Exercise, physical activity, and physical fitness in psoriasis and psoriatic arthritis: an umbrella review.

Abstract

Background: Exercise, physical activity, and physical fitness are increasingly discussed in psoriasis and psoriatic arthritis (PsA), but the evidence base is uneven: intervention reviews predominantly concern PsA, whereas evidence for cutaneous psoriasis is largely observational or embedded in broader lifestyle interventions.

Methods: This systematic review was conducted as an umbrella review of intervention effects and observational exposure-outcome associations. The protocol was registered in PROSPERO (CRD420261403713). PubMed, Web of Science, Embase, Cochrane Library, Scopus, and SPORTDiscus were searched from inception to 1 March 2026. Two reviewers independently screened records and extracted data, with disagreements resolved by discussion and, when necessary, a third reviewer. Reporting followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRIOR (Preferred Reporting Items for Overviews of Reviews). AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2), corrected covered area (CCA), GRADE (Grading of Recommendations, Assessment, Development and Evaluations), and the Ioannidis credibility classification were applied as appropriate.

Results: Nine reviews were included. Eight reviews provided PsA evidence, including interventional, descriptive, or observational findings; one observational meta-analysis concerned prevalent cutaneous psoriasis. No eligible review isolated the effect of exercise on cutaneous-psoriasis severity. Overall confidence was Moderate for one review, Low for five, and Critically Low for three. No umbrella-level pooling was undertaken because the same trials recurred across reviews, particularly in the high-intensity interval-training/cardiorespiratory cluster (CCA approximately 16.7%), and populations, outcomes, comparators, and effect measures were heterogeneous. Vigorous activity (RR 0.76, 95% CI 0.67 to 0.85) and regular exercise frequency (RR 0.88, 95% CI 0.82 to 0.95) were associated with lower psoriasis prevalence, both with suggestive credibility. In PsA, possible improvements in fitness, disease activity, pain, function, and body composition were based mainly on single small trials and had very low certainty.

Conclusion: The evidence differs by disease. For cutaneous psoriasis, current findings are observational and do not establish an exercise effect on disease severity or incidence. For PsA, intervention findings are sparse, duplicated across reviews, and of very low certainty. Safety reporting was incomplete and did not permit a disease-specific conclusion. Adequately powered, prospectively registered trials with disease-specific outcomes and systematic adverse-event reporting are required.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261403713.