Aquatic Exercise for Persons with Chronic Back Pain
As the weather heats up, more individuals have access to swimming pools either at their residences or in the community. Even a small, backyard pool can provide enough room for aquatic exercise, which has some important benefits for persons living with chronic pain. Unlike land exercise, exercising in the pool doesn’t put pressure on the joints, enabling these individuals to work out longer and potentially harder pain-free. Water suppresses heart rate, which is a benefit for those who have chronic cardiovascular problems. It is also diuretic, which can help persons for whom edema in the lower extremities is a challenge. Regular aerobic exercise utilizing the big leg muscles works the veno-muscular pumps of the lower legs (Uhl & Gillot, 2015), to pump blood back more efficiently to the heart. When the summer heat makes outdoor exercise more challenging, the pool is a refreshing alternative to land-based activities.
Several clinical trials have confirmed benefits for aquatic therapy compared to both passive physical therapy and land-based exercise. A small randomized controlled trial in Turkey (Dundar et al., 2009) compared two groups of patients living with chronic low back pain with one group receiving an intensive water-based exercise program and the second, land-based exercise. In this intervention, only the water-based exercise group received live instruction; the land-based program was home-based. Results indicated that the group participating in aquatic exercise five times per week for four weeks experienced more significant improvements in pain level, physical function, and quality of life than the land-based group.
A more recent study conducted at Shanghai University of Sport in Shanghai China (Peng et al., 2022) randomized younger patients (average age 30) living with moderate but chronic back pain to receive either aquatic exercise therapy or passive physical therapy consisting of transcutaneous electrical nerve stimulation (TENS) and deep heat. The aquatic exercise group had significantly better improvements in both physical function and mental health, including self-ratings on pain intensity, disability, quality of life, fear avoidance beliefs, sleep quality and kinesiophobia (fear of movement).
A systematic review of therapeutic aquatic exercise for low back pain (Waller et al., 2009) investigated results from seven clinical trials. Investigators were not able to complete a meta-analysis due to variations in study design. Authors concluded that aquatic exercise is potentially beneficial for persons living with chronic low back pain and pregnancy-related back pain. However, the evidence did not support superiority of aquatic exercise compared to other physical therapy modalities, including land-based exercise.
Importantly, all of the literature mentioned the relative safety of aquatic exercise, given live instruction. Only the Chinese study mentioned any adverse effects, with two participants out of 56 in the aquatic exercise group experiencing some pain related to that exercise program. Many fitness clubs, YMCAs, community and residential recreation facilities offer aquatic exercise classes, with some classes specializing in older adults. For more information on YMCA options, visit their national Web site.