Arthritis doctors say the warm water and jets of a Jacuzzi reduce arthritis pain and help you get exercise. Here's how to get started.

 

"The heat from the warm water makes joint movement in the person with arthritis much easier," says Washington, DC, rheumatologist Dr. Jack Klippel, president and CEO of the Arthritis Foundation. "We consider it an important component of therapy."

Sitting in a heated spa (hot tub) improves circulation. As your body temperature rises, blood vessels dilate, which enhances blood flow and relaxes body tissues. Spa jets massage sore areas, releasing tight muscles, improving range of motion, and relieving pain.

"More blood flowing to the joint makes it easier for you to move the joint. The massage causes the muscles to relax," Klippel says. "And having relaxed muscles allows for freer movement."

Spa Safety

Check with your doctor before using a spa, especially if you are pregnant or have a medical condition that might preclude you from using one. Soak safely by doing the following:

• Maintaining the water temperature between 98°F and 104°F Fahrenheit
• Gradually building up the amount of time spent in the water
• Staying in the tub for 15 minutes or less
• Not using the spa alone
• Avoiding alcoholic beverages or taking pain medication or muscle relaxers before or during spa use
• Getting out if you start to feel lightheaded or nauseous

Most hot tubs provide enough space to stretch small muscle groups supporting hands, wrists, knees, ankles, and toes. Some swim spas are even deep enough to perform aerobic routines and work large muscle groups. You can even get spas that come equipped with an underwater treadmill. If exercising in a swim spa, be sure to lower the temperature to between 83°F and 88°F.

Water Aerobics

Medical experts consider exercise essential for treating arthritic conditions. Without it, joints will stiffen and muscles will shorten. If morning stiffness plagues you, limber up in the spa before facing the day, or let the spa help you unwind after a busy one.

Note: The National Spa and Pool Institute recommends not soaking after a heavy meal.

Exercising has the following benefits:

• Improves balance and coordination, decreasing risk of falls
• Builds stamina
• Makes it easier to perform daily tasks, like writing and walking
• Enhances mood
• Relieves stress
• Elevates self-esteem and feelings of accomplishment
• Tightens and tones muscles
• Burns calories, which can help with weight loss

Why Water?

"Exercising in water is generally very good for patients, because there's less weight across the joints," Klippel says, especially people with osteoarthritis of the hips or knees, the most common form of arthritis. "It may also promote weight loss," he adds. "Any exercise for a person with arthritis that can lead to weight loss is very beneficial."

Water's buoyancy serves as a cushion, protecting joints during exercise routines. Because it is a liquid, water offers more resistance than air, helping people build muscle strength as they push against it.

Taking Classes

"I've seen many people make amazing recoveries, myself included," says Marie Ciaravino, an instructor at the Peggy and Philip B. Crosby Wellness Center in Winter Park, Florida. Ciaravino started walking in the water as therapy for a back condition, then progressed to water aerobics classes. Convinced of the benefits, she became an instructor.

You don't have to be a swimmer to enjoy water aerobics. One of Ciaravino's oldest clients is 94 years old. It's best to sign up for a group class, after receiving approval from your doctor. Call the local chapter of the Arthritis Foundation to find an approved aquatic program provider. If you have special needs, a physical therapist or water aerobics personal trainer can develop an individualized program.

Tips for exercise classes include:

• Always warm up before and cool down after exercising.
• Stay in water at a comfortable height.
• Watch your posture.
• Avoid standing on your toes and keep your shoulders relaxed.
• The Arthritis Foundation recommends moving each joint slowly through as much range of motion as possible, without forcing it, then repeating each movement three to eight times.

Have It Your Way

"Water aerobics is a very friendly and forgiving workout," Ciaravino says. "Nobody will notice if you miss a step. Even people who are not well-coordinated often feel at ease in the water." She goes on to say that you can work classes as hard or as easy as you want.

"You have to stay in tune with your body. If you don't feel good that day, tone it down," she continues. "Be kind to yourself. You don't have to work fast to get a good workout. If you feel pain, modify or eliminate that movement. Most importantly, do not try to push through extreme pain. If pain lasts more than two hours after exercising, you have done too much."

Want to Buy Your Own Spa?

Before buying, take a test soak. Ask to try a friend's spa or, during an out-of-town trip, stay at a hotel with a spa. If you're like many people, you'll find the water relaxing and will want to add a portable or in-ground model to your backyard or porch.

Test the spa you're considering. Sit in it, dry and wet, and ask yourself:

• Can you move around easily?
• Are the jets properly located to give you a good massage? Can you adjust them? Make sure the water pressure is not too powerful.
• Does the spa provide enough room to exercise?
• Is it easy to enter and exit? Can you add handrails, grab bars, or slip-resistant surfaces?
• Can you buy a cover lift to remove the lid? Covers keep the water warm and clean, but are quite heavy.
• Can you work the controls from inside the spa?
• Can you easily access the filter?

What About Mineral Water and Natural Hot Springs?

Although it is traditional to add minerals such as Epsom salts to hot baths to simulate natural hot springs, up until recently there was no evidence that this practice actually enhances benefits. However, in 2005 a respected German publication reported evidence that hot water infused with minerals may in fact offer superior benefits. In this study of 60 people with low back pain, use of a hot bath with high mineral content proved superior to a similar bath containing only tap water.

There was one problem with this study, however: it was single-blind rather than double-blind. Although the participants in this study did not know whether they were soaking in tap water or mineral water, the researchers did know. This was an error in study design that could have led to bias in the results.

Soak It All In

Whether you decide to invest in a spa for a convenient and more solitary experience or seek the camaraderie of exercising with others during a water aerobics class, let warm water's rejuvenating repertoire wrap you in comfort and renewed well-being.

RESOURCES:

American College of Rheumatology
http://www.rheumatology.org

Arthritis Foundation
http://www.arthritis.org

The Association of Pool and Spa Professionals
http://www.nspi.org

References:

Balogh Z, Ordogh J, Gasz A, et al. Effectiveness of balneotherapy in chronic low back pain: a randomized single-blind controlled follow-up study. Forsch Komplementarmed Klass Naturheilkd. 2005;12:196-201.

Questions and answers about arthritis and exercise. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.nih.gov/niams/healthinfo/arthexfs.htm.

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