June & July 2016: Common Joint Disorders

SPOTLIGHT ON AQUATICS & OSTRO & RHEUMATOID ARTHRITIS 

THE POOL IS CUSTOM-MADE FOR TREATING COMMON JOINT DISORDERS 

Content courtesy of the National Swimming Pool Foundation

One of the most effective treatments for the management of the symptoms of arthritis is physical exercise. However, many people mistakenly think that any kind of exercise will aggravate pain and further cause damage to the joint. Unfortunately, this belief diminishes exercise options for the person with arthritis, which often results in individuals abandoning exercise altogether. Pain means that people move LESS which means that those same people will experience more pain, more stiffness, new weakness and further destruction of arthritic joints. 

The therapeutic pool offers a unique environment in which patients can improve both the resistance to, and the assistance of, movement without fear of overdoing exercise, damaging the body or suffering a fall. So, knowing that, what would you think would be the #1 diagnosis seen in the pool across the country? Without question, the therapy pool was made for the patient with osteo- and rheumatoid arthritis. Read more about the effects of aquatic exercise below.

RECENT PUBLICATIONS

ANSARI ET AL, 2014
This study was designed to evaluate the effects of aquatic exercise on knee pain and motor performance associated with daily living activities and recreation in men over 50. The authors found that knee pain, symptoms, and motor function all significantly improved over the control group after a program of regular aquatic exercise for 6 weeks. Based on their findings, the authors recommend aquatic exercise as a safe and effective method of treatment for improving symptoms and quality of life in men over 50 with knee osteoarthritis.

Bartels ET AL, 2016
Osteoarthritis currently has no cure available, so the value of treating symptoms, improving quality of life, and decreasing pain is paramount. The authors of this study set out to review various trials involving the treatment of osteoarthritis by aquatic therapy. The trials that they reviewed showed an increase in quality of life and a decrease in pain after a mean of 12 weeks of aquatic exercise. 

Castrogiovanni ET AL, 2016
The authors of this study set to review methods of managing osteoarthritis and its symptoms. They conducted a literature search to compare various studies on the effects of physical activity. They researched findings concerning different methods of treatment, including underwater treadmill exercise and aquatic resistance exercise. Although they found that the methods of aquatic exercise may differ depending on the circumstances of the patient’s condition, they found that generally, these interventions had a positive effect on managing pain and improving quality of life for those suffering from osteoarthritis.

Davis ET AL, 2015
This study set out to demonstrate the effectiveness of aquatic exercise programming in minimizing pain of older adults suffering from osteoarthritis. The studies focused on strength, endurance, and balance by using aqua aerobic exercises. The authors conducted these interventions with community-dwelling adults over the age of 50.

Elnaggar ET AL, 2016
In this study, the effects of resistive underwater exercises and interferential current on the peak torque of the quadriceps and hamstrings and pain levels in patients with juvenile idiopathic arthritis we researched. The control group participated in a traditional physical therapy program, while the study group received resistive underwater exercises and interferential current therapy. After both 1 and 3 months of therapy, the study group showed a significant increase in comparison to the control group, suggesting that resistive aquatic exercise is a beneficial treatment for juvenile idiopathic arthritis.

Fisken ET AL, 2014
Aquatic exercise can be recommended as a more enjoyable therapeutic treatment for osteoarthritis than other traditional physical therapy interventions. This study compared various aquatic interventions with a group of older adults and found that subjective enjoyment increased while pain scores decreased. The authors suggest aquatic exercise as an enjoyable alternative to mediate the symptoms of osteoarthritis.

Fisken ET AL, 2015
Similar to any other treatment method, there are some specific barriers to aquatic exercise that may decrease compliance. The authors of this study conducted focus groups with older adults with osteoarthritis to discuss barriers they had observed that limited them from continuing to pursue aquatic exercise. The key barriers identified were a lack of classes, insufficient instructor knowledge, and cold water and changing facilities. They also found that key benefits perceived by the group included increased physical activity and social interactions. The authors suggest keeping these issues in mind when planning aquatic interventions in order to increase compliance.

Fisken ET AL, 2015
Many adults with osteoarthritis may be physically inactive, which may lead to worsening of their symptoms. The authors of this study researched the effects of aquatic fitness programs on older adults with osteoarthritis. The results of the study suggest that aquatic fitness classes are an accessible and effective method for reducing fear of falls, increasing quality of life, and managing pain.

