Aquatics for Treatment and Prevention of Arthritis
Michael Burrows
Captain U.S. Army, MBE, Personal Trainer
Arthritis and chronic joint pain are the leading causes of disability among US adults. Those living with arthritis experience disabling joint pain, decreased activity levels, functional decline, and a tremendous human and economic burden. Although rheumatic (RD) diseases have low death rates, they are one of the primary causes of compromised quality of life and absenteeism from work, which has economic and social consequences.
Aquatics present an opportunity to provide the large population of patients with osteoarthritis with a form of physical activity that is joint-friendly and appealing. Patients who have an intolerance to land-based exercise because of pain or who would prefer to improve flexibility or strengthen their muscles more easily may find aquatic exercise especially helpful. Treatment of arthritis focuses on decreasing pain and improving joint movement and function. Treatments can include a combination of weight loss, physical activity, joint protection, use of heat to reduce pain, physical therapy, or occupational therapy. Aquatic exercise is at this moment one of the main non-pharmacological interventions that is suggested by the OARSI (Osteoarthritis Research Society International), ACR (American College of Rheumatology), European League against Rheumatism (EULAR), and the Arthritis Foundation as a means of controlling the symptoms and to prevent or slow down the progression of arthritis. The Arthritis Foundation even has its own warm-water exercise program that has shown to reduce pain and improve overall health.
Both aerobic and resistance exercise in warm water therapy pools produce important health benefits for the treatment of arthritis such as reduced pain, improved function and mood, and delayed onset of disability. Despite this, 44% of adults with arthritis are physically inactive. Over 60% of people age 65 and older have arthritis. Arthritis can complicate other chronic diseases such as diabetes and heart disease by limiting activity. Arthritis also poses disease-specific barriers to exercise such as fears of worsening pain and injury.
Joint pain and stiffness are usually the primary symptoms of arthritis and can cause us to reduce our regular activity. If you have arthritis, you may think that exercise will increase your joint pain or speed the joint breakdown; however, regular exercise for the person with arthritis is actually beneficial and will decrease symptoms and enable you to continue with normal activities. Lack of regular exercise will lead to an increase in symptoms and loss of normal functions, and may even speed the breakdown within the joint.
Pain in your joints may make you want to hold them very still and avoid activities that increase pain. However, limiting use of your joints will, over time, cause muscles to weaken and the joints and muscles to lose flexibility (range of motion). Inactivity can also shorten and tighten muscles, causing you to feel more pain and stiffness and to be less able to do the things you want to do. If you don’t get your joints are to move through their full range of motion, the capsule and ligaments around the joint may contract, preventing full mobility. Regular exercise helps keep joints moving, reduces joint pain, restores and preserves strength and flexibility, and protects joints against further damage.
Aquatic exercises are exercises that are performed in water as a therapy or training program using the properties of water, designed by a suitably qualified physiotherapist, physical therapist, or personal trainer to improve function, ideally in a purpose-built and suitably heated pool. Certain aspects of the intervention should be considered such as: fluid mechanics, temperature, type of exercise (with intensity, frequency, and duration), the professional’s experience and costs. The effects of water resistance, for instance drag forces, may increase energy expenditure and decrease mechanical loads on lower extremity joints. The buoyancy of water reduces pressure on the bones, joints, and muscles facilitating movement, and may block nociception by acting on thermal receptors and mechanoreceptors, thus influencing spinal segmental mechanisms. In addition to the standard benefits of any exercise such as increased muscle strength, improved aerobic and cardiovascular capacity, the use of water exercise can reduce the risk of muscle or joint injury.
Aquatic exercises are frequently used to maintain or improve function for people with musculoskeletal disorders, especially arthritis. Exercise in warm water is a popular treatment for many patients with musculoskeletal conditions. Aquatic exercise is growing in popularity within the fitness industry and has been a popular way of keeping fit for years, particularly for people with musculoskeletal disorders or those recovering from injury. The mitigation of gravity by flotation reduces joint stress when stretching, and can allow a greater range of motion and makes aquatic exercises safe for individuals. The soothing temperature and buoyancy of warm water in a therapy pool make it a safe, ideal environment for relieving arthritis pain and stiffness, and improving the range of movement of joints affected by arthritis. Exercising in warm water raises your body temperature, causing blood vessels to dilate and increases circulation of blood in your body. This can ease joint pain and improve flexibility. Water exercise is a gentle way to train joints and muscles. Water supports joints, lessens stress, allows free movement, and provides mild resistance to help build muscle strength.
