Keeping active

Why should I exercise?

Psoriatic arthritis can cause pain, swelling, stiffness and fatigue which could cause loss of some home/work/recreational function, reduced general fitness and weight gain.  An exercise programme suited to your specific needs containing a balance of stretching, strengthening and cardiovascular exercise can help to reduce/optimise these symptoms by increasing physical activity/function/fitness and aid weight loss,  In addition physical activity can help reduce stress, improve mood and maintain bone density.

What happens if it hurts?

You must try to do some exercise every day. On days when your joints are swollen or painful you should aim to move the affected joints through as great a range as you can without aggravating your pain, regularly throughout the day. Strength and cardiovascular exercise should be performed at least three times a week but may need to be modified if a joint is painful. For example, you may choose to go swimming rather than take a walk if your knees or ankles are painful.

Exercise can lead to some discomfort. Strengthening exercises may sometimes lead to muscle ache, stretching exercises to joint ache, but neither should give rise to acute pain. If exercise leads to swelling or sharp pain, stop and make sure you are doing the exercise correctly. If discomfort lasts longer than a couple of hours you may be working too hard – slow down or reduce your repetitions. It can be difficult to get started with an exercise programme. If you are unsure about any aspect of exercise, ask for advice from your doctor or a physiotherapist.

What is a physiotherapist and how can I get to see one?

Physiotherapists work both in the NHS and privately. They are experts in the examination and treatment of muscles and joints. Some departments may have a physiotherapist with a special interest in rheumatological conditions like psoriatic arthritis and who will work closely with the local consultant rheumatologist. Your GP or consultant can refer you to see a physiotherapist in the NHS or you can self-refer to a private clinic.  You can also ask your GP if you can access an external exercise referral scheme.

Could I see an osteopath or a chiropractor instead?

Osteopaths and chiropractors are also experts in the treatment of musculoskeletal problems. If you choose to see an osteopath or chiropractor, discuss your condition with them before making your appointment, as it is important that they have a clear understanding of it and how it will affect the treatment they can offer you. It’s worth noting that they rarely work in the NHS and so are unlikely to have close links with your rheumatology consultant.

Whichever professional you see, they should be able to help ease the pain of arthritis and improve joint range and function. It is, however, important to recognise that arthritis is a long term condition and experts in the treatment of arthritis will place the focus of treatment on the teaching of self management strategies.

What is hydrotherapy?

Hydrotherapy is exercise in a warm pool. It is supervised by a physiotherapist, who uses the properties of water to help ease stiff joints and strengthen weak muscles. Unfortunately many pools have been closed and you may not find one locally.

Psoriasis is not usually affected by the water but if you have any concerns you should discuss them with your doctor or physiotherapist. Bring a supply of your usual creams to apply after the treatment. Exercises taught in the hydrotherapy pool can be continued at your local swimming pool.

How do I start?

Everyone has different levels of fitness depending on the lifestyle they lead. Which joints does your arthritis affect? Choose a selection of exercises that will work these joints. Consider what you can currently do (sit for 20 minutes without pain in your back or walk round the park with your dog) and decide on what you would like to be able to do. You can then set yourself goals to work towards, for example you may aim to participate in a local charity walk, learn to swim or be able to walk to the local shop.

How can I stay motivated?

Be realistic – set yourself achievable goals

• Keep a diary or schedule – record what exercises you have done and plan how you are going to progress them
• Join a class or exercise with someone else – recruit family or friends to help you stay on track
• Reward yourself from time to time – treat yourself if you reach a goal or complete a week without missing a day
• Make exercise fun where you can – try exercising to music or outside
• Try to work exercise into your daily routine – eg walk the kids to school; even doing the dusting can exercise the shoulders.

What type of exercise should I do?

There are two main types of exercise: therapeutic and recreational.

Therapeutic exercises

Therapeutic exercises are activities based on your exact needs. They are designed to achieve a certain goal, eg to increase muscle strength. There are two types used for arthritis: range of motion and strengthening.

Range of motion exercises help to maintain joint movement, relieve stiffness and restore flexibility. To increase or maintain range and flexibility you need to take your joints and muscles to their limits. Range of movement exercises should be carried out daily.

Strengthening exercises help maintain or increase muscle strength. To strengthen a muscle you need to apply resistance to the movement. This can be done using your own body weight, weights or resistance bands. Strengthening exercises should be performed on alternate days and not when a joint is hot (feels warm when touched) and painful unless you are supervised by a physiotherapist.

The following exercises are just some examples to get you started. A health professional can design a programme for your specific needs.

Fingers and hands

1. Forearm supported on a table, hand relaxed over the edge. Extend the wrist and clench your fist - relax and let your hand relax.

Repeat ten times.

2. Clasp your hands together and support your forearms on a table with your hands over the edge. Bend your wrist up and down.

Repeat five times.

3. Forearm on a table, elbow tucked in to your side and palm turned down. Turn your palm to face up, then back down, keeping the elbow still.

Repeat ten times.

4. Elbow on table with hand up. Straighten your fingers out then bend them to touch your fingertips to the base of your fingers.

Repeat ten times.

5. Palm on table. Lift each finger individually off the table.

Repeat five times.

