Physical activity is widely recognized as an effective, safe, and feasible component of standard care for individuals with inflammatory arthritis, including those with spondyloarthritis (SpA). However, one often-overlooked option for physical activity among individuals with SpA is water-based exercise. In this article, we explain why and how water exercise is so beneficial, and we give tips to optimize your water aquatic routine.
Benefits of Therapeutic Exercise
Therapeutic exercise, both land and water-based, is the most important non-pharmacological intervention in patients with SpA, having a preventive and therapeutic purpose. General positive effects of exercise include reduced risk of cardiovascular and metabolic diseases; maintenance of cognitive functions; increase in bone density; and improvement of mental health. In addition, exercise improves strength, mobility, balance, and coordination, reducing the risk of fall.
Some studies suggest that water exercise has increased benefits when compared with land exercise. Movement in water is often less painful than the same movement on land. An aquatic exercise program can improve circulation, muscle strength, flexibility, range of motion, and cardiovascular and respiratory conditioning. It can also reduce pain and muscle spasms.
The Science of Water Exercise
An understanding of hydrodynamic principles helps explain why water exercise has therapeutic benefits.
To help with arthritis, it is recommended to use warm water with a temperature of about 82-88°F/28-31°C for aquatic exercise programs. This warm water can help block pain receptors and improve proprioception by affecting thermal and mechanoreceptors. When the body is gradually immersed, the water displaces and creates an upward force called buoyancy. This force progressively offloads weight from the joints that are immersed. For example, when a person is immersed up to the symphysis pubis (i.e., the joint located at the front of the pelvis), about 40% of their body weight is effectively offloaded. Further immersion up to the navel offloads approximately 50%, and immersion up to the xiphoid (i.e., the lowest part of the sternum) offloads about 60% of body weight. When the immersion is up to the neck, only about 15% (15lb/7Kg) of compressive force is exerted on the spine, hips, and knees.
Hydrostatic pressure is the force that a liquid puts on an object when it is submerged or surrounded by the liquid. It happens because of the weight of the liquid pushing down on the object from all sides. Hydrostatic pressure is directly proportional to both the liquid density and the immersion depth. When a person is immersed in water up to their neck, the hydrostatic pressure exerted by the water on their body increases. This increased pressure helps to compress the tissues and blood vessels in the lower limbs, reducing swelling and promoting better circulation. In addition, neck-deep immersion in water makes the respiratory muscles work harder, strengthening both primary and accessory respiratory muscles and helping to improve the limited lung expansion that often affects people with spondyloarthritis.
Moreover, getting into the water we can use the speed of movement, frontal surface, the shape of a moving object (e.g., one’s palm or aquatic exercise equipment) and levers (limbs and joints) to adjust the level of the resistance. In more detail:
Getting the Most of an Aquatic Exercise Routine
The WHO, ACSM, and EULAR recommendations for patients with inflammatory arthritis are to combine three different types of exercise: cardiovascular (aerobic), resistance (strength), and flexibility (stretching). (Editor’s note: Many other organizations, such as the American College of Rheumatology, stress the importance of a fourth type of exercise: balance.) This exercise plan requires a significant time commitment. For cardiovascular exercise, the plan recommends 30-60 minutes per day, up to 5 days per week. For resistance exercise, training each major muscle group 2-3 days per week is suggested, with rest intervals of 2-3 minutes between sets. Flexibility exercises should be done 2-3 days per week, with each session lasting around 10-30 seconds per stretch. Overall, this plan requires consistent dedication and time allocation to achieve the recommended exercise goals.
However, results show that a combined exercise program (range of motion, strengthening, and aerobic exercises) seems to be more beneficial rather than range of motion exercises alone. An aquatic exercise program can easily give a safe and effective solution by combining the different types of exercise. In addition, aquatic exercise can achieve positive results in fewer training sessions by establishing the following training guidelines:
All photos by Andreas Iacovou
Warm-up: Begin by walking in the water, gradually increasing your pace. This helps to warm up your muscles and prepare your body for the exercises.
Water marching: Stand in chest-deep water and lift your knees high, as if marching in place. Engage your core and maintain good posture throughout. Perform 10-15 repetitions. This exercise helps to strengthen your leg muscles and improve mobility.
Water squats: Stand with your feet shoulder-width apart in chest-deep water. Slowly lower your body into a squat position, as if sitting back into an imaginary chair. Keep your knees aligned with your toes and your back straight. Rise back up to the starting position. Repeat for 10-15 repetitions. This exercise strengthens your leg muscles and improves mobility.
Arm curls: Stand in shoulder-deep water with your arms extended straight down. Hold a water dumbbell or a water bottle in each hand. Bend your elbows and bring the weights towards your shoulders, then slowly lower them back down. Perform 10-15 repetitions. This exercise targets your biceps and improves upper body strength.
Leg kicks: Hold onto the pool edge or use a flotation device for support. Extend one leg straight out in front of you, then kick it out to the side, and finally bring it back to the center. Repeat this movement for 10-15 repetitions on each leg. This exercise helps to strengthen your hip muscles and improve mobility.
Water lunges: Stand with one foot in front of the other, hip-width apart, in chest-deep water. Take a step forward with one leg and lower your body into a lunge position, keeping your front knee aligned with your ankle. Push back up to the starting position and repeat on the other leg. Perform 10-15 lunges on each leg. This exercise strengthens your leg muscles and improves mobility.
Cool-down: Finish your aquatic therapy routine by walking in the water at a slower pace for a few minutes. This helps to gradually lower your heart rate and cool down your body.
Remember to consult with a healthcare professional or a certified aquatic therapist before starting any new exercise routine. They can provide personalized guidance and ensure the exercises are suitable for your individual needs.
Further Resources:
Input your search keywords and press Enter.
