Physiotherapy and the Impact of Exercise in Psoriasis

Fat Cells Can Produce Inflammatory Signals

Psoriasis is a chronic inflammatory skin disease in which cytokines (molecules that regulate the immune system and inflammation) play a significant role in the condition’s development.^[1] In psoriasis, increased blood levels of inflammatory cytokines have been detected.^[2] Adipose tissue, or fat that accumulate throughout the body, has been identified as a culprit in the production of these cytokines and previous studies have found that increased adiposity and weight are strong risk factors for the development of psoriasis.^[3,4] Strong associations have been made between obesity and the severity of the disease, and it has been noted that psoriasis is more prevalent in obese populations.^[5]

Role of Exercise and Weight Loss in Psoriasis

Studies have shown that implementing goals such as exercise and weight loss can help reduce the severity of psoriasis.^[6] One randomized control trial demonstrated the effects of a 20-week intervention of diet and exercise in reducing the symptoms of overweight or obese patients with psoriasis.^[7]  Participants in the treatment group were given individualized advice and personalized instructions on diet and exercise. Dietitians were made available to the treatment group and monthly follow up was conducted to reinforce the advice and to adjust the lifestyle-focused plans in the case of specific complaints. An aerobic physical exercise was suggested for at least forty minutes, three times a week.

Compared to the control group, which received a simple fifteen-minute informative session, patients in the dietary arm saw a significant reduction in weight. Though the difference in weight loss was significant, the average weight difference was just under three pounds.  Yet, there was a significant difference in how psoriasis improved. The Psoriasis Area Severity Index, or PASI, a score is a tool used to monitor and measure psoriasis by assessing the intensity and the area affected in different regions of the body. Compared to the baseline, the overall PASI score at week 20 was reduced by 48% in the dietary arm compared to 25.5% in the control arm.^[7]

It Needs to Be Vigorous Exercise and Not Just Any Exercise

In another study, a population of over eighty thousand US female nurses was followed to examine the effect of exercise on psoriasis. This study found that vigorous physical exercise was associated with a significantly reduced risk of developing psoriasis. Simply walking was not enough as the reduction in psoriasis risk was only achieved with activity equivalent to two hours a week of running or three hours a week of swimming or tennis.^[8]

Traditional Chinese Medicine Approach to Exercise in Psoriasis

In Traditional Chinese Medicine (TCM), psoriasis is not approached as one condition with one standard treatment. Psoriasis is graded on how it presents for each patient and their specific symptoms. The herbs, dietary therapy, acupuncture, and other lifestyle guidelines will likely vary. In general, the three most common presentations of psoriasis in TCM are:^[9]

• Blood Heat
• Blood Stasis
• Blood Dryness

While exercise can benefit many people suffering from various conditions, those who have been diagnosed with blood stasis by their TCM practitioner may see the most benefit from increasing their amount of daily exercise.

Imbalances Seen in Psoriasis Relevant to Exercise

Blood stasis can arise from a wide variety of conditions and can affect people in many ways. In psoriasis, those diagnosed with blood stasis may find their lesions darker in color (dull red, purple or brown) and those lesions are often thicker than those found in other TCM diagnoses.^[10] One primary treatment for people suffering from blood stasis includes activating the blood circulation, often through specific herbal formulas and acupuncture treatments. Additionally, including regular physical activity in your daily routine can also help move you toward this goal of proper blood movement and circulation.

Effect of Exercise

It has been found that increased Body Mass Index (BMI) and increased waist circumference are two risk factors in both adults and children for the development of psoriasis Not only are overweight and obese patients at a higher risk of developing psoriasis, but their symptoms tend to be more severe and they appear to have a reduced response to some treatments. The good news is that even small reductions in weight can improve psoriasis.^[7]