Most experts agree that participating in a regular exercise program that follows ACSM (American College of Sports Medicine) guidelines is important and safe for those with arthritis. This means your program should include aerobic conditioning (30 to 60 minutes on five days per week), resistance training (one set, major muscle groups, two times per week) and flexibility activities. Some benefits from aquatic exercise relevant to those living with arthritis include:
Decreased joint pain and stiffness
Improved or maintained joint motion
Decreased risk of cardiovascular disease (higher in those with rheumatoid arthritis)
Improved ability to do daily activities such as getting in and out of a car or going up and down stairs
Decreased disease activity
Improve your coordination and endurance
Increase energy
Reduce fatigue
Improve sleep
Lead to an improved sense of self-esteem and accomplishment
Be a good way to have fun and meet new people
Aquatic exercise greatly reduces the risk of injury.
If you have arthritis, starting a regular exercise program can provide you with multiple benefits. Aquatic classes are great for reducing stress to the joints. Tai Chi, which is often promoted for balance and fall prevention, provides good conditioning and flexibility and there is a form which was specifically developed for individuals with arthritis. While some individuals can successfully jog for their aerobic training, others find that the impact of jogging starts to become too stressful for their joints. Aquatic aerobics, underwater treadmill jogging, and water walking are exercise activities that will reduce joint impact. Resistance training is especially useful – it will help with functional activities, absorb stress around a joint, and help support unstable joints. “The water’s buoyancy supports the body’s weight, which reduces stress on the joints and minimizes pain,” says Vennie Jones, aquatic coordinator for the Baylor Tom Landry Fitness Center in Dallas. “And it’s still a great workout. Water provides 12 times the resistance of air, so as you walk, you’re really strengthening and building muscle.” And if you fall in love with swimming and walking, you can keep going in cooler months – just switch to an indoor heated pool.
Aquatic Yoga and Tai Chi can provide the opportunity for everyone to engage in a practice that is mentally stimulating and physically vigorous, yet controlled so as not to induce strain, or overuse injuries. With the mantra “no pain and lots of gain,” Aquatic Yoga and Tai Chi offer a long list of benefits that support healthy, happy, and independent living.
Using a heated therapy pool can add an additional benefit – massage. Jet nozzles release a mixture of warm water and air, massaging your body, helping relax tight muscles, provide relief from joint pain, and increase the ability to do range-of-motion and strengthening exercises. The use of heat is recommended for many people with arthritis and related conditions. Your doctor can help you determine if it is appropriate for you.
Benefits of HydroMassage can include muscle relaxation, decreased pain and stiffness, and greater ease when performing exercises and daily activities. Warm water therapy pools and a HydroMassage bed are an especially good way to apply heat to joints affected by arthritis.
The term balneotherapy (spa-therapy) involves treating health problems by bathing, usually in hot springs. Long practiced in traditional medicine systems all over the world, balneotherapy is often offered at spa, wellness centers, and hot springs resorts. Proponents claim that balneotherapy can help treat a number of health conditions, including arthritis, respiratory disorders and high blood pressure. Balneotherapy is one of the oldest forms of therapy for arthritis and aims to soothe pain and improve joint motion. The water is generally heated to a temperature between 34_C. (93_F.) and 36 _C. (97_F.) The hydrostatic force (Archimedes’ principle) brings about relative pain relief by reducing loading; the water reduces gravity on painful joints. The warmth and buoyancy of water may block nociception by acting on thermal receptors and mechanoreceptors. Warm water may also enhance blood flow, which may dissipate allogeneic chemicals and facilitate muscle relaxation. Apart from these mechanical and thermal mechanisms one should not undervalue the psychological mechanisms of the spa environment. The related mental relaxation may also play a role in pain relief.
Many people with arthritis and related conditions find that pain and stiffness are worse in the morning. Doctors and or therapists often advise soaking, massaging, or exercising in warm water before beginning your daily activities to help relieve pain and reduce stiffness. You may find it just as helpful to use warm water therapy pools in the afternoon to help relax muscles and joints after a full day of activities, to loosen muscles before doing exercises, and in the evening before bedtime to relax you for a restful sleep.
H3O Aquatics offers many safe ways to minimize and treat pain and loss of motion from arthritis, including all of the above mentioned areas. By working with your doctor, we at H3O Aquatics can help to develop a treatment program that is right for you. Remember, regularity is the key – keep moving! Talk to your doctor to find out if water exercise (hydrotherapy) is right for you.
