Arthritis primarily consists of two types: rheumatoid and
osteoarthritis. Osteoarthritis is a degenerative condition that results
from wear and tear on joints and breakdown of cartilage that covers the
ends of bones. Typical symptoms of osteoarthritis include pain and
stiffness that can be relieved by movement. Movement releases synovial
fluid which helps to lubricate the stiff joints.
rheumatoid arthritis is a systemic disease that affects the entire
body. Symptoms of rheumatoid arthritis include joint pain and
inflammation, especially in the hands and feet, and leads to joint
deformity over time. The challenge for people with rheumatoid arthritis
is that inflammation prevents normal use of joints and limits
activities. This reduced activity leads to loss of strength, endurance
and mobility. Over time, muscles and ligaments become so weak that
people experience further loss of function.
Exercise provides a
safe, effective and much needed intervention to prevent a continuous
cycle of functional loss. Through age alone, the average individual
loses muscle mass (50% between the ages of 20 and 90) and gains fat even
as the bones weaken. Add arthritis to this and the potential for a
rapid downhill spiral is certainly there.
The exercise goal for
people with arthritis is to increase range of motion (ROM), muscular
strength, flexibility, and balance, and to develop and maintain
endurance. Since arthritis is a joint disease, people with arthritis
need to try to move through each jointís active range of motion on a
daily basis. This regular movement helps prevent stiffness and loss of
mobility. Remember that range of motion is unique to each person and is
specific to each joint. Encourage full ROM, while reminding people to
tune into their own body cues.
Since people with arthritis may
move less during pain episodes, itís important for them to perform
higher intensity strength exercises when they are not in an inflamed
condition. Strength training supports the ability to maintain
function. Strong muscles also assist movement and enable activity with
less stress on joints. Therefore mobility should be encouraged as much
possible during every program.
the participants moving as soon as they get into the water. Walking to
engage the large leg muscles is the easiest and safest way to warm up
the body and immediately begin strength training for both core and the
Add some rocking movement to provide active stretching using balanced and coordinated movement for the arms and legs.
the Modified Rebound position for walking when strengthening the upper
body. This movement will submerged the shoulders for protection during
the power phase of muscle targeting and promote superior leg and core
strength with each forward step.
Even when inflamed, joints
can still be moved gently through as full a ROM as possible. In other
words, joint inflammation should not be an excuse to skip exercising.
participants to take responsibility for their own bodies, to recognize
their own limits, to respect pain, and to adjust the level of physical
activity to the level of disease activity. However, emphasize that
exercise will not always be pain free and that to maintain (and
hopefully increase their ROM) individuals will have to explore and
challenge their personal pain zone. This is not another way of saying
ďno pain, no gainĒ, but rather that arthritis has to be approached much
like rehab where you have to push a little past the point of pain and
then back off. If you consistently stop short of the point of pain,
your ROM will decrease. Very much in play here is the SAID principle: Specific Adaptations to Imposed Demands. Nevertheless, each participant must set limits to avoid overstressing a joint.
Basic Training Guidelines
balance and upper/lower body coordination challenges. These components
of fitness are absolutely essential to functional daily living.
Stress postural components and cue recruitment of transverse abs and other deep core muscles
Do strength training before cardiovascular training, especially if there are gait disorders.
an extended warm up of gentle range of motion exercises to fully warm
up joints before performing more vigorous strengthening or conditioning
Change activities and body positions frequently to avoid excessive joint strain from too many repetitions
working joints in the water but do not allow those participants with
high body fat to simply float around in deeper water. This will not
benefit their cardio, muscular strength, or endurance. Also, these
individuals need to lose weight and change their body compositions.
Moving to shallower water for reduced buoyancy assistance will help meet
Encourage participants to work at their own pace and
reduce intensity throughout exercise as needed. Itís far more likely
that you will have to encourage them to pick up the pace. You
absolutely donít want an infirmity
Avoid excessive impact or excessive momentum
sure to progressively challenge the clients capacity. As with any other
individual, strength training must be incrementally progressive in
terms of intensity. There is no evidence that those with arthritis or
even the frail elderly cannot handle high intensity exercise.
frequently (if using hand held equipment) to maintain a relaxed grip
and provide breaks for hand and wrist relief. All isometric exercise
increases blood pressure, so a tight grip kicks up the BP unnecessarily.
Thermo-regulate! Warmer body temperatures encourage greater
muscle elasticity and enhance ROM. Ideal water temperatures for
arthritis classes range from 83-88 degrees Fahrenheit (28 - 31 degrees
Celsius). For more comfort & warmth, participants can wear thermal
pool attire to cover arms, legs and the neck area and exercise mitts.
Remind participants to move continuously in the water to improve thermal
Key Exercises for Arthritis Participants:
Forward, backward, sideways, diagonal, ice skater, wide leg swings, add
balance exercises such as external hip rotation, grapevine for those
without Total Hip Replacements,
Lunges: Backwards ( alternate & stay on one side), Add combinations such as march, march , march and lunge.
Squats: with biceps curls to help get the buttocks down and up, sideways and combinations.
to strengthen hamstrings & gluteuals. Be sure to bend the knee on
the follow through. Excellent exercise for the supporting hip stabilizer
muscles and training balance and core.
to strengthen the quadriceps and Tibialis anterior. Excellent exercise
for the supporting hip stabilizer muscles and for training balance and
Arm swings with walking: ideally elbows are
kept at 90 degrees and arms swing movement initiates from the
shoulders. Start with short levers and increase range of motion to
longer lever swings,
Noodle cycling : Seated, or sidelining
cycling may be performed alternating legs for cardiovascular training
or for overload of the muscles when staying on one leg.
not jump nor bounce any movements. Try to anchor under the water to
maximize core strength and eliminate vertical stress or jarring on the
Use rocking to help with spinal mobility (front and back) and (side to side).
Use the cross-country ski for hip extension stretching and mobility.
Use a side walking JAX for hip stabilization.
Use a tuck jump (keep shoulders submerged) to stretch the lower back
Use a frog jump (keep shoulders submerged) for ankle, knee, hip and back mobility
moving for warmth and mobility to incorporate a variety of the basic
moves with upper body exercises. Use neutral and/or modified rebound
working position for protection of the shoulders. Walk, jog, rock,
kick, JAX, Cross country Ski or neutral working position jump/ ankle
These WaterART basic moves will provide infinite variety
and training for the body. For upper body training: start with short
levers, then increase lever length. Start with the hands slicing, then
fisting, then if able web using aquatic mitts.
Suggested upper body training:
Chest Fly ( arms cross in front of body - Pectorals)
Back Fly ( scapulae squeezes back Rhomboids)
Shoulder Horizontal Adduction
Shoulder Horizontal Abduction
Pull down for Latissimus Dorsi
Internal & External Shoulder Rotation with Elephant Trunk and/or Single Arm Figure of Eights for thoracic mobility.
Submitted by Bill Fitts,
Masters in Exercise Science from Central Connecticut University
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