---
title: "Exercise, Physical Activity, and Fitness in Psoriasis and Psoriatic Arthritis: Umbrella Review Ove"
id: "frontiers-in-immunology-13-exercise-physical-activity-and-physical-fitness-in-psoriasis-and-psoriatic"
canonical_url: "https://medichelpline.com/clinical-feed/frontiers-in-immunology-13-exercise-physical-activity-and-physical-fitness-in-psoriasis-and-psoriatic"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "Frontiers in Immunology"
source_url: "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1921728"
published_at: "2026-10-09T00:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Exercise, Physical Activity, and Fitness in Psoriasis and Psoriatic Arthritis: Umbrella Review Ove
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/frontiers-in-immunology-13-exercise-physical-activity-and-physical-fitness-in-psoriasis-and-psoriatic
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** Frontiers in Immunology
- **Source URL:** [Original Journal Publication](https://www.frontiersin.org/articles/10.3389/fimmu.2026.1921728)
- **Published At:** 2026-10-09T00:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The source article is titled “Exercise, physical activity, and physical fitness in psoriasis and psoriatic arthritis: an umbrella review” and is classified as a SYSTEMATIC REVIEW article in Frontiers in Immunology. The document available in the provided source contains site navigation and journal pages but does not include the body of the umbrella review itself. - The core topics implied by the title are **psoriasis**, **psoriatic arthritis**, **exercise**, **physical activity**, and **physical fitness**, and the article type indicates a synthesized review of existing reviews (an **umbrella review**). - Key study elements commonly expected in an umbrella review—objectives, inclusion criteria, search strategy, number and type of included reviews, quality appraisal, pooled outcomes, and main findings—were not reported in the provided source content. - No information about specific interventions (types, dose, duration), outcome measures (skin scores, joint outcomes, function, fitness metrics, quality of life), statistical results, effect sizes, or certainty of evidence was present in the available source. - Author names, institutions, funding, conflicts of interest, registration (PROSPERO or similar), and publication metadata beyond journal and article type were not reported in the source content. - Because the source text contains only Frontiers in Immunology navigation and header material, extraction of methods, results, recommendations, and clinical implications is not possible from this input. - Any further clinical interpretation, practice recommendations, or numerical summaries cannot be derived from the provided source and would require access to the full article text or the published umbrella review PDF/HTML.
## Clinical Analysis & Structured Key Points
Frontiers | Exercise, physical activity, and physical fitness in psoriasis and psoriatic arthritis: an umbrella review SYSTEMATIC REVIEW article Front. Immunol. , 09 October 2026 Sec. Inflammation Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1921728 Published in Frontiers in Immunology Inflammation 7 impact factor 11.3 citescore Editor & Reviewers Edited by R J Ruano Juan Reviewed by C N Charlotte Näslund-Koch S A Sohrab Ahmad Khan Outline Figures and Tables Figure 1 View in article Figure 2 View in article Figure 3 View in article Figure 4 View in article Figure 5 View in article Table 1 Characteristics and disease focus of the included reviews. View in article Table 2 Selected quantitative estimates from core-eligible reviews, grouped by disease and outcome domain. View in article Table 3 Methodological quality of the included reviews (AMSTAR 2) and critical-domain assessment. View in article Table 4 Certainty of the evidence by outcome domain. View in article Table 5 Primary-study overlap among the included reviews, by exercise/activity cluster. View in article SYSTEMATIC REVIEW article Front. Immunol. , 09 October 2026 Sec. Inflammation Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1921728 Exercise, physical activity, and physical fitness in psoriasis and psoriatic arthritis: an umbrella review Z L Zikun Lyu 1 † J M Jingshi Ma 1 † C M Chenzhe Ma 1 X T Xuechen Tian 2 L L Liye Liu 3 J Z Jiayi Zhang 1 * Y G Yafei Gao 1 * 1. Department of Physical Education, Kunsan National University, Gunsan-si, Republic of Korea 2. School of Physical Education, Handan University, Handan, Hebei, China 3. Northeast Petroleum University, Daqing, China See more Article metrics View details 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. Introduction Psoriasis is a common, chronic, immune-mediated inflammatory disease affecting a substantial share of the adult population worldwide ( 1 ). A considerable proportion of people with psoriasis develop psoriatic arthritis (PsA), a heterogeneous musculoskeletal disease that can involve peripheral joints, the axial