Fisken ET AL, 2015
This study conducted a focus group of older adults with and without osteoarthritis to discuss their perceived motivation and benefits that incentivizes them to attend aquatic treatment classes. Pain reduction was the primary motivator for those with osteoarthritis, while increased health and fitness motivated the non-OA group. The authors suggest considering these motivators when planning treatment interventions to increase adherence.

Fortunati ET AL, 2016
Spa therapy is a popular treatment for many rheumatic diseases, including osteoarthritis of the hand. This study summarizes the literature currently available that demonstrates the clinical effects and mechanisms of action of spa therapy in OA of the hand. The result of this study supports a beneficial effect of spa therapy in treating pain, function, and quality of life in hand osteoarthritis.

Lau ET AL, 2014
The aim of this study was to examine how effective and feasible a community-based aquatic exercise program would be in treating older adults with knee osteoarthritis. This 10-week program measured outcomes including range of motion and power of extension of the knees, functional reach tests, and repeated sit-to-stand tests. The authors found that the median range of knee flexion improved, in addition to the median strength of the quadriceps. They also found improvements in the other outcome measures tested. These findings suggest a benefit in community-based aquatic exercise as a self-management option for older adults with knee osteoarthritis.

Lu ET AL, 2015
This systematic review assessed literature of trials comparing aquatic exercise to a control group. They found evidence for considerable short-term benefits for those suffering with osteoarthritis compared with land-based interventions. The results of this meta-analysis suggest aquatic exercise as a safe management option for osteoarthritis.

Manukka ET AL, 2016
This study assessed the efficacy of aquatic resistance training on the biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis. The authors also aimed to assess the secondary outcomes of cardiorespiratory fitness, isometric knee extension and flexion force, and a knee injury and osteoarthritis outcome questionnaire. Based on the improvements observed during a 4-month aquatic resistance training program, they found the joint cartilage may be responsive to low shear and compressive forces during aquatic resistance training, in addition to improvement of the secondary outcomes. The results of this research suggest aquatic resistance training as a beneficial treatment for mild knee osteoarthritis.

Rewald ET AL, 2015
Aqua-cycling has often been recommended as a safe, easy, and fun method for patients with osteoarthritis. This study conducted focus groups with a class of older adults suffering from knee osteoarthritis who attended an aqua-cycle class. The results show a high level of satisfaction, perceived value, and pain relief. These findings suggest that aqua-cycle is a good option for treating pain in those suffering from osteoarthritis of the knee.

Rewald ET AL, 2016
Since stationary biking and aquatic exercise are already well-accepted methods of treatment for knee osteoarthritis, one could logically assume that together, they would offer many benefits. This study sets the foundation for a randomized controlled trial to determine the positive effects of aqua-cycling in the pre-surgical stage of osteoarthritis. The authors will conduct trials over a period of 12 weeks to demonstrate if aqua-cycling, in supplement to usual care, will assist in improving the impairments caused by knee osteoarthritis.

Salvador ET AL, 2015
The authors of this study seek to show the positive effects that Tai Chi can have in musculoskeletal diseases when combined with hydrotherapy, as opposed to either intervention on their own. This study is a literature review and suggests that the slow, methodical movements of Tai Chi are well-suited to the low-impact environment of hydrotherapy interventions, as they both involve equilibrium, mobility, strength, coordination, and sensory input.  

Siqueira ET AL, 2016
This study compared the effects of land-based and water-based aerobic exercises in women with rheumatoid arthritis. They found a significant improvement in disease activity and functional ability in the water-based group after 8 and 16 weeks. These results suggest that women suffering from rheumatoid arthritis can find pain relief and increased functional capacity through water-based interventions.

SO ET AL, 2016
Knee osteoarthritis is a prevalent musculoskeletal condition that affects the older population. By comparing the results of a community aquatic exercise program with that of a land-based therapy program, the authors of this study found that the aquatic exercise group reported decreased pain, increased exercise capacity, and increased quality of life. These results suggest that community aquatic exercise programs can greatly benefit older adults.

SWÄRDH ET AL, 2016
This literature review compares the results of trials of various types of aerobic exercise used to treat rheumatoid arthritis. The authors found differing benefits in oxygen uptake and muscle development in both land-based and water-based interventions, suggesting that a combination of the two may be a more ideal treatment for rheumatoid arthritis.

