Water Exercise for Arthritis

Let’s get this little misconception out of the way: Water exercise is not just for senior citizens with joint pain. Water exercise for people with arthritis is for all ages at all levels of ability and disability, says Julie Mulcahy, DPT, physical therapist with McLaren Health Management Group, a Michigan-based organization that provides home health care.

From water walking to water aerobics, and even water Zumba, aquatic exercise programs can be modified to any fitness need — from a gentle range-of-motion and floating routine to high-level intensity workouts for athletes.

For people with arthritis, recent research has shown that water exercise can be a safe and effective exercise option. One study published in the American Journal of Physical Medicine and Rehabilitation found women with rheumatoid arthritis (RA) who did water-based exercises three times a week for sixteen weeks saw significant improvements in disease activity, pain, and functional capacity compared to those who did land-based exercises. And in a recent Cochrane Review of 13 trials that included 1,190 patients with knee or hip osteoarthritis (OA), researchers found aquatic exercise may help improve pain and function.

Why Water Workouts Are Good for Your Joints

Think of the pool as “nature’s body weight support system.” It can unload up to almost 90 percent of your body weight, according to experts at the American Physical Therapy Association. That buoyancy makes moving in the water easier on the joints. “It allows you to perform movement with an arthritic joint that would be painful on land, which then helps improve strength and flexibility in that joint,” explains Dr. Mulcahy, who also works with Physera, an app-based platform for physical therapy. For example, it may be tough to perform a squat on land with knee OA, but in the water, the squat is more doable.

Water exercise puts less stress on your joints

“Exercise in the water removes the impact stress of ground reaction force,” explains Lauren Shroyer, MS, senior director of product development at the American Council on Exercise. The impact of stepping on the pool floor is significantly less than stepping on dry land. “When joints are inflamed and painful during weight-bearing exercise, working out in the water allows you to experience the advantages of movement without the negative consequence of impact,” she explains.

Water exercise puts more resistance on your muscles

It takes more effort to walk from one side of the pool to the other in the water than it does out of the water. That’s because water provides greater resistance than air — up to 12 times more, says Dr. Mulcahy. That resistance to your movements not only helps strengthen muscles, but also burns more calories to help you lose weight faster. The faster you move, the higher the resistance.

Water exercise boosts cardiovascular fitness

Water exercise works your whole body in multiple directions and promotes smooth movements (instead of quick, jerky motions), says Dr. Mulcahy. It also allows you to work at a higher level that you could tolerate on land, which helps improve mobility and strengthen cardiovascular endurance. “Patients with chronic joint conditions often say they feel free from their disability when in the water,” she adds.

Is Water Exercise for Arthritis the Same as Swimming Laps?

Not exactly. One big difference is the water temperature, says Dr. Mulcahy. “Many arthritis water exercise programs are conducted in hotter water, which is meant for low-intensity exercise and more soothing for arthritic joints,” she explains. Pool temps for a water exercise classes for people with arthritis range from 92 to 98 degrees F.

Lap swimming, on the other hand, is a moderate intensity exercise that requires a cooler pool, with a water temperature between 83 and 88 degrees F, says Dr. Mulcahy. “Swimming laps in water that’s too warm, such as 90 degrees F or greater, can lead to exhaustion and overheating,” she says.

Lap swimming, however, is also great exercise for people with arthritis. It has little impact on joints, lengthens muscles, and improves cardiovascular fitness.

Precautions to Keep in Mind Before You Exercise in the Water

Regular exercise is an important part of your arthritis treatment plan, and your doctor will recommend it — whether you have osteoarthritis or an autoimmune, inflammatory form such as rheumatoid arthritis. But before you try any water exercise program, talk to your doctor or physical therapist to make sure pool exercises are right for you.

Here are more tips before getting started:

Consider your gear. Water shoes will give you extra traction on the pool floor. If you are exercising in deeper water, use a Styrofoam noodle or flotation vest to keep you afloat. You can also use Styrofoam weights or a kickboard for increased resistance.

Stay hydrated. You won’t notice if you’re sweating with pool exercises, so be sure to drink plenty of water.

Stop if anything hurts. “Listen to the pain,” says Shroyer. Take a break when your joint starts to ache. If you feel any new joint pain, it’s time to stop. Talk to your doctor about what pain is normal and when it’s a sign of something more serious.

Water Exercises to Ease Arthritis Pain

Many aquatic centers, YMCAs, and community pools have water exercise classes designed for people with arthritis. The following water exercises were recommended by Shroyer at ACE and Dr. Mulcahy, and are inspired by some of the exercises here and here.

Water Exercise for Arthritis Water WalkingWater Walking

  • Stand in waist- or chest-high water.
  • Walk 10 to 20 steps forward, then walk backward. Repeat.
  • For added resistance, increase your speed.

Water Exercise for Arthritis Forward LungeForward Lunge

  • Stand in waist- or chest-high water (near a pool wall for support, if needed).
  • Take an oversized lunge step in a forward direction, without letting your forward knee go past your toes.
  • Return to start position and repeat with other leg.

Water Exercise for Arthritis SidesteppingSidestepping

  • Stand in waist- or chest-high water, facing the pool wall.
  • Take sideways steps with your body and toes facing the wall.
  • Take 10 to 20 steps in one direction and then return. Repeat in the other direction.

Water Exercise for Arthritis Hip KickerHip Kickers

  • Stand in waist- or chest-high water, with the pool wall on the right side of your body for support.
  • Kick your left leg forward, keeping your knee straight; then return to start position.
  • Kick your left leg out to the side; then return to start position.
  • Kick your left leg behind you; then return to start position.
  • Turn so the pool wall is on your right side and repeat movements with your left leg.

Water Exercise for Arthritis Jumping JacksJumping Jacks

  • Stand in chest-high water, with your feet together and hands at your side.
  • Jump your feet out to a straddle and bring your hands up to the top of the water level, keeping them in the water.
  • Return to start position, and repeat as quickly as comfortable.
  • For added resistance, hold foam water dumbbells. (You may need to slow down the motion when using water dumbbells.)

Water Exercise for Arthritis Hacky SackHacky Sack

  • Stand in chest-high water.
  • Lift your right leg, with your knee bent and hip rotated open, and tap the inside of your ankle with your left hand.
  • Lower to start position, and repeat with the opposite side.
  • Alternate sides as quickly as is comfortable.

Water Exercise for Arthritis Frog JumpsFrog Jumps

  • Stand in chest-high water.
  • Keeping your body in the water, quickly pull your knees up toward your armpits (with your knees wide and heels toward your groin), while reaching your hands down to touch your feet as they come up to about the level of your hips.
  • Return to start position, and repeat as quickly as comfortable.

Water Exercise for Arthritis Squat JumpsSquat Jumps

  • Stand in waist- or chest-high water.
  • Hinge your hips and bend your knees, lowering your body into a squat position with your arms reaching forward.
  • Jump up, coming out of the water, drawing your arms to your sides.
  • Land on the balls of your feet and lower your heels, bending your knees and hips into a squat landing.
  • Repeat as quickly as comfortable.

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