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Living with Psoriatic Arthritis (PsA)

How much exercise is too much?

#1

I’m so newly diagnosed with PsA that I am still thankful for the abbreviation!
How can I tell when I am over doing exercise other than the pain that comes later? If it causes pain should I stop or just work through the pain in order to achieve health and fitness goals? Thank you for sharing your wisdom and experience.

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#2

I’ve got super mixed feelings about this. I tend to work through it whenever possible in terms of aerobic exercise. When I do weights I go easier because of PsA. It’s important to move and to stay strong, but it makes it easy to overdo it. Okay fine. I tend to overdo it.

What I’ve learned? When I’m having a flare take it easy. Walking is typically perfect. The only weight bearing exercise I’ll typically do during that time is if I’m doing physical therapy, and I definitely back off a bit on that as well. Physical therapy can make a really big difference in joints in order to strengthen and protect the joint.

I’ve also been learning the hard way that protecting my joints isn’t the only thing that I need to be mindful of. I’ve developed some systemic health issues that I need to make sure I’m not overdoing myself with, so the same rules apply.

I also deal with fatigue regularly, but a flare will just knock me off my feet. Right now I’m having a flare and am just taking it really easy, making sure I am resting, etc.

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#3

Thanks for the quick reply. I’ve only been on MTX for 3 weeks and not seeing any difference. When I know I have a full day ahead, a cup of coffee and 1000mg Tylenol really helps settle the pain and fatigue. I have been off caffein for a few years but it sure seems to help now.

#4

The DMARDs, including methotrexate, can work really well as the main therapy for a lot of people. But they do take time to work. And it’s really hard to wait. It can take a few months actually. Definitely talk with your doctor about how to best manage your symptoms while you wait.

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#5

Doing my laundry… :grin:

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#6

Hmmmm, this is so dependent - both on your PsA, but probably more importantly, on you.

What type of person are you? When you say work through the pain, do you mean a lttle more discomfort than would be normal, or ending up in tears?

I don’t think there is anything wrong with moving through a bit of extra fatigue and discomfort in a controlled way, however the recent pain theory here in Australia (and my personal experience is consistent with this), is that if you regularly push through pain and fatigue to the point of tears (or near to - well past your comfortable limit), it will actually create a negative feedback loop that associates pain and exercise. Not a good association to entrench.

So, because I was the type of person who would push through to tears, I honestly misinterpreted advice to keep moving and flogged myself for many years. Which was not helpful.

The advice from my pain clinic, which I think has really helped me manage perspective, was to be honest with yourself about what you can comfortably do, then do an extra 10%, knowing that it may be extremely variable each day with PsA.

At the end of the day, activity has never been demonstrated to exacerbate damage, but over activating those pain centres, or overly avoiding pain, have both been shown to have detrimental effects on how we process pain, which can have significant impacts on quality of life.

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#7

PsA likes to set me new challenges, just in case I start to think I’ve got the measure of it. Latest one is that I sink like a stone days after ‘overdoing it’ (which is a horrible phrase, if apt). If I seriously enjoy myself doing loads of stuff, the knock back can come a week or so later. Maybe I’m imagining it, but that is what seems to happen.

Oh well, the one thing I’m sure of is that being a couch potato is bad news for PsA patients. Best avoided if at all possible. Anyone who has been diagnosed quite recently and is thinking and asking about exercise is already ahead of the game I reckon!

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#8

Thank you for your well thought out response. If I made all my “doing stuff” decisions based on how I feel when I first get up from sitting or lying down, I wouldn’t do anything. Once loosened up, I walk and do physical things ok. Yesterday I changed all four wheels on my truck from winter to summer wheels. It felt ok but I paid for it later with old (ha! I’ve only had this a couple of months…officially!) and new bursts of pain. As long as doing things, riding bike, hiking, yard work etc aren’t causing progression of the disease, I think it is worth the pain and sleepless night as a result. On the positive side, it helps keep from having muscles go to mush.
Our Canadian system makes it difficult to have on going correspondence with a specialist like my Rheumatologist. Three months between visits and I can’t get important questions answered: Can I use Voltaren Extra Strength on painful joints? Can I take Celebrex occasionally when pain is overwhelming? How about Protopic ointment for the Psoriasis flare up? The pharmacist tells me to check with the Rheumatologist and the Rheumatologist says I should check with the dermatologist which I haven’t needed for 5 years and takes 5 months to get an appointment. Meanwhile, I need some answers NOW. I tend to be very proactive and thrive on good information…sometimes its just hard to get in a timely manner.
Sorry, that was a long rant! Overall, life is great and neither pain nor change needs to take all the joy out of my life!

