Hip and knee osteoarthritis is one of the leading causes of disability throughout the world. Being the most common type of arthritis, osteoarthritis is characterized by inflammation, localized loss of cartilage, and remodeling of surrounding bone. Three major problems of osteoarthritis are decreased quality of life and increased pain and disability. Although there are no cures for osteoarthritis, medication, education, weight loss, and exercise are recommended as the best places to start with conservative treatment.
Exercise is a very generalized term defined as “activity requiring physical effort, carried out especially to sustain or improve health and fitness”. There are aerobic exercises, things like walking, running, biking, and swimming which target primarily the cardiovascular system and endurance of muscles. Aerobic exercise also has vast benefits, one of large interest is reducing pain.
At times with osteoarthritis when pain is severe and regular aerobic activities are difficult to perform, having a method to exercise that limits stress to joints can be a great way to get the benefits of aerobic exercise and movement without the impact of walking or running. The water is a great way to limit the stress through joints. Depending on the depth of the water, one could take off 25%, 50%, or even 90% of one’s body weight. Therapeutic water temperatures typically range between 89-96 degrees which can also help with comfort during exercise.
Aquatic exercise for those with osteoarthritis may sound and feel good, but does it improve one’s pain, disability, or quality of life? The best research shows that there is moderate evidence for small short-term improvements in pain, disability, and quality of life.
Now, small and short-term may not sound great, but with an incurable, degenerative disease this is a great option for either management of the condition or as a bridge to other land based exercises. Also, if I told you that I walked 4 miles a year ago, then sat on a couch for the next year, would you expect that the walk to help me a year later? Short term improvements are typically described on a days to weeks basis while long term improvements are usually described as one to two years. Exercise is a powerful stimulus, but inactivity is even more powerful. The concept of “use it or lose it” has been displayed time and time again in research. So unfortunately, one cannot afford to “bank up” a bunch of exercise and then stop, expecting the previous exercise to last all the way through retirement. Small improvements may also sound discouraging but currently there are not any interventions that consistently make large improvements in pain, function, and disability.
Aquatic exercises can be a great option for individuals with hip or knee osteoarthritis, especially when “land-based” exercises are too challenging. The ability of water to decrease the amount of stress through the knee and hip joints, combined with warmth, can make exercising feel great. If you know someone with arthritis whom struggles to exercise due to the discomfort, ask them if they have tried aquatic exercises. A physical therapist can help individuals create a custom exercise program which can help integrate aquatic and land based exercises to try to optimize improvements in both pain and function.
Aquatic Exercises for Hip and Knee Osteoarthritis
Marcia R. Franco, Priscilla K. Morelhão, Augusto de Carvalho, Rafael Z. Pinto; Aquatic Exercise for the Treatment of Hip and Knee Osteoarthritis, Physical Therapy, Volume 97, Issue 7, 1 July 2017, Pages 693–697, https://doi.org/10.1093/ptj/pzx043
Exercise-definition of exercise, Oxford, https://en.oxforddictionaries.com/definition/exercise. Accessed 14 Aug. 2017.