WALLER ET AL, 2016
High intensity aquatic resistance training and daily physical activity are recommendations for maintaining fat mass and walking ability for postmenopausal women with knee osteoarthritis. This study seeks to compare both the long-term and short-term effects of aquatic programs, with a specific regard to body composition and walking ability.

WALLER ET AL, 2014
Therapeutic aquatic exercise is an often prescribed treatment option for management of osteoarthritis, but there are no current systematic reviews that cover the effect of this treatment on symptoms and function of lower limb osteoarthritis. The authors of this study set out to conduct a meta-analysis to determine the effects of therapeutic aquatic exercise on lower limb function. The results from their literature review seem to suggest that therapeutic aquatic exercise is an effective symptom management system for lower limb osteoarthritis.

WALLER ET AL, 2016
This systematic review investigates the effects of aquatic exercise and its effects on physical functioning in older adults. Compared to the control interventions, the authors found that aquatic exercise had a positive effect on physical functioning. 

ANNOTATED REFERENCES

Ansari, S., Elmieh, A., & Hojjati, Z. (2014). Effects of Aquatic Exercise Training on Pain, Symptoms, Motor Performance, and Quality Of Life of Older Males with Knee Osteoarthritis. Annals of Applied Sport Science. Retrieved from http://www.aassjournal.com/browse.php?a_code=A-11-42-3&slc_lang=en&sid=1

Bartels, E. M., Juhl, C. B., Christensen, R., Hagen, K. B., Danneskiold-Samsøe, B., Dagfinrud, H., & Lund, H. (2016). Aquatic exercise for the treatment of knee and hip osteoarthritis. The Cochrane Database of Systematic Reviews, Epub ahead. http://doi.org/10.1002/14651858.CD005523.pub3

Castrogiovanni, P., & Musumeci, G. (2016). Which is the Best Physical Treatment for Osteoarthritis? Journal of Functional Morphology and Kinesiology, 1(1), 54–68. http://doi.org/10.3390/jfmk1010054

Davis, J., & Nelson, R. (2015). Aquatic Exercise for Pain Management in Older Adults with Osteoarthritis. Therapeutic Recreation Journal, 49(4), 326–330. Retrieved from http://search.proquest.com/openview/42b9715405bd65b72b9a82d8921e6550/1?p...

Elnaggar, R. K., & Elshafey, M. A. (2016). Effects of Combined Resistive Underwater Exercises and Interferential Current Therapy in Patients with Juvenile Idiopathic Arthritis: A Randomized Controlled Trial. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists, 95(2), 96–102. http://doi.org/10.1097/PHM.0000000000000347

Fisken, A., & Waters, D. (2014). Perception and responses to different forms of aqua-based exercise among older adults with osteoarthritis. …  Journal of Aquatic  …. Retrieved from http://epublications.bond.edu.au/hsm_pubs/736/

Fisken, A. L., Waters, D. L., Hing, W. A., & Keogh, J. W. (2015). Perceptions towards aqua-based exercise among older adults with osteoarthritis who have discontinued participation in this exercise mode. Australasian Journal on Ageing. http://doi.org/10.1111/ajag.12167

Fisken, A. L., Waters, D. L., Hing, W. A., Steele, M., & Keogh, J. W. (2015). Comparative effects of 2 aqua exercise programs on physical function, balance, and perceived quality of life in older adults with osteoarthritis. Journal of Geriatric Physical Therapy (2001), 38(1), 17–27. http://doi.org/10.1519/JPT.0000000000000019

Fisken, A., Keogh, J. W. L., Waters, D. L., & Hing, W. A. (2015). Perceived benefits, motives, and barriers to aqua-based exercise among older adults with and without osteoarthritis. Journal of Applied Gerontology : The Official Journal of the Southern Gerontological Society, 34(3), 377–96. http://doi.org/10.1177/0733464812463431

Fortunati, N., Fioravanti, A., & Seri, G. (2016). May spa therapy be a valid opportunity to treat hand osteoarthritis? A review of clinical trials and mechanisms of action. International Journal of Biometeorology, 60(1), 1–8. Retrieved from http://link.springer.com/article/10.1007/s00484-015-1030-x

Lau, M., Lam, J., Siu, E., & Fung, C. (2014). Physiotherapist-designed aquatic exercise programme for community-dwelling elders with osteoarthritis of the knee: a Hong Kong pilot study. Hong Kong Med J. Retrieved from http://www.hkmj.org/system/files/hkm1402p16.pdf