skeleton, entheses, and skin and nails, and that carries a meaningful burden of pain, fatigue, and functional limitation ( 2 ). Beyond the skin and joints, psoriatic disease is recognized as a systemic condition associated with substantial impairment of health-related quality of life and with a range of comorbidities ( 3 ). Among these comorbidities, cardiovascular and cardiometabolic disease are especially prominent: psoriasis has been associated with an increased risk of major adverse cardiovascular events ( 4 ) and with a higher incidence of cardiovascular disease more broadly ( 5 ). This cardiometabolic burden provides a strong rationale for interventions, such as exercise and increased physical activity, that may influence both inflammatory and metabolic pathways. General-population guidance recommends regular physical activity for adults of all ages as a cornerstone of health promotion ( 6 ), and disease-specific recommendations endorse physical activity for people with inflammatory arthritis and osteoarthritis ( 7 ). Exercise, physical activity, and physical fitness are distinct but related constructs. Exercise denotes planned, structured, repetitive activity undertaken to improve or maintain fitness; physical activity encompasses any bodily movement that expends energy; and physical fitness describes attributes such as cardiorespiratory capacity and muscular strength. In psoriatic disease, these constructs are of dual interest: as potential interventions that may improve symptoms, function, body composition, and fitness, and as exposures that may be associated with the risk of developing psoriasis or PsA, or with structural progression. Mechanical stress at entheses, for example, has been proposed as a factor in PsA, raising the possibility that some forms of loading could carry risk as well as benefit. Systematic reviews have examined exercise, physical activity, and physical fitness in psoriasis and PsA, but they differ in population (PsA-specific versus mixed rheumatic and musculoskeletal disease), exposure, comparator, outcome, study design, and methodological rigor. The evidence base is also asymmetric: several reviews concern PsA or mixed inflammatory arthritis, whereas cutaneous-psoriasis evidence is largely observational or embedded in broader lifestyle interventions. A single review therefore gives only a partial view, while counting reviews without examining their primary studies can overstate the amount of independent evidence. An umbrella review ( 8 ) is useful here not to force a pooled estimate from an immature evidence base, but to separate the two diseases and evidence types, quantify repeated primary studies, appraise confidence, and identify where review-level evidence is absent. This overview followed Preferred Reporting Items for Overviews of Reviews (PRIOR) ( 9 ), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 ( 10 ), and PRISMA-S ( 11 ). Accordingly, this umbrella review mapped and appraised review-level evidence separately for cutaneous psoriasis and PsA. We asked: (i) whether the evidence was interventional or observational; (ii) which exercise or activity types, intensities, durations, comparators, and outcomes had been studied; (iii) how large and clinically interpretable the reported findings were; (iv) how certain and independent the evidence was; and (v) where the major evidence gaps remained. An intervention-effect branch and an observational exposure-outcome association branch were kept separate throughout. Methods Protocol, registration, and reporting This systematic review was conducted as an umbrella review (overview of reviews) and is reported in accordance with PRISMA 2020 ( 10 ) and PRIOR ( 9 ); the literature search follows PRISMA-S ( 11 ). The protocol was registered in PROSPERO (CRD420261403713). The registered record prespecified review-level evidence on both intervention effects and observational exposure–outcome associations and a narrative umbrella synthesis, with pooled estimates reported only as presented by source reviews and no de novo meta-analysis of primary studies. Accordingly, the two evidence streams and the completed narrative approach without new pooling were consistent with the registered plan; only the branch labels and allocation rule were operationalized during extraction. Departures or additions were that SPORTDiscus was searched instead of the planned PsycINFO, A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) appraisal was performed independently by two reviewers rather than by one assessor with a second checker, and the evidence-tier classification and Ioannidis credibility framework were added after registration. Adverse events, flares, and safety were prespecified additional outcomes; because review-level harms reporting was sparse and non-standardized, they were summarized narratively rather than quantitatively. The eligibility criteria and other outcome domains were unchanged. No de novo pooling of primary-study effect estimates was performed. Eligibility criteria