May 25, 2022 9 min read

Arthritis is a chronic joint disorder affecting an estimated 3.6 million (15%) of Australians. Despite the pain and functional limitations it imposes on those affected, regular exercise is indispensable for effectively managing this condition. In particular, exercise reduces pain, sustains muscle strength in the affected joints, diminishes joint stiffness, averts functional deterioration, and enhances overall quality of life. Notably, exercise can be as efficacious in alleviating symptoms as pain medication and anti-inflammatory drugs, with fewer associated side effects and numerous additional health benefits.

Those with arthritis may feel that many forms of land-based exercise or physical activity are off-limits to them due to pain associated with achy and inflamed joints. The arthritic joint's unstable nature also puts many land exercises at high risk for falls. Often, the fear of experiencing pain is enough to put someone off working out entirely. However, movement is essential to a healthy body and mind and combating arthritis, so aquatic exercise can be an excellent solution for folks suffering from arthritis to exercise without exacerbating their joint pain. According to Arthritis Australia, water exercise is ‘one of the most comfortable and effective ways someone with arthritis can exercise.’


Arthritis is a broad term that refers to inflammation of one or more joints in the body. While there are over 100 types of arthritis, the most common ones include Osteoarthritis and Rheumatoid Arthritis.

Osteoarthritis (OA) is caused by wear and tear over time that erodes the protective cartilage that cushions the ends of the bones in a joint.In healthy joints, cartilage covers the surface of the joint, helps to absorb shock, and allows for smooth movement. In arthritis, the cartilage breaks down, tearing the ends of the bone unprotected, and the joint loses its ability to move smoothly. Risk factors include age, joint injuries, obesity, and genetics.

Rheumatoid arthritis (RA) is an autoimmune disease where the immune system attacks the lining of the joint capsule, leading to inflammation and joint damage. Its exact cause is unknown but is believed to involve a combination of genetics and environmental triggers.

Though arthritis is related to age-related decline, it can affect anyone at any age. It can be at any joint, but it’s most often felt in the hips, knees, fingers, toes, and neck.


Common symptoms across most forms of arthritis include:

  • Joint pain
  • Swelling
  • Stiffness
  • Redness
  • Decreased range of motion
  • Chronic pain

The severity and duration of these symptoms can vary; in some cases, they can lead to chronic pain and disabilities.

Arthritis is a leading cause of disability worldwide. A global study published in The Lancet projects that osteoarthritis rates will only increase until 2050, placing immense pressure on health systems. The prevalence of arthritis increases with age, and it's more common among women than men. There is a need to find ways to better prevent and manage osteoarthritis amongst all age groups. Prevention and appropriate management can help manage the symptoms and improve the quality of life for those affected.


Aquatic exercise has several benefits for orthopaedic conditions like arthritis because the water removes the weight of gravity and provides a low-impact supportive environment compared to exercising on land. Overall, the main benefits include:

Buoyancy: It reduces stress on joints, allowing for more effortless movement.

Resistance: Water provides natural resistance for muscle strengthening without adding heavy weights.

Temperature: Warm water can soothe joints and reduce pain.

Increased Circulation: Water’s resistance improves blood flow, which can help reduce inflammation and promote healing.


Our joints are designed to last us a lifetime, barring instances of joint replacements. Yet, the idea of undergoing anesthesia and having a surgeon replace an entire joint isn't the first step. Such surgeries are seen as a last resort, especially considering the extensive recovery and rehabilitation required after the procedure.

Regrettably, prevention often doesn't get the attention it deserves in musculoskeletal health. Engaging in low-impact activities like water exercises can be instrumental in preventing musculoskeletal problems throughout one's life. This approach is particularly beneficial for individuals with a genetic predisposition to arthritis or those who are overweight, making aquatic exercises an even more logical choice for them.


Carrying excess weight is a key risk factor for developing arthritis, especially in the knees. It’s no secret that water exercise is great for physical fitness by increasing muscle tone and cardiovascular endurance, leading to fat loss. Furthermore, aqua fitness is ideal for those with obesity or overweight due to the lessened impact on joints in the water.


