Psoriasis: Physical Activity May Reduce Risk, Disease Course

Lara C. Pullen, PhD

August 26, 2014

Regular physical activity appears to lower the risk for psoriasis and improve the natural course of the disease, according to a new study. Physical activity may also improve the incidence and severity of metabolic comorbidities associated with psoriasis.

Nicola Balato, MD, from the Department of Dermatology at the University of Naples Federico II in Italy, and colleagues analyzed data from a group of 416 consecutive individuals who engaged in recreational sports regularly and a group of 489 sex- and age-matched control individuals. They compared data from that analysis with data from a group of 400 consecutive patients with psoriasis, but not psoriatic arthritis. The investigators note that their study, published online July 30 in the Journal of the European Academy of Dermatology and Venereology, is observational in nature and does not account for all the variables that may contribute to the relationship between psoriasis and physical activity.

A similar proportion of patients in the control and sportive groups reported a family history of psoriasis (10.2% vs 9.6%, respectively). However, psoriasis was significantly more common in the control group (5.4%) compared with the sportive group (1.7%; P < 0.01).

In addition, the proportion of individuals who participated in sports activities was significantly lower in the group with psoriasis compared with in the control group (11% vs 21.3%; P < 0.001).

Psoriasis and Metabolic Syndrome

Psoriasis is a common dermatological condition that presents with periodic recurrences and remissions. Patients with psoriasis are at higher risk for metabolic syndrome, making exercise particularly important for this patient population.

As Matteo Megna, MD, one of the study's authors, explained to Medscape Medical News: "Indeed, it is well known that higher [body mass index] represents a risk factor for psoriasis and that obesity, with its chronic low-grade inflammatory status, may put individuals at increased risk for the development of the dermatosis. On the other hand, physical activity is one of the most powerful weapons to fight against weight gain, and it is able to decrease chronic inflammation, lowering levels of pro-inflammatory cytokines such as [tumor necrosis factor]-α and [interleukin]-6, which play a major role in psoriasis pathogenesis, and elevating levels of anti-inflammatory cytokines, including adiponectin, whose expression is significantly lower in psoriasis subjects than controls, even independently of [body mass index]."

Psoriatic Arthritis

Unfortunately, many patients with psoriasis experience joint impairment and consequent physical limitations resulting from psoriatic arthritis. Dr. Megna believes exercise can help these patients as well.

"Indubitably, the positive effects of physical activity on the natural course of psoriasis should encourage sports practice also in subjects suffering from psoriatic arthritis. However, psoriatic arthritis is able to significantly limit the range of motion and physical activity habits due to joint pain and impairment. Therefore, a full medical consultation (especially with a rheumatologist) is strictly necessary to determine, on the basis of the number, type, and features of joints involvement, the specific types of exercise which can be more appropriate in an individual in order to get the positive effects of physical activity in overall well-being, range of motion, joint pain and stiffness, flexibility, and endurance, avoiding the possible negative influence of uncorrected and/or overexercising," he said.

Melissa Piliang, MD, a dermatologist at Cleveland Clinic in Ohio who is not affiliated with the study, reviewed the results for Medscape Medical News and agreed there is a role for exercise in the lives of patients with psoriatic arthritis.

"Patients with psoriatic arthritis must find a way to include exercise in their treatment regimen. Physicians need to work closely with patients whose arthritis may limit their mobility and physical therapists to find a regimen that the patient can follow without causing additional joint pain. I have found that low-impact sports such as swimming or water aerobics are a good option for many patients with psoriatic arthritis," Dr. Piliang noted.

The authors and Dr. Piliang have disclosed no relevant financial relationships.

J Eur Acad Dermatol Venereol. Published online July 30, 2014. Abstract

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