Physical fitness and physical activity in psoriatic arthritis: a systematic review

Despite the increased cardiometabolic risk in psoriatic arthritis (PsA) and the known beneficial effects of physical fitness (PF) and physical activity (PA) on cardiometabolic health, evidence of the current status of PF and PA in PsA is still unclear. Therefore, this study aimed to systematically review research on PF and PA in PsA.

A systematic literature search using four databases was performed to include studies examining PF, specifically cardiorespiratory (CRF) and muscular fitness (MF), and PA in patients with PsA (PROSPERO ID 255501). Risk of bias (RoB) assessment was conducted. Due to the diversity of outcomes, a narrative synthesis was used.

Eighteen papers reporting PF and 33 papers examining PA were included. RoB was low in two studies assessing PF and in four PA studies. CRF was evaluated in two studies, indicating CRF levels similar to a sedentary general population. Handgrip strength (HGS) was reduced in PsA compared with healthy controls, but results concerning additional MF parameters were inconclusive. Three studies measured PA objectively and eight studies used a validated PA questionnaire, suggesting a decreased PA level in PsA. A negative impact of low PA and CRF levels on disease onset was observed. In contrast, a potential negative effect of biomechanical loading on disease parameters (disease onset, disease activity, structural joint and enthesial damage) was suggested.

Current literature suggests a reduced PA level and decreased HGS, but is inconclusive regarding additional MF outcomes. Data on CRF are limited in PsA. Further robust methodological longitudinal and interventional research is needed to examine the relation between PF and PA on PsA disease parameters and cardiometabolic risk.