Finding the right water activity to help with PsA

| Emily Delzell

For Avette Gaiser, who has been living with psoriatic arthritis (PsA) for more than 50 years and with psoriasis for almost as long, swimming is much more than a non-impact exercise that provides a joint-friendly workout. “I swim to help the symptoms of my psoriatic arthritis, but it also helps my whole body: my mind, my lungs, my heart — everything,” says Gaiser, an avid swimmer since early childhood who was diagnosed with PsA at 17 and psoriasis at 24.

Her rhythmic breathing during the 30 or so laps she swims twice a week puts her mind into a “meditative place,” says Gaiser, who is now 70 and living in Neotsu, Oregon. She credits her years of regular swimming and the gentle motions of the breast stroke, her preferred stroke, for keeping her active and highly mobile (she also enjoys dancing) despite severely affected joints in her feet, wrists, and hands.

Swimming is an excellent option for the regular physical activity people with PsA need to keep up and even expand their everyday functional abilities, says Alice Gottlieb, M.D., Ph.D., professor of dermatology at New York Medical College at Metropolitan Hospital in New York City, New York, and a member of the National Psoriasis Foundation's Medical Board.

“Swimming builds muscle strength that supports joints and gives the body a range-of-motion workout that promotes flexibility. The buoyancy of the water means there’s no stress on joints, yet you can still get an aerobic workout that will increase endurance and lower the risk cardiovascular disease, which is increased in people with psoriatic arthritis,” says Gottlieb, who is board-certified in rheumatology and internal medicine in addition to dermatology.

Like other, higher-impact types of cardiovascular exercise such as running, swimming also burns a significant number of calories to help control weight. Exactly how many calories depends on the stroke, speed and weight of the swimmer.

“You name the joint – shoulders, elbows, knees, hips – and swimming affects it by building the power and tone of the muscles surrounding and supporting it,” says U.S. Masters Swimming coach Jim Miller, M.D., a sports and family medicine physician in Midlothian, Virginia, and the national team physician for USA Swimming.

“Swimming also works and strengthens the stabilizing muscles of your core, and, because it works both types of muscle [fast and slow twitch], it improves balance and reaction time as well as endurance – all of which are crucial for people
with psoriatic arthritis.”

And age doesn’t matter. Exercising in the water is an activity that’s accessible to just about anyone. For Thomas Dvorak, 13, swimming doesn’t take any formal form, but he finds just spending time in the pool helps ease his symptoms of PsA and psoriasis.

“It’s really easy for me to move around and exercise my joints without stressing them out, and the sun helps my skin,” says Dvorak, who lives in North Haledon, New Jersey, and spends his summer breaks swimming at an outdoor pool in his grandmother’s nearby neighborhood. It’s a good physical and social outlet for the eighth grader, who had to stop playing football and basketball to spare his joints.

Diving in

Here, five tips for starting an aquatic exercise routine.

Don’t stress about getting in and out
If you have mobility limitations, you can still get the benefits of swimming and other types of water-based exercises. Federal regulations mandate that public pools be accessible to people with disabilities, and most of these facilities now have pools with some combination of ramps, shallow steps, handrails or powered lifts, says Miller. Check before you go so you know what to expect.

Just float
Gaiser, who last year celebrated her 69th birthday by swimming an equal number of laps in an Olympic-size pool, touts the benefits of simple floating for joint pain. “I lie on my back and float for 15 minutes and that puts me in a space where I have no gravity pushing on my body anywhere, so my body is free from the pain of standing, walking, and sitting,” she says. “When I’m floating, I don’t have any pain at all.”

Avette Gaiser, triumphant.

Find a water-based activity you enjoy
All aquatic exercise is beneficial for people with PsA – the key, as Dvorak and Gaiser have found, is picking an activity you like and want to do. Name the activity – walking, Zumba, boot camp, even salsa dancing – and there’s a good chance you can do it in the water in a class near you. Check the local YMCA, community pool, or fitness and aquatic centers to see what’s available. Some facilities offer classes specifically designed for people with arthritis.

Learn lap swimming
Maybe you’re considering the major benefits of lap swimming – longer, leaner muscles and the stress-busting effects of meditative motion in a quiet environment – but your only formal swimming lesson was decades ago, or never. If so, Miller recommends starting with a U.S. Masters Adult Learn-to-Swim class  or another that teaches basic techniques for breathing and positioning of the body in the water optimal comfort.

“If you are brand new to swimming or are intimidated by watching people do laps, a few basic lessons can help you start out correctly and avoid frustration,” he says. “Learning step by step to breathe and to move in the water defuses that intimidation. And the group experience of classes, where everyone is learning the same thing, is also supportive. There’s friendship and encouragement from peers.”

Once you’ve got the basics under your belt, says Miller, you can start learning and experimenting with different strokes to find what works best for your joint issues.

Consider the temperature
Heated pools, typically warmed to 82 to 88 degrees, can ease the joint pain of PsA. Many water-based exercise classes, particularly those designed for people with arthritis, take place in warm water pools. The heat relaxes muscles, making it easier to stretch and be active. For seasoned lap swimmers, however, a heated pool isn’t usually the best option. The intense activity combined with higher temperatures can cause overheating.

Skin care for swimmers

The chemicals with which most pools are treated aren’t generally a problem for people with PsA who also have psoriasis, says Gottlieb. “Unless you have a specific allergy, it’s not usually an issue,” she says. “If your skin is deeply fissured or you have a lesion that’s open and bleeding, however, the chemicals in the pool may be irritating.”

Salt water pools can help exfoliate scaling psoriatic skin, but for some people, salt is more irritating to skin than standard pool chemicals, she says.

If your skin is badly cracked or bleeding, consult your dermatologist about treatment before
getting in the pool. Open wounds make you vulnerable to infection and facilities may deny you entry if you’re bleeding, says Gottlieb, who stresses that this should never happen if you have visible but non-bleeding lesions.

“Explain that it’s psoriasis, a non-contagious skin disease. This should reassure facility staff and other swimmers. There is better understanding of psoriatic disease now, and many more people are familiar with the condition,” she says.

After your workout, shower to wash off chemicals or salt, she recommends. Then moisturize well with your dermatologist-recommended product, and apply any topical medications.

Tools for the pool

Besides a comfortable bathing suit that allows you maximum freedom of movement, you don’t need much equipment for water-based exercise.

Depending on what kind of aquatic workout you’re doing, however, these items can make your time in the pool more enjoyable and productive.

They protect your eyes from chemicals and salt. If you wear glasses and swim regularly, consider investing in prescription goggles.

Swim cap
A cap won’t keep your hair completely dry but will protect it from the effects of chemicals or salt.

This trusty sidekick can help you modify your strokes or focus on a lower-body workout. 

Get ready for the pool

Summer is here. If your psoriatic disease is keeping you from enjoying the water, contact the NPF Patient Navigation Center today. Specially trained staff can answer questions about symptoms and treatments and help you get back to doing the things you love.

Driving discovery, creating community

For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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