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Aquatics Offers Freedom
By Dianna Borsi O’Brien
I believe in activity and movement. I think arthritis steals a person’s body and their spirit by limiting their movement, and if people can allow themselves to keep moving longer, they’ll enjoy better quality of life.
These are the reasons Joanne Macher gave for training to teach Aquatics, an in-pool exercise program for people with arthritis.
Macher knows about arthritis – she has osteoarthritis -- and she knows about the benefits of water-based exercise. She has more than 30 years of experience as a swimming coach and more than 45 years as a swimming instructor.
“Exercising in the pool gives you freedom,” said Macher. “Freedom from gravity. You can move and not pay the price for it. In the water, you can balance on one foot and if you fall over, you won’t get hurt. I’ve never heard of anyone falling in the water and breaking a hip. On land, all the time.”
But it’s not just the water that provides the benefits, say health care experts.
“It has to be warm water,” said Marilee Bomar, R.N., M.S.(N), associate director of the Central Missouri Regional Arthritis Center (CEMRAC) in Columbia, Mo.
Aquatics is a specialized class developed by the Arthritis Foundation. The one-hour class includes 50 minutes of water-based exercise as well as warm-up and cool-down exercises. The class is usually offered on a two to three times a week basis.
Aquatics is beneficial for four reasons.
1. Warm water helps limber up stiff joints and ease pain of arthritic joints. For Aquatics, the water must be kept at 83 degrees or warmer.
2. Water supports a person’s weight and takes the pressure off joints.
3. The weightless effect of water allows for easier movement while the warmth of the water eases painful joints.
4. Water offers resistance, allowing exercisers to do strength training without putting weight or additional stress on their joints.
Research Findings
For people with fibromyalgia, research findings reported in the February 2001 issue of Arthritis & Rheumatism showed the benefits of pool-based exercise. Such exercise, the report state, resulted in improvements in “cardiovascular capacity, walking time and daytime fatigue.” The report noted that people with fibromyalgia who did pool based exercises also showed improvement in “days of feeling good, self-reported physical impairment, pain, anxiety, and depression.”
The results lasted, too. “The results were mainly unchanged at six months followup,” the report stated, concluding that pool-based exercises “may have some additional effects on symptoms.” The study included 18 people with fibromyalgia who did pool-based exercises and 16 people with fibromyalgia who did land-based exercises. The assessments were based on the Fibromyalgia Impact Questionnaire, the Arthritis Self-Efficacy Scale and physical fitness tests.
People with rheumatoid arthritis who did hydrotherapy – a combination of warm water immersion and exercise – had significant improvement in joint tenderness and in knee range of movement. Again, the results lasted. “At follow up, hydrotherapy patients maintained the improvement in emotional and psychological state,” according to findings published in the June 1996 issue of Arthritis Care & Research.
The study involved 139 people with rheumatoid arthritis. The subjects were randomly assigned to groups to receive hydrotherapy, seated immersion, land exercise, or progressive relaxation. The sessions were twice a week for four weeks.
The abstract conclusion noted, “Although all patients experienced some benefit, hydrotherapy produced the greatest improvements.”
Dangers and Difficulties
Cold water can actually increase joints stiffness and the difficulty in movement for people with arthritis. The ideal water temperature for people with arthritis, she said, would be 87 degrees. Typically indoor pools are kept at 78 degrees, temperatures more agreeable to lap swimmers and competitive swimmers.
The air outside the pool should also be warm, cooler air could increase stiffness for people with arthritis.
The need to heat the pool and the air outside the water can make it difficult to find a facility willing to host Aquatics. Few clubs are willing to incur the increased costs of heating the water and air to these high temperatures. The higher water temperatures also make the pool less attractive to lap swimmers and other water athletes, making the pool use limited to those taking Aquatics.
Not Just Water-based Exercise
Aquatics is more exercising in the water. Aquatics for arthritis offers six features:
1. A shorter repetition cycle
2. No heavy lifting
3. Fewer repetitions, with a focus on not overstressing a joint
4. An emphasis on strengthening muscles and tendons
5. A focus on stretching, increasing flexibility, motion and range of motion
6. Some attention to increasing cardiovascular endurance
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