May 13

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Aquatic Exercise Arthritis Teaching Tips

Aquatic exercise arthritis teaching tips can be summarized as helping our aqua yoga clients build their best selves despite arthritis. We want out clients to get stronger in body, mind, and spirit.
One of the most important things we can do for our clients who live with arthritis is to help them build strength. Yes, that means our traditional assumptions of muscular strength, since strong muscles support weak joints, but it also includes other aspects of strength such as cardiovascular endurance, resilience to stress or pain, and self-knowledge. Thinking of strength in its broadest terms for this population, yoga has a lot to offer.

Applying Aquatic Exercise Arthritis Teaching Tips – Body

People with arthritis need muscular strength. Since osteoarthritis of the knee is the most common type and site for arthritis, research specific to that area backs up this generalization. Culvernor, et al showed that thigh muscle strength was the greatest predictor of knee replacement surgery in women with osteoarthritis. Stronger thighs can help delay knee replacements (1).
Aqua yoga postures such as Warrior II and Chair build strength in a person’s legs. Doing these postures in the pool reduces fall risk, and makes the postures more accessible. However, it also reduces the muscle load compared to land yoga. Some workarounds to keep that muscular engagement would be to increase the number of times your students do the postures, and/or how long they hold them. You can add noodles to the postures to add a buoyancy resist challenge such as under the legs (behind the knee) or under the toes.

How to do Warrior II pose


Build knee strength with Chair pose

Applying this principle to arthritis in any joint, muscular strength around the affected joint is the desired outcome, so target postures and exercises to support those areas.
People who live with the autoimmune forms of arthritis, face a significantly greater risk for coronary artery disease and heart failure (2). Increasing cardiovascular fitness is even more important for this population than the average person. You can add a cardiovascular fitness component to your aqua yoga classes by increasing the pace of the practice, doing a more vigorous practice such as sun salutations, or moving the yoga practice into the deep end requiring more muscular effort.

Applying Aquatic Exercise Arthritis Teaching Tips – Mind


Resilience is our ability to bounce back from stress and adversity. It requires mental toughness, not physical strength. We can help our clients build resilience with aqua yoga through the duality of the yoga concepts of ahimsa (non-harming) and tapas (right effort). By providing a supportive environment for people to try challenging things, at the level that’s appropriate for them, they build the elements required by resilience. Resilience is strengthened by acknowledging their fears (worries they might fall and make a fool of themselves in class), trying anyway (being brave despite adversity), and doing everything in class with self-compassion (taking care of themselves in aqua yoga and only doing what’s right for them). (3)

Applying Aquatic Exercise Arthritis Teaching Tips – Spirit


The latest pain research has shown a person’s experience of pain is dynamic and not as static as once thought. Mind-body therapies have been shown to positively impact people’s reported pain levels and perception of pain (4).
In aqua yoga, we get curious about all aspects of our bodies including our pain. When we can be objective about our pain, on a minute-by-minute basis, we realize that the pain we assumed to be constant will actually vary. Knowing that pain is not a constant frees people from catastrophizing about future pain and reduces the incidence of depression.
The meditation element in aqua yoga classes reinforces both resilience building and pain management skills. Meditation is not about thinking about nothing, it’s about controlling our thoughts. We’re trying to strengthen our ability to focus on what we want and thereby get less distracted by all the rest. There are different styles of meditation you can offer your aqua yoga students such as mindfulness, body scans, mantra, etc. Each strives to strengthen the ability to focus on a chosen thing. When we have the mental toughness to keep our thoughts positive, we literally feel less physical pain from arthritis (5).
One of the goals of aqua yoga is building body awareness. Better body awareness allows clients to improve their practice while they’re in the pool but also improves their arthritis management in their daily lives. For example, anyone with arthritis has plenty of doctor appointments. Having better body awareness allows our clients to more accurately track and report their symptoms to their health care providers, thereby increasing their overall health.
We build body awareness in aqua yoga by asking students to get curious about how they move their bodies. Something as simple as walking sideways: When you walk sideways to the right, are your steps as big as when you walk sideways to the left? Are you turning your toes out when you walk? Are the toes on one side turned out more than the other? When you change the tempo and walk sideways fast three steps, then do two slow, are your steps the same size the whole time? It’s more powerful for people to come to these realizations themselves than being told, and as teachers, we’re trying to foster an environment for self-discovery.
Empowerment is something everyone with arthritis needs since it can easily feel like the disease is robbing people of their abilities. With aqua yoga we want people to feel like while they can’t cure their arthritis, they can affect its impact on their lives. They can be strong despite arthritis with the tools of aqua yoga.

If you’d like more articles written for pros, read my review of the Arthritis Foundation’s Aquatic Exercise AEA Training Program or Tips for Winterizing your Aquatics Instructor Business.

This article was published by the Aquatic Therapy and Rehab Institute. You can read the article on their website as well, Helping our Aqua Yoga Clients Build Their Best Selves Despite Arthritis.


Woman on the pool deck teaching aqua yoga chair pose to a group of ladies with arthritis to illustrate Aquatic Exercise Arthritis Teaching Tips

References mentioned in the Aquatic Exercise Arthritis Teaching Tips article

[1] Thigh muscle strength predicts knee replacement risk independent of radiographic disease and pain in women – data from the Osteoarthritis Initiative https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494847/

[2]Rheumatoid Arthritis and Cardiovascular Disease  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890244/

[3] Mental Wellbeing, Quality of Life, and Perception of Chronic Illness in Yoga-Experienced Compared with Yoga-Naïve Patients  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542302/

[4] Impact of Iyengar yoga on quality of life in young women with rheumatoid arthritis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644391/

[5] Positive Affect as a Source of Resilience for Women in Chronic Pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593933/


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yoga for arthritis


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