Though the idea is for a joint replacement to be the last resort, at a certain point, it is necessary. Prehabilitation is a unique term in the prevention world that refers to improving functional outcomes before surgery to speed up recovery post-operatively and minimize any decline after surgery.

In this pilot study, knee osteoarthritis patients undergoing aquatic exercises for 4-8 weeks before knee arthroplasty displayed improved functional outcomes, mood, and cognitive function. Another study of 192 people with hip osteoarthritis concluded that aquatic therapy reduced pain both before and after a hip arthroplasty.



To avoid exacerbating symptoms, keeping joints loose and active through regular range of motion (ROM) exercises is essential. Often, when individuals experience pain, they develop a fear of movement. Unfortunately, this reduced movement can lead to even more pain, creating a vicious cycle. Thus, it's imperative to start managing arthritis symptoms early, preferably with aquatic fitness or therapy. Doing so can significantly enhance an individual's quality of life for an extended period.


When fear of movement takes hold, numerous health aspects are at risk: cardiovascular endurance decreases, muscle tone weakens, bone density drops, and, broadly speaking, overall quality of life diminishes.


Since aquatic exercise is excellent at recruiting smaller stabilizer muscles and activating core muscles, it is a great way to improve balance. This is especially important in people with already limited movement, like arthritis.

This study assessed the impact of aquatic exercise and education on fall risk factors among elderly individuals with hip osteoarthritis (OA) and included 79 participants aged 65 or above with hip OA. Results showed that combining aquatic exercise and education significantly enhanced participants’ confidence to prevent falls and functional performance, highlighting its effectiveness in lowering fall risk factors for those with arthritis.


While the physical advantages of water-based exercise are clear, it's essential not to overlook the psychological benefits, especially for arthritis patients. There’s something about immersing oneself in water that can offer a sense of relaxation; there’s even blue space science to back it up. The soothing properties of water can provide relief not just to the joints but also to the mind, helping in reducing stress, anxiety, and even depressive symptoms, which often accompany chronic pain conditions.

Moreover, as patients notice improvements in their physical capabilities, they often experience a boost in self-esteem and confidence. This can set off a positive feedback loop: increased confidence can lead to more regular exercise, which can lead to better mental and physical health.


It’s not to say that only older people suffer from arthritis, but generally, the aging population is in the most arthritic pain. There are multiple other benefits associated with group exercise classes since classes can foster a sense of community and support.

For many arthritis sufferers, especially the elderly, feelings of isolation or loneliness can be overwhelming. Participating in group classes allows individuals to connect with others who may share similar experiences and challenges. This camaraderie can be incredibly motivating and an added incentive to attend classes regularly.


Since many aquatic classes are group classes, it can be a real opportunity for connection among people in pain. This study aimed to determine if a community-based aquatic exercise program could enhance the quality of life for osteoarthritis sufferers. After a 20-week trial involving 249 participants, it was found that aquatic exercises positively influenced the perceived quality of life, especially among obese participants. The research suggests that community aquatic programs could benefit those with obesity and osteoarthritis.


This review, which encompassed 20 studies, found that aquatic exercise significantly reduced pain compared to both control and land-based exercise groups. A similar article examined the benefits of aquatic exercise for individuals with knee or hip osteoarthritis by examining data from 13 trials involving 1,190 participants. Both of the studies revealed that aquatic exercise can offer short-term improvements in pain, disability, and quality of life for arthritic patients.

Compared to land-based training, participants from this study had higher adherence and satisfaction in the aquatic training group. Researchers from a similar meta-analysis determined that positive results from aquatic exercise were sustained for 3 months post-intervention. Both large-scale review studies concerning aquatic training for knee osteoarthritis deemed aquatic exercise safe, with no significant adverse events reported.


Though most clinical research focuses on osteoarthritis, aquatic therapy can assist with other types, like rheumatoid arthritis. In a controlled trialwith 82 female participants with Rheumatoid Arthritis water-based aerobic exercise improved disease activity, pain, and functional capacity more than land-based aerobic activities.


