight training (two rounds of eight to 10 machine, hand-weight, or body-weight exercises, 10 to 12 reps each). Follow with 30 minutes of yoga or another stretching program. "Aim for 150 minutes a week of exercise, which doesn't include mowing the lawn or doing housework," Schumann said, noting 250 minutes a week can result in weight loss, which can decrease inflammation and psoriatic flares.
A nutritious diet supports the immune system and aids weight loss, said Marisa Moore, a registered dietitian in Atlanta, who adds that a healthful diet also benefits the heart and helps prevent or reduce metabolic problems such as diabetes. To begin the journey to a healthier diet:
Start with vegetables. Fill half your plate with vegetables — and eat them first, said Moore. You can also start with a salad — try spinach and dark berries for an antioxidant boost — or a broth-based vegetable soup.
Add omega-3 fatty acids. Omega-3 fatty acids, found in fatty fish, chia and flax seeds, and walnuts, reduce inflammation. Studies haven't found a clear benefit to those living with psoriasis, but there is good evidence for their use in the fight against heart disease. "Salmon and sardines are rich sources," said Moore. "Try using walnuts for crunch on salad, or stirring seeds into yogurt or oatmeal."
Grab a smart snack. Combine protein with a fiber-rich carbohydrate. "Try an apple with nut butter, cheese with a pear or hummus with whole grain crackers," she said. Plan ahead for stress-related snacking. If you crave a salty crunch, keep a stash of popcorn. If sweets relieve your stress, have small portions of dark chocolate or yogurt on hand.
Cigarettes take a toll on cardiovascular health, immune function and on psoriasis and psoriatic arthritis. Studies show that heavier smoking over longer periods of time is linked to more severe psoriasis, and that smokers with psoriatic arthritis have poorer physical function than nonsmokers. To get on the road to a smoke-free life:
Create a quit plan. Bill Blatt, director of Tobacco Programs for the American Lung Association, said that setting a formal quit date, telling friends and family your plan, asking for their support and planning strategies to deal with your smoking triggers is the best setup for quitting successfully.
Know your smoking triggers. If stress makes you reach for a cigarette, decide in advance what you'll do when the urge hits. Try walking around the block or calling a friend for support. If socializing is your trigger, gather in venues that ban smoking. The urge to smoke generally passes in three to five minutes, said Blatt, who also suggests carrying strong mints or cinnamon toothpicks to help curb cravings.
Combine medication with group support. People who combine smoking cessation medication with interpersonal support have the highest quit rates, Blatt said. Call 1-800-LUNGUSA (800-586-4872) for free counseling from respiratory therapists and nurses, and check local ALA chapters for group sessions.