6. Elbow on table with hand up. Bring the tip of the thumb to the tip of the little finger, repeat so the thumb meets the other fingers in sequence.

Repeat five times.

Neck and back

For the first three exercises sit up straight in a supportive chair, ie one with back support.

1. Tilt your head towards one shoulder until you feel the stretch on the opposite side. Hold for approximately ten seconds.

Repeat to the other side.

 Turn your head to one side until you feel the stretch. Hold for approximately ten seconds. Repeat to the other side.

Repeat five times to each side.

3. Pull your chin in, keeping your neck and back straight (not tipping your head forwards). Hold at the end position and feel the stretch in your neck. Hold this stretch for 10 seconds.

Repeat five times.

4. Lie on your back with your hands on your stomach, legs bent at the knee, feet flat on the bed or floor. Tighten your stomach muscles to flatten your lower back against the bed.

Hold for ten seconds, repeat ten times.

5. Lie on your back as with the previous exercise. Keeping your shoulders down flat, slowly roll your knees from side to side.

Hold for ten seconds, repeat ten times.

6. Lie on your back as before. Keeping your stomach muscles tight push down through your heels to lift your bottom and lower back off the bed.

Hold for ten seconds, repeat ten times.

Feet and toes

1. Press your toes down and shorten your foot by pulling up the arch on the inside of the foot.

Repeat on the other foot.

2. Lie with your legs out straight and pull your feet up, then push your feet down.

Repeat ten times

3. Wiggle your toes.

Repeat ten times.

4. Circle your feet around one way, then the other way.

Repeat ten times.

Hips and knees

1. Lie face down with both legs outstretched for five minutes. Then gently bend each knee to its limit, then relax with your legs straight.

Repeat five times with 30-second breaks.

2. Sit with your legs outstretched on a firm bed. Press each knee down onto the bed to straighten it. Hold for ten seconds. Relax.

Repeat ten times.

 Lie on your back with your knees bent and feet flat on the bed. Lift each knee in turn to meet your stomach, straighten the leg and then lower it to the bed.

Repeat five times.

Jaw

Gently open the mouth to its full width. Stretch a little and hold for five seconds. Then close your mouth completely.

Repeat five times.

Recreational exercise

• This type of exercise includes any form of movement or relaxation that refreshes the body and mind. Recreational exercises or activities improve your fitness and help maintain or improve joints’ range of motion and muscle strength. They add to a therapeutic programme but do not replace it. Swimming is a good all-round exercise that does not stress your joints. Psoriasis is not generally affected by the chlorine in swimming pool water, but if you find it becomes itchy when dry, apply some barrier cream before you swim and after your shower at the end.
• Walking is another good way of exercising. If your arthritis affects your feet, make sure you wear a well-fitting, comfortable pair of shoes, and insoles if they have been prescribed for you.
• Cycling is an alternative to walking and often more comfortable on the feet.
• Going to the gym is popular, but it is important to know your limitations and needs. A physiotherapist should be able to advise on appropriate activities for you; usually a mixture of cardiovascular (bike, cross trainer etc) and specific exercise (floor, machine, ball etc) according to your particular condition and fitness levels.
• For those who might benefit from more vigorous exercise but do not feel inclined to follow formal routines, activities such as gardening might be an alternative and rewarding activity but proceed with caution and within your limits and wear appropriate clothing and footwear.
• Activities such as yoga, pilates and other complementary therapies may be beneficial for people with arthritis. Contact your local council offices or community centres for further information and details of classes or events.

What else can I do to help myself?

Ice packs - you can buy special ice packs from a chemist or they can be made from a packet of frozen peas wrapped in a damp towel. If you use frozen peas remember to label them not to be eaten as they will have defrosted and refrozen if you  use the same pack each time and could lead to food poisoning! Ice packs can help reduce the heat and swelling in an inflamed joint. Apply for about ten minutes every two hours. If you have poor circulation, check with your doctor first. Never apply ice directly to the skin.

Rubbing or massaging an area of swelling can help improve the circulation. Ask your doctor about the use of anti-inflammatory gels available at pharmacies.

Splints to help a painful joint can be supplied by a doctor, physiotherapist or occupational therapist. All splints should be prescribed and fitted by a health professional, who will give you advice on when and how long to wear them.

Heat may also be useful to relieve pain and stiffness. The simplest forms are a hot bath or shower, or a hot water bottle or microwave heat packs. These can be useful to relieve morning stiffness. Do not purchase wax baths except on the advice of a doctor or physiotherapist.

A TENS machine gives low voltage, intermittent currents to painful areas and has been shown to help manage pain very effectively. The machines are inexpensive and can be bought or hired. Your doctor or physiotherapist can give you more information.

Look after your health in general and follow the latest recommendations about diet, weight, alcohol, exercise and stopping smoking.

Before undertaking any self-help you may wish to speak to your consultant, GP or healthcare provider to make sure that the activity is appropriate for your needs.

Summary

• Regular low-impact routine exercise is best
• Little and often is best, especially for weak muscles
• Mix your exercises to avoid boredom
• Ease out stiffness - do not force your joints
• Accept the odd setback
• No excuses – regular, gentle activities will help you feel empowered and keep you mobile and fit!

This article is adapted from the Physiotherapy and exercise: Psoriatic arthritis leaflet.

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