The foundation of any PsA workout program is cardiovascular exercises like walking and swimming to get your heart pumping, plus strength training and range-of-motion or flexibility exercises to keep your muscles strong and your joints limber, explained Hui. In the real world, he continued, the best exercise is whatever will motivate you to get moving.

Hui recommended starting with a gentle form of exercise to get you going. If you’re not sure where to begin, a physical therapist can help you design a workout program that’s achievable and safe on your joints.

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HSS physical therapist Wai-Kwong Hui, PT, DPT, MS, noted “If you’re not challenging yourself, you get stagnant." 

Challenging yourself physically doesn’t mean taking on big athletic feats that could land you on the couch with really bad back pain. It can be as simple as mixing up the balance activities you do so that you’re not always moving in the same way. For example, if you always do one type of yoga pose to work on balance, switch it up by adding another option to your repertoire. “It changes the position of balance all of a sudden,” said Hui . The best way to train for life is to train your body in all the ways that you might move, so that nothing takes you by surprise. For example, twisting moves can prep you for the motions required for putting away groceries or pulling laundry out of the dryer. Working your squatting muscles can build your ability to get up and down from seated or lying-down positions. 

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Maintaining your balance and flexibility are important for a few reasons, said Hui. First, when you have inflammatory arthritis, your joints can get stiff. “Once you stop moving, you’re creating rust. That’s going to make it harder to move,” noted Hui. As the old saying goes, “motion is lotion,” he added. Second, the pain and stiffness caused by these conditions tends to lead people to alter their movement patterns and move in ways that limit balance and mobility. Improving these skills requires working on them often—every day if possible, even if it’s just for a few minutes at a time—by doing exercises that challenge your body.

Hui recommends stretching in small amounts throughout the day, which has the added benefit of building in movement breaks. “If you’re sitting at a desk a lot, getting up and moving and stretching what’s tight is a great thing to do to change your position,” Hui says. Sitting in one position all day long contributes to stiffness and reinforces bad posture, so the more you can stand up and reset, however briefly, the better.

Hui suggests stretching the body parts that feel particularly tight—likely, different areas of the spine, shoulders, and neck, though the lower body can also contribute to overall stiffness and discomfort—and holding each stretch for 30 to 60 seconds to really feel the stretch response of the muscles and tendons. “You can work your way up even longer to really feel that stretch over time,” he adds.

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In some instances, strength work is critical for relieving muscle tightness. If your chest is tight, it could be that your back muscles are a little too weak to properly pull you into an upright posture, Hui explained. This results in hunching forward into a position that closes and tightens the muscles in the chest.

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“When you sit around too much or do not move around enough, the muscles in your legs, trunk, and even the arms will become weaker and lose some of their flexibility,” explained Hui. That atrophy can make daily activities like climbing stairs or putting groceries away feel like workouts, he added.

Hui continued, ”Plus, in people with inflammatory arthritis, such as ankylosing spondylitis (AS) and rheumatoid arthritis (RA), lack of movement can translate to increased stiffness and pain in whatever joints are affected, be it knees, ankles, hips, feet, shoulders, wrists, hands, or the spine. And when one area is always stiff, it can cause additional tightness and pain elsewhere. Over time, you can also lose mobility and function.

Hui provided the publication with suggested low-impact strength and mobility exercises to improve function that will be featured and released in an article series in the weeks to come. 

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Hui explained, “As you spend time in this posture, the muscles in the front of the body shorten, and muscles on the back of the body lengthen.”

“People with AS really need to remind themselves about their posture,” he noted.

Hui recommended the posture-training activity called the Kitchen-Bathroom Workout. He noted, “First thing in the morning when you get to work, go to the little kitchenette. Walk around and drink a cup of water. Finish drinking and then come back to your desk and work for 30 minutes. Then, go use the bathroom. Then, back to your desk.” Thirty minutes later, do it all over again: kitchen for water, desk, bathroom.

According to Hui, “When we’re working at a desk, it’s easy to lose track of time and then two hours later you realize you haven't moved from your desk. So this is a great way to force people to get out of that position.”

He explained that good, seated posture looks like feet flat on the floor in front of the body, shoulder blades back and down and chest up (but not flared out), and core engaged.

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