Lu, M., Su, Y., Zhang, Y., Zhang, Z., Wang, W., He, Z., … Zheng, N. (2015). Effectiveness of aquatic exercise for treatment of knee osteoarthritis : Systematic review and meta-analysis. Zeitschrift Fur Rheumatologie, 74(6), 543–552. http://doi.org/10.1007/s00393-014-1559-9

Munukka, M., Waller, B., Rantalainen, T., Häkkinen, A., Nieminen, M. T., Lammentausta, E., … Heinonen, A. (2016). Efficacy of Progressive Aquatic Resistance Training for Tibiofemoral Cartilage in Postmenopausal Women with Mild Knee Osteoarthritis: A Randomised Controlled Trial. Osteoarthritis and Cartilage / OARS, Osteoarthritis Research Society, Epub ahead of print. http://doi.org/10.1016/j.joca.2016.05.007

Rewald, S., Mesters, I., Emans, P. P. J. P. P. J., Arts, J. J. C., Lenssen, A. F., & De Bie, R. A. (2015). Aquatic circuit training including aqua-cycling in patients with knee osteoarthritis: A feasibility study. Journal of  …, 47(4), 376–81. http://doi.org/10.2340/16501977-1937

Rewald, S., Mesters, I., Lenssen, A. F., Emans, P. J., Wijnen, W., Bie, R. A. de, & de Bie, R. A. (2016). Effect of aqua-cycling on pain and physical functioning compared with usual care in patients with knee osteoarthritis: study protocol of a randomised controlled trial - Springer. BMC Musculoskeletal Disorders, 17(88), 88. http://doi.org/10.1186/s12891-016-0939-5

Salvador Israel Macías-Hernández, Lucio Vázquez-Torres, Juan Daniel Morones-Alba, Roberto Coronado-Zarco, María de los Angeles Soria-Bastida, Eva Cruz-Medina, T. I. N.-B., Macías-Hernández, S. I. S., Vázquez-Torres, L., Morones-Alba, J. D., Coronado-Zarco, R., de Los Angeles Soria-Bastida, M., … Nava-Bringas, T. I. (2015). Water-based Tai Chi: theoretical benefits in musculoskeletal diseases. Current evidence. Journal of Exercise Rehabilitation, 11(3), 120–4. http://doi.org/10.12965/jer.150207

Siqueira, U. S., Orsini Valente, L. G., de Mello, M. T., Szejnfeld, V. L., & Pinheiro, M. M. (2016). Effectiveness of Aquatic Exercises in Women With Rheumatoid Arthritis: A Randomized, Controlled, 16-Week Intervention-The HydRA Trial. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists, Epub ahead of print. http://doi.org/10.1097/PHM.0000000000000564

So, C. L., Chan, T. H. J., & Hung, L. K. (2015). The effects of a community aquatic exercise programme for chinese people with knee osteoarthriris. Physiotherapy (United Kingdom), 101, eS1415–eS1416. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id...\nhttp://dx.doi.org/10.1016/j.physio.2015.03.1369\nhttp://limo.libis.be/resolver?&sid=EMBASE&issn=00319406&id=doi:10.1016%2...

Swärdh, E., & Brodin, N. (2016). Effects of aerobic and muscle strengthening exercise in adults with rheumatoid arthritis: a narrative review summarising a chapter in Physical activity in the prevention. British Journal of Sports Medicine, Epub ahead. Retrieved from http://bjsm.bmj.com/content/early/2016/02/03/bjsports-2015-095793.abstract

Waller, B., Munukka, M., Rantalainen, T., Lammentausta, E., Nieminen, M., Kiviranta, I., … Heinonen, A. (2016). High intensity aquatic exercise or daily physical activity for maintaining fat mass and walking ability for postmenopausal women with knee osteoarthritis? Osteoarthritis and Cartilage, 24(Supplement 1), S467. http://doi.orghttp://dx.doi.org/10.1016/j.joca.2016.01.852

Waller, B., & Ogonowska-Slodownik, A. (2014). Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: a systematic review with meta-analysis. Physical Therapy, 94(10), 1383–95. Retrieved from http://ptjournal.apta.org/content/early/2014/06/04/ptj.20130417.short

Waller, B., Ogonowska-Słodownik, A., Vitor, M., Rodionova, K., Lambeck, J., Heinonen, A., & Daly, D. (2016). The effect of aquatic exercise on physical functioning in the older adult: a systematic review with meta-analysis. Age and Ageing, Epub ahead. http://doi.org/10.1093/ageing/afw102