High-intensity Aquatic Exercise for Adults With Rheumatic Diseases

Exercise is important to manage rheumatic diseases (RDs). In 2007, the American Collegeof Sports Medicine (ACSM) launched a global initiative to advocate the use of exercisenot only to prevent illness but to serve as a key element in the management and treatmentof multiple chronic diseases. Their "Exercise is Medicine" initiative promotes exerciseas a highly potent free medicine with few side effects. Despite catchphrases such as"best drug ever," few adhere to the global recommendations for weekly physicalactivities. Exercise is one of the therapeutic strategies that helps minimise deleteriouseffects on the musculoskeletal system generated by aging while preserving independence,promoting weight control, and maintaining or improving quality of life, functionalcapacity, and emotional well‐being. However, exercises performed on the ground canaggravate joint pain and increase the risk of falls among those with RDs. Aquaticexercises are a popular adjunct treatment modality for patients with inflammatory RDs.Aquatic exercises are highly preferred by people with RDs, who are more likely to reportfeeling better than those treated with similar exercises on land. A preference for awater‐based rehabilitation or environment may enable greater exercise compliance.A systematic review and meta‐analysis from 2011 concluded that the effects of aquaticexercise for adults with arthritis appears comparable to land‐based exercise. When peopleare unable to exercise on land or find it difficult, aquatic programs provide an enablingalternative strategy.Aquatic exercise programmes have been criticised for being non‐progressive orlow‐intensive. One possible advantage of the aquatic environment is that the people withchronic diseases may be able to train at higher intensities than on land.The effectiveness of aquatic exercise needs further comprehensive investigation,particularly related to the link between load, types of exercise, and degree of changesin physical functioning and physical fitness.Method: ‐ Design: The study will be a randomized clinical trial. Patients will be recruitedfrom different municipalities in Norway with possibilities of pool training intemperate water (between 30‐34┬░C to be optimal). ‐ Intervention group: The intervention group will receive aquatic high intensityinterval exercise training twice a week for 12 weeks. ‐ Control group: The control group will receive aquatic moderate intensity exercisetraining twice a week for 12 weeks. ‐ Sample Size Estimation: Sample size is calculated on the basis of the primaryoutcome variable, where a between‐group difference in VO2peak of 15% or 3.5mLΓêÖkg‐1ΓêÖmin‐1 is considered to be of clinical relevance. Both groups are receivingan exercise intervention, therefore we estimate a smaller between group differenceto be 2.0 mLΓêÖkg‐1ΓêÖmin‐1. Using a reported standard deviation of change in VO2peak of3 and 80% power to detect this difference, approximately 35 participants arerequired in each group. To allow for a possible 20% drop‐out rate, we plan torandomise 84 patients in total (i.e. 42 per group). ‐ Statistical analyzes: Descriptive data are reported for variables of interest andwill be analysed following the intention‐to‐treat principle. Prospective differencesin primary and secondary outcomes and baseline characteristics between theintervention group and the control group will be assessed by t‐tests for continuousand normal distributed variables and non‐parametric tests for categorical variables.Multiple linear regression modelling is used to control for confounding differencesbetween study groups.The study will provide evidence‐based knowledge for performing high‐Intensity waterworkout in municipalities and investigates the factors that determine successful effectson physical fitness, disease activity and pain and tests the programme's utility formunicipal health care services.