Eligibility was defined using a PICOS framework. The population comprised people with psoriasis or PsA; reviews of mixed inflammatory arthritis or rheumatic and musculoskeletal disease populations were eligible only when psoriasis- or PsA-specific results were separately extractable. The intervention, exposure, or index factor comprised exercise, physical activity, and physical fitness, including active exercise components of physical therapy, high-intensity interval training (HIIT), aerobic, resistance or strengthening exercise, walking, home-based exercise, and physical-activity or fitness exposure levels. Comparators included no exercise, usual care, waiting list, lower physical activity, healthy or reference groups, pre–post comparisons, and alternative exercise formats, as reported by the included reviews. Outcomes included cutaneous-psoriasis severity (e.g., PASI), psoriasis prevalence or incidence associations, PsA disease activity (e.g., DAPSA, PASDAS, BASDAI, DAS, and patient global assessment), pain, fatigue, physical function, quality of life (e.g., DLQI and SF-36), inflammatory or imaging outcomes, body mass index and body composition, cardiorespiratory or muscular fitness, and physical-activity level. Eligible designs were systematic reviews, meta-analyses, Cochrane reviews, and umbrella or overview reviews; an observational meta-analysis was eligible for the psoriasis-prevalence association branch. Only full-text reviews published in English were eligible; no language restriction was applied at the search stage. Narrative reviews, scoping reviews, and guideline records were not treated as formal review-level units, and mixed reviews without extractable psoriasis- or PsA-specific results were excluded from the main effect extraction. The two evidence streams—intervention effects and observational exposure–outcome associations—were kept separate at every stage. Information sources and search Six bibliographic databases were searched from inception to 1 March 2026: PubMed (MEDLINE), Web of Science Core Collection, Embase, the Cochrane Library, Scopus, and SPORTDiscus, the last selected as a topic-specific database appropriate to an exercise-focused question. Concept blocks combined the population (psoriasis or PsA) with the exercise, physical-activity, and physical-fitness exposure and a systematic-review or meta-analysis design filter, using controlled vocabulary and free-text terms adapted to each interface. The full, interface-specific search strategies are provided in Supplementary Table S1 . Selection and data collection Two reviewers independently screened the retrieved records using prespecified eligibility criteria. They first screened titles and abstracts independently; full texts were then obtained for records that appeared potentially eligible or provided insufficient information, and each reviewer independently assessed full-text eligibility. Screening decisions were cross-checked. Disagreements were resolved through discussion and, if consensus could not be reached, by review and final adjudication by a third reviewer. Two reviewers independently extracted data using a prespecified, piloted extraction form and then cross-checked their completed forms. Extracted items included review characteristics, populations, exercise or activity exposures, comparators, outcomes, effect measures and estimates, confidence intervals, heterogeneity statistics, contributing primary studies, time points, source-review certainty ratings, and primary-study risk-of-bias information as reported by the review. Differences were resolved through discussion and, when unresolved, by a third reviewer. Each estimate was labeled as source-review-reported or overview-author-derived and mapped to a standardized outcome construct and evidence tier ( Supplementary Table S2 ). Methodological quality of the included reviews Two reviewers independently appraised each included review with AMSTAR 2 ( 12 ), compared item-level judgements, and resolved disagreements through discussion; a third reviewer adjudicated any unresolved item. Overall confidence reflects the 16 AMSTAR 2 items and the seven critical domains (items 2, 4, 7, 9, 11, 13, and 15): one critical weakness lowers confidence to Low and more than one lowers it to Critically Low. Primary-study risk-of-bias tools used by the included reviews (for example, RoB 2 or the Newcastle–Ottawa Scale) were transcribed separately and were not conflated with the AMSTAR 2 appraisal; item-level ratings and rationale are provided in Supplementary Table S3 . Overlap among primary studies Because reviews on a shared question often include the same primary studies, overlap was quantified using the corrected covered area (CCA) ( 13 ). A study-by-review citation matrix was constructed, and the CCA was computed as ( N − r )/( r × c − r ), where N is the number of inclusions (filled matrix cells), r is the number of unique primary studies, and c is the number of reviews. Overlap was interpreted using established thresholds: 0%–5% slight, more than 5%–10% moderate, more than 10%–15% high, and more than 15% very high. Overlap was examined overall and within prespecified exercise or activity clusters. Certainty of the evidence Certainty was characterized by evidence type and rating provenance. