Water-based workouts are the bedrock of low-impact training for people with psoriatic arthritis (PsA), an immune-fueled condition that involves not just joint pain, but also uncomfortable, scaly patches of skin. You can improve your range of motion, strengthen joint-supporting muscles, and even lose weight, says Carlos Julio Aponte, M.D., chief of rheumatology at the Cleveland Clinic Fairview Hospital. And, thanks to your body’s buoyancy in the water, you can reap those benefits without extra stress on your joints.
How to Do the Workout
Try for one to three 30- to 60-second sets of each move up to three times per week. Everyone’s needs are different, so pay attention to how you feel, says Pamela Purcell, P.T., a physical therapist at Northwestern Medicine Delnor Hospital who specializes in aquatic therapy. If you encounter joint pain, try slowing down or submerging deeper into the pool so that your body feels more weightless. If you experience intense post-workout soreness or any muscle pain that lasts for more than three days, do fewer reps or sets during your next workout, she says.
When exercising in the water, be sure to protect your skin. Consider covering any open lesions with a waterproof bandage designed for sensitive skin. Wear a swimsuit or even loose clothing that’s non-irritating, and if you have any psoriasis patches on your feet, wearing pool or canvas shoes can add comfort, Aponte says. (And if you're outside, don't forget your SPF.) As soon as you get out of the pool, shower with warm water and apply your usual non-scented lotion, including any prescription lubricants, Purcell recommends.
Standing Belly Breath
Starting off with deep diaphragmatic breathing calms the body’s sympathetic nervous system to help reduce excessive muscle tension and decrease pain, prepping you for the best workout possible, Purcell says.
How to: Stand in the pool at a comfortable depth. Place one hand on your stomach and the other on your chest. Take a deep, maximum inhale through your nose, filling the bottom of your lungs first (your stomach will expand before your chest). Pause, then forcefully exhale out your mouth. Repeat 10 times.
Warming up the muscles and joints at the beginning of the workout promotes easier, more comfortable movements through the rest of your workout, Aponte says.
How to: Slowly walk back and forth from one side of the pool to the other to help mobilize the hips and knees. As you do so, using your arms to help propel you forward will increase blood flow through your shoulders and arms to warm up their muscles and joints as well.
This gentle mobility exercise helps to open up the hips to ease muscle tightness and reduce knee discomfort in the exercises that follow, Purcell says.
How to: Stand in the pool, holding onto the edge with one or both hands for balance. Bend one knee to raise that foot behind you. Place a foam noodle or other flotation device under the front of your ankle and let it raise your foot toward your glute. Feel a gentle stretch in the front of your thigh—your quadriceps muscles. Repeat on the other side.
Follow the quad stretch with a mobility exercise to target the opposing muscles in the back of your thigh, Purcell says.
How to: Stand in the pool, holding onto the edge with one or both hands for balance. Lift one foot from the floor and raise one knee toward your waist. Place a foam noodle or other flotation device under your knee to let the float draw your knee toward your chest. Feel a gentle stretch in the back of your thigh. Repeat on the other side.
Push and Pull
Open up the chest muscles, reduce common tightness in the back, and prepare yourself for upper-body exercise ahead—while still strengthening.
How to: Stand in water that's just above your shoulders. With your palms out for resistance, slowly push your arms forward from your chest as far as possible. Let your upper back curve forward to deepen the stretch. Pause, then pull your hands straight back, just outside of your shoulders, as far as possible. Let your upper back curve behind you to deepen the stretch.
This exercise strengthens the muscles of your outer hips, improving joint function, stability, and reducing hip and knee pain, Purcell says.
How to: Standing in the pool, sidestep with one leg, then bring the other to meet it. Travel to the other end of the pool, then back again, leading with the opposite leg. Focus on maintaining a slight bend in your knees.
Apart from strengthening muscles throughout the entire body, treading water is an effective way to increase your heart rate for improved aerobic fitness and cardiovascular health, Purcell says.
How to: Get in the water at a comfortable depth and lift your feet from the floor of the pool. Kick your legs like egg beaters while moving your arms back and forth to the sides just under the surface of the water. If needed, use a noodle or other pool float for assistance.
When you have any form of arthritis, on-land plyometric exercises are often off-limits. However, by drastically reducing the impact on your joints, water-based plyometrics allow you to safely train muscle power, Purcell says.
How to: You know how to skip, just do it in the water, from one side of the shallow end to the other. Prioritize big arm swings and exaggerated movements, keeping as much of your body submerged as you feel comfortable. Bring your knees high toward your chest and, as you get comfortable, try to increase how high you pop up.
Single-Leg Curl to Press
Single-leg exercises are great for improving balance and stability, Purcell says, and adding upper-body motions to the mix increase how hard your body has to work to stabilize. The curl to press in this exercise will strengthen the biceps, shoulders, and core.
How to: Stand in the pool at a comfortable depth and raise one foot just off the floor. Starting with your arms at your sides, curl your fists to your shoulders, then press your arms straight overhead. Pause, then reverse the arm movements to bring your arms back down. Complete one set and then switch legs.
The squat is one of the most functional exercises you can perform to strengthen your hips and legs, and reduce pain with everyday acts of living, Purcell says.
How to: Stand in the pool at least waist deep and extend your arms straight in front of you for balance. Brace your core. Bend at the hips and knees to lower straight down as far as feels good on your joints. Pause, then drive through your heels to stand back up.
K. Aleisha Fetters