Show Notes
Welcome Back Rheumatology Fans! Swimming is often recommended for people with arthritis, but is it actually better than other types of exercise? The short answer: it depends on the individual. Swimming and water-based exercise can be helpful because the buoyancy of water reduces the amount of weight going through the joints. For example, when standing in water up to belly-button depth, the body is only bearing around 40% of its usual weight . This reduction in joint loading can allow people with painful hips, knees, or feet to move more comfortably and exercise for longer. Water immersion also provides a cardiovascular benefit. The pressure of the water increases venous return — meaning more blood is pushed back to the heart — which makes the heart work slightly harder and therefore provides a cardiovascular training effect . In addition, buoyancy can make it easier to move stiff joints and take them through their range of motion. However, swimming is not without downsides. Many barriers are logistical: travelling to the pool, changing clothes, slippery surfaces, cold environments, and cost. Some people also accidentally overdo activity in the water because the reduced joint loading masks normal pain signals. Ultimately, swimming is a good exercise option for arthritis, but it is rarely the only or “best” option. The most effective exercise is usually the one a person can do consistently and safely. * Water reduces joint loadingBuoyancy can significantly decrease the weight passing through painful joints, making movement easier. * Swimming provides cardiovascular benefitsWater pressure increases venous return, which places a mild training demand on the heart. * Movement can be easier in waterBuoyancy can help people move joints and the spine through their range of motion with less discomfort. * Logistics often limit swimming as exerciseTravel, changing facilities, cost, and cold environments can be significant barriers. * Exercise choice should be individualisedSwimming is helpful for some people with arthritis, but it is not inherently superior to other forms of exercise. Check out our new CPD from PMAP!
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Welcome Back Rheumatology Fans, Ooof this is going to rattle some cages. Synopsis below but the best of this is watching the video. A recent news report about a woman with rheumatoid arthritis who was convicted of benefit fraud caught my attention. The case involved footage of her participating in activities including gym classes and running events despite having previously reported substantial limitations in her day-to-day function. I don’t know enough about the individual circumstances to comment on whether the judgement was appropriate. In fact, the reported offence appears to relate specifically to failing to notify the Department for Work and Pensions of a change in circumstances. But the story raises a broader issue that is highly relevant to people living with inflammatory arthritis and the clinicians treating them. Being physically active does not necessarily mean someone is not disabled. Rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and other long-term inflammatory diseases can be enormously variable. Symptoms may fluctuate over time, treatments can substantially improve function, and limitations in one activity do not necessarily predict someone’s ability to perform another. Exercise also forms an important part of rehabilitation. I might see someone who currently cannot run, play tennis or golf because their inflammatory arthritis is poorly controlled. Following improvements in medication and a structured rehabilitation programme, one of our explicit treatment goals might be to return them to those activities. For another person, the goal might simply be getting upstairs more comfortably. To achieve that, we may use relatively demanding strengthening exercises in a gym. Seeing that person performing a squat or leg press tells you very little, in isolation, about how easily they can negotiate their stairs later that day. That distinction matters. We should not create an environment where people receiving appropriate financial support become frightened of exercising because they worry that being seen in a gym, lifting weights or participating in sport could somehow be interpreted as evidence that they are no longer disabled. From a clinical perspective, I want people with inflammatory arthritis to be as active as their condition, preferences and circumstances allow. Where possible, that includes meeting general physical activity recommendations and incorporating cardiovascular and resistance exercise. There are good reasons for doing so. Maintaining physical activity can help protect muscle and bone, improve cardiovascular health and support broader long-term health outcomes. For some patients, returning to demanding exercise is itself a major marker of successful treatment. None of this means that changes in someone’s circumstances should not be reported where required. That is a separate issue. The important point is that exercise capacity and disability are not opposites. A person can exercise and still experience meaningful restrictions from inflammatory disease. They can also improve dramatically with treatment while continuing to have limitations elsewhere. As clinicians, we should be encouraging people towards greater function—not inadvertently giving them another reason to be afraid of achieving it.
This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.com
This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.com