Aquatic Exercise and Arthritis

Arthritis, which literally means “joint inflammation,” affects 43 million Americans, according to the Arthritis Foundation. Consisting of more than 100 different forms, each form shares general characteristics of joint pain, stiffness and potential swelling. Aquatic exercise, in particular, is recommended for people with arthritis as a safe and effective means to exercise, improve endurance, mobility and strength, enhance well-being and reduce physical limitations.

Arthritis primarily consists of two types: rheumatoid and osteoarthritis . Osteoarthritis is a degenerative condition that results from wear and tear on joints and breakdown of cartilage that covers the ends of bones. Typical symptoms of osteoarthritis include pain and stiffness that can be relieved by movement.

In contrast, rheumatoid arthritis is a systemic disease that affects the entire body. Symptoms of rheumatoid arthritis include joint pain and inflammation, especially in the hands and feet, and leads to joint deformity over time. The challenge for people with rheumatoid arthritis is that inflammation prevents normal use of joints and limits activities. This reduced activity leads to loss of strength, endurance and mobility. Over time, muscles and ligaments become so weak that people experience further loss of function. Exercise provides a safe, effective and much needed intervention to prevent a continuous cycle of functional loss.

Exercise Program Guidelines

• Remember to train with a heart. Arthritis is a chronic disease that requires people to cope frequently with pain. Dealing with chronic pain is not only physically draining, it can also be emotionally debilitating. While it’s essential to understand the technical aspects of how to adapt exercises for your students, you must never forget the human aspect of the daily challenge that sufferers of arthritis face. Your class members come to exercise not only for physical benefits, but also for the chance to enjoy movement and camaraderie. If you keep this thought foremost, you will experience training success.
• Encourage communication with health care providers. Your clients with arthritis are likely to be under medical supervision. Depending on whether or not they have multiple health conditions, they may require medical clearance before participating in exercise activities so be sure to discuss this with your participants. If any participant experiences increased pain either during or immediately following exercise or redness or swelling around joints, encourage them to consult a doctor.
• Use it or lose it, but don't overdo it. The goal of exercise for people with arthritis is to improve range of motion, increase muscular strength and develop and maintain endurance. Since arthritis is a joint disease, people with arthritis need to try to move through each joint’s active range of motion on a daily basis. This regular movement helps prevent stiffness and loss of mobility. Remember that range of motion is unique to each person and is specific to each joint. Encourage fullness of motion, while reminding people to tune into their own body cues. Ask for feedback If participants experience persistent pain after class, it is likely that the intensity was too high.
• Strong muscles support joints. Strengthening exercises are important to enhance functional movement and facilitate activities of daily living. Since people with arthritis may move less during pain episodes, it’s important for them to perform exercises when they are not in an inflamed condition. Strength training supports the ability to maintain function as much as possible. Strong muscles also assist movement and enable activity with less stress on joints.
• Endurance enhances functional activities. Cardiorespiratory endurance activities are important to maintain overall health. An individual’s best form of exercise, however, should be determined together with their doctor. If more vigorous aquatic aerobic exercises are recommended, then the water can provide an excellent training environment. Muscular endurance is also valuable for all people with arthritis – again to enhance functional movement with minimal joint stress.

Aquatic exercise principles for people with arthritis include the following:

• Try to exercise daily.
• Exercise in warm water pools with temperatures between 83-88°F.
• Wear thermal attire to maintain joint warmth (if needed).
• Wear aquatic exercise shoes for greater support and cushioning.
• Move affected joints gently through a comfortable range of motion.
• Reduce range, decrease speed and minimize surface area to reduce intensity of movements.
• Provide an extended warm up of gentle range of motion exercises to fully warm up joints before performing more vigorous strengthening or conditioning exercises.
• Submerge working joints in the water.
• Change activities and body positions frequently to avoid excessive joint strain from too many repetitions.
• Encourage participants to work at their own pace and reduce intensity throughout exercise as needed.
• Avoid extreme ranges of motion and overstretching.
• Avoid excessive impact or excessive resistance.
• Remind participants to keep joints in neutral.
• If using hand held equipment, cue frequently to maintain a relaxed grip and provide breaks for hand and wrist relief.
• Encourage participants to take responsibility for their own bodies, to recognize their own limits, to respect pain and to adjust the level of physical activity to the level of disease activity.

Recommended Conditioning Exercises

Water Walking

• Objectives: warm up, cardiorespiratory endurance, core conditioning and cool down
• Action: walk in shallow water with neutral posture. Swing arms freely to simulate a natural gait.
• Variations: (easier) walk in place while barely lifting feet. (harder) Increase speed of walking and size of leg swing forward. Maintain neutral posture. Walk backwards. Do not lift leg too high to avoid arching the lower back.

Side Stepping

• Objectives: warm up, cardiorespiratory endurance and cool down
• Action: face front, step sideways across the pool. Arms rise as you step side. Arms lower as feet come back together.
• Variations: (easier) side step with arms held out to sides. (harder) Increase speed and size. Add a squat down as you step side, up as legs come together. Maintain neutral posture. Travel diagonally.

Recommended Strengthening Exercises

Kicks

• Objectives: strengthen quadriceps, hip flexors.
• Action: bend knees and extend lower leg while maintaining neutral spine.
• Variations: (easier) keep knee lift low and do not fully extend leg. (harder) raise knee higher and straighten leg without locking knee. Increase speed.

Leg Curls

• Objectives: strengthen hamstrings.
• Action: alternate bending knees and lifting heels towards buttocks extend while maintaining neutral spine.
• Variations: (easier) keep knee lift low. (harder) increase size of heel lift. Increase speed.

Recommended Range of Motion Exercises

All range of motion exercises should be performed in a deliberate and controlled manner. Joints should be submerged either by standing in appropriate water depth or by bending the knees in a lunge or squat stance to lower joints into the water.

Shoulder Rolls

• Action: make shoulder circles, forward then back. Maintain neutral alignment.

Big Hugs

• Action: extend arms out reaching towards sides of pool. Wrap arms comfortably around chest in a big hugging motion. Alternate right and left arm on top with each hug.

Breaststroke Arms

• Action: in an upright position, perform a breaststroke movement with arms in front of the body. Lengthen arms forward, bend elbows as arms come back to center. This can be performed with big hugs for a soothing front to back exercise combination.

Goals of Aquatic Exercises for People with Arthritis

Physical:

• Decrease pain
• Increase mobility
• Increase strength
• Increase coordination
• Improve ambulation
• Improve endurance

Mental and Emotional:

• Increase feelings of well-being
• Decrease depression
• Increase socialization
• Increase fun and pleasure

Source: Arthritis Foundation YMCA Aquatic Program

Water Temperature for Arthritis Classes

Warmer water temperatures encourage greater muscle elasticity and enhance range of motion. Ideal water temperatures for arthritis classes range from 83-88 degrees Fahrenheit (28 - 31 degrees Celsius). Some participants enjoy “hot” water classes in pools as warm as 90 degrees Fahrenheit. Hot water pools are only suitable for range of motion exercises and are not recommended for higher levels of activity.

If participants prefer more warmth, recommend that they wear thermal pool attire that cover arms, legs and the neck area and to wear exercise mitts. Remind participants to move continuously while in the water to improve thermal regulation.