In the comic book, The Incredible Hulk, Hulk possesses an incredible level of superhuman physical strength, which increases based on his level of anger or emotional stress. If only living with psoriatic arthritis could give us Hulk-like superpowers, then we’d be unstoppable, right?
In reality, PsA tends to do the opposite – limiting our mobility and range of motion over time. But it’s important to remember that a PsA diagnosis is not a life sentence to becoming a couch potato. In fact, exercise is the key to overcoming PsA symptoms. Movement keeps your joints and tendons loose and limber, which can help you fight swelling and reduce pain.
“A lot of people are fearful of moving because they think exercise is going to make them worse, but it’s the complete opposite,” said Lauren Piljic, assistant section manager of the Orthopedic Physical Therapy Center at the Hospital for Special Surgery in New York City. “Pain is a vicious cycle because when we have pain, we don’t want to move, but then you become stiffer, which leads to more pain. Moving can actually loosen things up and decrease pain.”
Exercise also helps you maintain a healthy body weight and keeps your muscles strong, which decreases the workload on your joints. And working out gets your heart pumping, which will help you lower the risk of developing a comorbid condition like cardiovascular disease. So to put it in Hulk terms: exercise, good; couch potato, bad.
The goal is 30 to 45 minutes of moderate activity four to five times a week, Piljic said, but always “start at your own pace and slowly work up.” You don’t want to overexert yourself and cause further damage to your joints. A physical therapist or a qualified fitness professional can help you create a workout plan specifically tailored to your capabilities. But you should always consult with your doctor before beginning any new exercise routine.
Here are some exercises generally recommended for people with PsA
- Walking builds strength and maintains joint flexibility. Try walking in short bursts, say 10 minutes each. Build to half an hour, then a full hour. Break up your workout throughout the day. A gradual approach will help prevent injuries and make it easier to start a new habit (and keep that habit going). If your feet, ankles or knees are affected by arthritis, you may need a walking aid or shoe inserts to avoid putting undue stress on your lower joints.
- Yoga employs controlled movements, stretching and deep-breathing relaxation, all of which helps relax stiff muscles, ease sore joints and improve your range of motion. A study published in the journal Cerebral Cortex in 2014 found that regular yoga alters brain anatomy to increase pain thresholds over time. The study found that people who practice yoga tolerate pain more than twice as long as those who don’t, and this can come in handy when you’re living with PsA.
- Swimming or warm-water exercises ease stiff joints and relax sore muscles. Think of it as a no-impact way to build strength and flexibility because the water helps support your body while you move your joints. Swimming and other water exercises can help strengthen the back, shoulders and hips while providing a good cardiovascular workout, getting that heart rate up easily and painlessly.
- Tai chi is a gentle martial arts exercise with origins in ancient China. A 2016 study published in the Physical Therapy Journal found that tai chi was effective for chronic pain in patients with osteoarthritis. In 2010, rheumatologists at Tufts University School of Medicine published a study in BMC Complementary and Alternative Medicine, which found that in 21 of 33 trials, tai chi significantly reduced stress, anxiety and depression. Qigong, a simpler, less dynamic form of tai chi, is a suitable alternative for those with severe arthritis pain.
Workout gear for PsA
When inflammation and pain strike the shoulders and elbows, Kinesio tape, the colorful tape used on athletes and typically administered by physical therapists, can offer relief in these areas. Another option? Neoprene sleeves can help your elbow feel more stable. If you suffer from knee pain, over-the-counter or prescription knee braces can relieve pain because they take pressure off the joint. Since PsA can affect ankle strength, make sure you have comfortable workout shoes. A rheumatologist or podiatrist could also prescribe custom-made orthotic inserts that can offer relief and support.
5 tips for troubleshooting the gym
1. Find your perfect fitness class.
Look for low-to-moderate impact classes like Pilates or water aerobics. The instructor will often demonstrate modified versions of workout moves for those with limited physical capabilities. Go at your own pace and don’t feel embarrassed if you can’t do everything the instructor or other classmates can do. It’s not a competition. You’re there to have fun.
2. Tread carefully with cardio machines.
Walking on a treadmill is something just about anyone can do at their own pace. The elliptical machine is also a good choice because the gliding motion puts very little pressure on your knees and ankles. Riding an upright or recumbent bike and hitting the stair climber are viable options as long as you don’t have hip or knee arthritis.
3. Weight machines are worth the wait.
Training with weights, exercise bands or weight machines can be very beneficial for people with PsA because it keeps those muscles lean and strong. However, it’s important to perform these exercises properly to avoid injury. If you are new to resistance training or haven’t started a weight training program since your diagnosis, see a physical therapist or specialized trainer first to learn how to use the equipment and develop a training program that suits your needs.
4. Don’t forget to cool down.
There is nothing more rewarding than a good stretch after a solid workout. Now might be a good time to try out some of those light yoga or tai chi moves. Stretching after a workout helps reduce muscle fatigue and increase blood circulation. It also improves your flexibility and lowers your risk of injury in the future, while helping stiff joints glide through a full range of motion.
5. Take care of yourself.
If you pushed yourself too hard, a light massage could help stimulate blood flow to cramped muscles and help relieve inflammation – emphasis on the word “light” though. Or you can use a heat pack for five minutes to bring in healthy oxygenated blood, then switch to five minutes of ice to reduce inflammation. Do this for two to three cycles, always ending with ice.
(Editor's note: See you on Monday, May 1, for Psoriatic Arthritis Action Week!)
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