In the Swim: Aquatic Exercise for Arthritis

Water-based activities can help ease arthritis symptoms.

By Linda Rath | Aug. 15, 2022

For decades, if rheumatologists mentioned exercise at all to their arthritis patients, it was generally swimming and other types of water (aquatic) exercise. Now, exercise is known to be an essential part of arthritis treatment. Done regularly, strengthening, stretching and cardiovascular activities reduce pain, improve lung and heart health and restore or maintain flexibility and strength. Aquatic workouts do all this, too, while putting less stress on joints and allowing more movement with less strain.

Aquatic Exercise and OA

Although there’s plenty of evidence that aquatic exercise is beneficial for all types of arthritis, a lot of studies have focused on people with knee or hip osteoarthritis (OA). For example, Korean researchers reviewed 20 randomized controlled trials about degenerative arthritis and aquatic exercise — defined as walking, running or weight training in waist- or chest-high water. Without exception, the studies showed that water workouts reduced pain and joint dysfunction and improved quality of life for people with OA. Of particular note: Aquatic exercise relieved pain better than land-based exercise, possibly because warm pool water relaxes muscles and nerve endings. Also, aerobic exercise in general may change the way the brain processes and perceives pain.

The studies the Korean researchers looked at varied. In some, aquatic exercise was compared to land-based exercise; in others, it was compared to not exercising. In studies where aquatic exercise was paired with land-based weight training and cardio, it was hard to tease out what was most beneficial. But the main finding was that people with OA who exercised had less pain and better function than people who didn’t.

The studies lasted from a few weeks to three months. Most aquatic sessions took about an hour and were performed two or three times a week. Quality of life improved more as time went on, possibly because the more people exercised, the better they felt.

While these findings are encouraging, a lot of people don’t have access to heated pools and trained instructors; others are afraid of or dislike water or never learned to swim. If you’re timid around water, gear like kickboards and flotation vests may help.

And although water’s buoyancy is ideal for older adults and people who are obese, land-based exercise can provide the same health benefits, though without the extra mobility and support you get in the water.

Aquatic Exercise and Inflammatory Arthritis

Water-based exercise, including swimming laps, has also been studied in patients with inflammatory forms of arthritis, including rheumatoid arthritis (RA) and spondyloarthritis. One review of nine studies involving more than 600 patients showed that exercising in water relieved pain, improved function and lowered disease activity — sometimes better than land-based exercise did.  

In 2022, the European Alliance of Associations for Rheumatology (EULAR, formerly known as European League Against Rheumatism) published new treatment recommendations for most types of arthritis. The organization’s international task force looked at a range of exercises for each arthritis type.

They found that aquatic exercise led to small to moderate improvements in pain and function for people with RA. High-intensity exercise was more beneficial than low-intensity — for example, jogging in place as opposed to paddling around in the pool’s shallow end.

Overall, the task force found that both land-based and aquatic exercise improved pain, function and quality of life, and it recommended daily exercise for everyone with a rheumatic disease.

The American College of Rheumatology (ACR) also strongly recommends physical activity as a key part of treatment for arthritis, but it doesn’t suggest specific types of exercise. One exception is tai chi, which gets a big thumbs-up. The ACR stresses that patients need specific guidance about the amount and kind of exercise, not a vague suggestion to “move more.” Also, exercise must be affordable and accessible, which doesn’t always apply to pool workouts.

Aquatic Exercise and Juvenile Arthritis

Kids with arthritis tend to be less active than their peers, yet exercise is crucial for improving health outcomes and building resilience and confidence as children grow. Experts say children with arthritis should learn to manage their pain and other symptoms so they can participate in life as fully and confidently as other kids.

A group of Canadian experts called the Ottawa Panel evaluated different types of physical activity for juvenile arthritis based on systematic reviews of randomized controlled trials. They found benefits for almost every type of exercise, including Pilates, land-based strengthening programs, aquatic aerobic exercise and cardio karate (which uses basic karate movements but is more free form). All improved pain, range of motion, function and quality of life.  Other studies have shown that balance training, running in the water and underwater resistance work are also great for kids with arthritis.

Exercise Tips

Exercise is central to arthritis treatment, no matter what your age, fitness level or type of arthritis. Water workouts may help you move with less discomfort and better range of motion, and you may find you can more easily do things in the water than you can on land. A few tips:

  • Be sure the part of your body you’re working is submerged in water.
  • Start slowly and gently and work up to more intense movements as you get warmer. If you’re in a class, your trainer will make sure you warm up and cool down.
  • Check with your local YMCA or rec center. They often offer free or low-cost classes for kids and adults.