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology followed established guidance ( 14 ), RoB 2 was the relevant randomized-trial risk-of-bias framework where used by source reviews ( 15 ), and observational meta-analysis reporting was interpreted in line with MOOSE ( 16 ). Of 87 effect-level ratings, 81 were applied by the overview team and six were retained from source reviews. When an included review reported an outcome-specific GRADE rating for the same construct, comparator, and time point, that rating was extracted without alteration and labeled source-review-reported. Otherwise, two overview reviewers independently applied GRADE de novo to the unique outcome construct/evidence body using the review-reported primary-study risk of bias, inconsistency, indirectness, imprecision, and publication-bias information; duplicated estimates inherited the same construct-level judgement rather than being rated as independent evidence. Disagreements were resolved by discussion and, if necessary, a third reviewer. Narrative findings that could not support formal GRADE judgments received explicitly labeled descriptive, non-GRADE assessments. For pooled observational psoriasis-prevalence associations, the overview reviewers applied the Ioannidis class I–IV credibility criteria ( 8 ); unavailable bias inputs precluded higher classes. Heterogeneity was described with review-reported I 2 values ( 17 ). The most conservative constituent judgment is shown when an outcome domain contains several constructs. Evidence tier Before synthesis, each review was assigned using three operational criteria applied to its primary scope: (i) the review question and synthesis were specific to psoriasis or PsA rather than a mixed-disease population; (ii) exercise, physical activity, or physical fitness was the primary index construct rather than one component of a broader lifestyle or non-pharmacological review; and (iii) at least one prespecified disease-specific outcome was extractable. Reviews meeting all three criteria were core-eligible and supported the principal conclusions. Reviews with relevant subgroup data but a mixed-disease or broader-intervention scope were evidence-map-only; their estimates were retained in the evidence map but were not used to support the principal disease-specific conclusions. Synthesis approach Synthesis was narrative and organized by disease, evidence type, and outcome domain. Umbrella-level pooling was not performed for four reasons: (i) the same primary trials and numerical estimates recurred across several reviews, creating non-independent data; (ii) populations ranged from PsA-specific samples to small PsA subgroups within mixed rheumatic populations; (iii) exercise modalities, comparators, intervention durations, and outcome time points differed; and (iv) outcomes and effect measures were not commensurable, including native-scale mean differences, standardized mean differences, ratios, descriptive values, and direction-only findings. Pooling review-level estimates under these conditions would create pseudo-replication and a clinically ambiguous summary. Quantitative estimates were therefore reported as provided by source reviews, with repeated primary-study estimates shown once in the main text and selected main table; all review-level rows remain in Supplementary Table S2 . Publication bias and small-study effects were described only as reported by the source reviews. Without a valid pooled model, conventional sensitivity analyses and subgroup or meta-regression analyses were not applicable and were therefore not conducted. Certainty-rating provenance and rationale are reported in Supplementary Table S4 . The CCA verification and near-duplicate-study what-if analysis are reported in Supplementary Table S5 . Results Review selection Nine reviews met the eligibility criteria. Eight reviews provided PsA evidence, including interventional, descriptive, or observational findings, and one observational meta-analysis provided cutaneous-psoriasis prevalence associations. Effect estimates were allocated to the intervention-effect or observational-association branch according to their design rather than by assigning each review exclusively to one branch. The flow of review-level records is summarized in Figure 1 . The included reviews were those of Björk and colleagues ( 18 ), Gwinnutt and colleagues ( 19 ), Hailey and colleagues ( 20 ), Kaerts and colleagues ( 21 ), Kaerts and colleagues ( 22 ), Kessler and colleagues ( 23 ), Santos and colleagues ( 24 ), Sutherland and colleagues ( 25 ), and Zheng and colleagues ( 26 ). Four reviews were core-eligible ( 21 – 23 , 26 ); the remaining five contributed to the evi
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