Hydrotherapy, or water therapy, is also recommended as an adjunct therapy to help manage ankylosing spondylitis (AS), which is an inflammatory type of arthritis that affects the spine and sacroiliac (SI) joint. In a recent meta-analysis study, authors concluded that water treatments can help lessen pain and symptoms for people with ankylosing spondylitis.


Did you think that swimming was the only form of exercise you could do in a pool? Think again. There are multiple types of workouts that can all be done in the water to keep the impact on the joints low while still burning calories and building strength. There is even specialised aquatic equipment for this method of working out.



Water cycling, or aqua cycling, is performed on an Aqua Bike. It’s an excellent cardiovascular workout. Of course, it also challenges muscular strength and endurance, focusing on the quadriceps, hamstrings, calves, glutes, and core.

A Water Resist class participant mentioned that she loved doing aqua cycling in the morning to loosen up her joints and reduce arthritic pain in her knees and hips before the day began. Water cycling can even become a part of daily routine, especially for those with arthritis or those reaching a certain age who appreciate low-impact cardio.


Water circuit classes are low-impact classes that improve cardiovascular health and muscle strength, too. This way of working out can be flexible and fun to intense and strenuous. Specific water circuits for arthritis are key for optimal benefits. The best part is that the water is forgiving, and people can feel like they can push themselves without risking injury.


Walking or running on underwater treadmills uses water resistance for a low-impact cardio workout. Due to this resistance, the muscles are also working a bit harder than on land.


Several kinds of resistance exercises can be employed in the water using equipment like foam weights or resistance bands. Also, any bodyweight exercises that can be done on land can be done in water. For example, squats and lunges are perfect lower-body resistance moves that may be painful on land for someone with arthritis in the knee or hip joints. These moves become much more accessible with the water’s support, however.


Water fitness encourages flexibility, including flexibility at the joints. The water relaxes the muscles enabling more stretch (approx.10%). Gentle stretches and movement performed in water can be very beneficial for increasing flexibility and reducing stiffness.



While swimming, when you turn your head to breathe, ensure that you do it with a controlled, smooth motion. This exercise provides gentle stretching for the neck, promoting mobility without straining.


With the help of a pool noodle or float, keep your head above water and allow your body to float. Move your head slowly from side to side. It provides relief by stretching and relaxing the neck muscles.



With hands submerged, open them wide, then swiftly clap them together. Do this repeatedly. It’s simple yet effective for hand arthritis.


Of course, swimming is always an excellent option for those with arthritis, particularly in the hands and the spine. A freestyle arm pull or breastroke arms can be helpful for the hands and arthritis in the fingers.

Back swimming may be better for those with arthritis in the neck so that no pressure is placed on the neck’s delicate structures when turning the head to breathe, like in a normal freestyle stroke.


  • Practice patience. It’s important to ease into aquatic exercise.
  • Stay hydrated even if you’re not feeling thirsty in the water as it helps to lubricate the joints. Water is a component of synovial fluid, which lubricates and cushions the joints and cartilage surrounding them, keeping bones from rubbing together. It also helps cartilage keep its sponginess. Proper hydration can improve the production of synovial fluid, reduce inflammation, and maintain the shock-absorbing properties of cartilage.
  • Practice post-exercise care, like gentle stretches, warm showers, and adequate rest.
  • Consult with a water specialist for personalised advice.
  • Invest in appropriate swimwear and accessories, like water shoes for grip.
  • Use the ramp to enter the pool safely if suffering from a lower limb arthritic condition.


The advantages of aquatic exercise for arthritis are numerous. Working out in the water is an excellent way to prevent musculoskeletal strain that can lead to arthritis, soothe pain, and relieve the symptoms, and it can also serve as a medium for prehabilitation and post-rehabilitation for joint surgery. Aquatic fitness is excellent for managing arthritis symptoms by maintaining flexibility, keeping fear of movement at bay, lowering fall risk by improving strength and balance, decreasing pain, and improving quality of life overall.

If you or a loved one suffers from arthritis or its genetic disorder, the earlier you start with aquatic exercise, the better your body will feel. Speak with a water specialist for an aquatic program as a part of an arthritis management plan.

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