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#9

Thanks. You mentioned “joint protection”. I think that is what I am having trouble understanding. I just don’t know what is harmful or helpful…I guess I need more experience with this. My psoriasis, after an initial bad flare up has been very minor for the last 5 years…can PsA also go into a long remission? If so, how would one know while on the various meds? I hope you don’t mind all the questions…perhaps another reader has answers too. Keep looking up and I will pray for you as you handle the current flare. Peace.

#10

For example, small joints in the hands are particularly easy to damage. Use two hands whenever possible. Use grippy pads to assist so that less force is needed to open jars, etc.

If something hurts while you’re doing it, you need to back off. That’s part of the process of protecting joints. Maybe you can walk by you can’t jog or bike right now, as an example. Maybe swimming or water walking is what you really need. I encourage you to work with an ot. I’ve worked with both for many years and they can teach you a lot about joint protection. Sometimes it means using a mobility device such as a cane.

Remission. Yes. It can happen for some people, especially early in the course of the disease. With meds or without it can still be considered remission.

#11

I always get referred to do water exercise which I think it s great idea to reduce joint impact but in my area there is nothing close, well I take that back maybe a pond. I generally try to make myself walk for thirty minutes at a minimum in a day. The problem is severe pain or fatigue can interrupt that activity. I am looking to expand that on good days but I agree that it comes down to what is happening to the patient and what they are dealing with. The open jar thing is weird after being the go to guy to open hard things to not being able. The other thing is the dexterity hit to mechanical motion. This includes tool use and playing instruments. Some days holding stuff is a challenge. Anyone else notice that?

#12

It’s the meds - for me that’s biologics (I’m on a biosimilar to Enbrel) - that maintain my capacity. And for the want of a better word - remission. I don’t actually believe though my disease will ever go into a remission. I see it as a persistent battle to keep it behaving itself.

Presently because of them (given I’m taking them as prescribed) I barely have any symptoms of PsA presently. I can physically do almost all of what I want to do. Note though I put my back out from doing a little bit of light gardening just a few weeks ago and that took 3 weeks to get better on muscle relaxer meds too.

However this has only been this reliable since Christmas. And over the last three years since PsA hit me all of a sudden, I’ve dealt with far too many weird and idiotic nonsense due to this disease too. Two fractures in my pelvis from doing nothing at all except possibly climbing a stile into a field I had done many, many times before. A shin wound that took 7 long months to heal. A temper tantrum between two meds that had me resident in my bathroom for 7 weeks eventually landing me in hospital on IV antibiotics.

All of that of course decreased my overall level of fitness. So now whilst I’m physically capable, I’m generally unfit. Three years is a long time to be doing too little, especially given I’m now 57. I used to spend my weekends mucking out pigs, and any other type of farm animal you can think of. Hence my name on here. But since then I’ve sometimes had trouble trying to pick up my dog’s poo when necessary.

So I just persistently keep being as physical as I can manage. It also doesn’t help my full time job is one where I sit at a computer all day.

Incidentally I had horrid psoriasis as a tennager which disappeared completely in early 30’s and has not returned. But the way I look at our disease is solely from the point of view that I have an abnormal immune system first and foremost. And it can cause whatever issue it wants to whenever it wants to unless I work hard at throwing meds at it to make it behave more normally. So initally it flared my skin as a teenager and now it went hell for leather on my joints and tendons. I tend not to overly distinguish between the two, because both are caused by abnormal immune system.

I’ve found it far more helpful to look at our disease that way. It stopped me getting too bogged down by one symptom or the other. For me looking at the big picture of what’s going on in my body helps me keep persepctive on all of it to include the ridiculous fatigue issues which can also hit us straight from nowhere.

#13

Thank you, your reply is very helpful in helping me learn the ways of Psa and encouraging to be patient as today’s misery may not be the long term picture. Right now I’m still only on a start up dose of methotrexate and enduring a flare up until it starts to work. Muck on! :grin:

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#14

My Pain Management Dr. suggested physical therapy for my increased back pain, knee bone on bone arthritis, and general weakness. I guess I my therapist was so impressed by my flexibility and all, that by my second session he had me pushing a wooden sled contraption across the room five times. Like pushing a shopping cart of lead basically. Then he had me do sidesteps with rubber banded thing around calves about 70 to 80 steps . Keep in mind I can’t leave work at lunch because walking to the car and back exhausts me, and I am in bed just about every weekend as I can barely function. I stopped going after my 5 th session after bursting into tears when I got there. The workouts killed me. I worried all day about having the energy to go there after work, and I worried about how I would feel going to work the next day.
My therapist said it does not matter what you suffer from, the treatment to gain strength is the same,
I guess he never heard of Psoriatric Arthritis and flares.
I need to find somewhere that understands the fragile state of this disease.

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