Rheumatoid Arthritis–Friendly Water Exercises
Easy on the joints and soothing, water workouts are recommended for people with RA. Here’s how to get started.
By Stacey Colino
Medically Reviewed by Alexa Meara, MD
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Ahhh, hydrotherapy. You’re probably familiar with the fact that immersing yourself in water can be comforting and soothing. That’s why people often take a warm bath when they have body aches or sit in a Jacuzzi or hot tub when they want to relax.
But you may not realize that if you have rheumatoid arthritis (RA), exercising in water can make you feel better too, easing joint stiffness, decreasing pain and swelling, and improving your range of motion. It may be more comfortable to move in water when you’re in pain — indeed, people with RA reported feeling much better right after working out in warm water than they did after otherwise similar exercise on land, according to research published inBMC Musculoskeletal Disorders — and if it feels better, you may be more likely to do it.
Why Water Workouts Feel So Darn Good
Exercise in water is beneficial for those with chronic pain conditions for several reasons. For one thing, “the buoyancy of the water off-loads your body weight and reduces impact on your bones and joints as you move,” explains Paula Richley Geigle, PhD, a clinical research physical therapist at the University of Maryland School of Medicine in Baltimore. Plus, “the viscosity of the water adds natural resistance while your weight is off-loaded, and the pressure from the water gives sensory input to the joints in a gentle way that helps you reestablish a neutral body position and train balance. This can help reduce your risk of falls.”
Water Workout Pitfalls
Don’t be fooled into thinking water workouts are easy. Whether you swim, walk, jog, or do aerobic moves in water, you’ll get a cardiovascular workout and a strength-building one. Among people with rheumatoid arthritis, running in water while wearing a flotation device increased heart rate and ratings of perceived exertion more than riding a stationary bicycle did, according to research published in the journalPhysical Therapy.
“Pushing a limb through water resistance, compared with air, requires more energy but will be slower and will help strengthen muscle,” notes Paresh Jobanputra, doctor of medicine, a consultant rheumatologist and a clinical service leader at the Queen Elizabeth Hospital in Birmingham, UK.
Workout Bonus for People With RA
Besides being important for weight control, these aerobic and strength-building benefits help mitigate the risk of complications, such as heart disease and bone loss, that naturally come with RA. Water workouts also can “mediate some of the metabolic effects that occur from RA by bringing bad inflammatory proteins down and increasing anti-inflammatory substances in the body,” Geigle explains.
What’s more, exercising in water allows you to have a greater range of motion, which enhances flexibility, notes Kimberly Sackheim, DO, an assistant clinical professor of rehabilitation medicine at the New York University Langone Medical Center in New York City. “Working out in water challenges opposing muscle groups — namely, those involved in flexing and extending — which strengthens muscles on both sides of a limb or the body without causing pain. This is significant because it helps prevent muscle imbalances from developing and improves overall movement efficiency.”
Ways to Exercise in the Water
When it comes to exercising in water, there’s a menu of options to choose from. Start by selecting an activity such as water jogging, water Zumba, aqua cycling, or ai chi (which is like tai chi in water). “You don’t have to be a swimmer or even put your head in the water,” Geigle says. “Work with a skilled professional at the beginning to find a program that’s safe for you.” Over time, you can work up to more intense aqua aerobics classes or lap swimming. Many gyms, health clubs, and community pools offer water-based exercise classes, or you can do pool walking on your own once you get the go-ahead from your doctor.
Getting Started in Aqua Exercises
Your best bet is to start slowly (with twice-a-week water workouts) and gradually increase the frequency or intensity as your pain level goes down and your fitness level goes up. Then, you can add more complicated maneuvers or different devices (such as resistance bands, flippers, water balls, or aquatic dumbbells) to increase the challenge, Dr. Sackheim says.
“My patients usually start with a six-week program, then we reevaluate to see if it’s necessary to continue it,” she says. “Most of them end up going for a few months, then continue the exercises daily on their own.” The pain-reducing benefits of aqua exercise tend to be cumulative over time, which means the longer you do it, the better you’ll feel and function.
Video: How to Do Water Exercises for RA | WebMD
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