Aquatic exercise is one of the most studied — and recommended forms — of hydrotherapy for people with RA. Exercising in water allows for strength training, aerobic exercise, and flexibility work with less stress on the joints than with land-based exercise, says Thoma.
“Doing exercise in the pool can have several benefits, including taking the load off of painful joints, providing a soothing sensation, warming joints in a warm rehabilitation pool, and providing pressure, which can help with inflammation and circulation,” she says.
For some people with RA, exercising on land may be harder because of the impact on their joints. “In this case, starting in the water can be a gentler approach to start moving,” Thoma says.
Exercises include water walking, leg lifts, sidesteps, and arm exercises, typically in a large pool that’s about 80 degrees F, Gallucci says. The warm water combined with the buoyancy of a pool allows patients to perform these low-impact movements safely while the water resistance strengthens muscles.
Gallucci says that physical therapists often supervise these exercises initially — in one-on-one sessions or in small group classes. “Once [patients] learn from a trained physical therapist and understand the exercises, there’s no reason why they wouldn’t be able to add one or two days on their own.”
One study that followed 43 women with rheumatoid arthritis found that a 12-week supervised aquatic exercise program — with 45-minute sessions twice a week in a warm pool — led to small improvements in physical fitness, but “large effects” on improving pain and, in turn, depression.
A systematic review of nine controlled studies and 604 adults with inflammatory arthritis — including rheumatoid arthritis — found that exercise in warm water helped with improving key outcomes, such as pain, disease severity, and daily physical function compared with land-based exercise or no exercise at all.
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