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Juvenile Rheumatoid Arthritis (JRA) is an inflammatory disease of the connective tissue, usually affecting the joints, that affects children. The primary joints involved are usually the hips, knees, elbows, ankles and neck. The condition onsets between 2 and 5 years.
Aquatic Exercise

The aquatic environment may be a safe and stimulating environment in which individuals with JRA can exercise. Many of them can exercise with less pain, while enjoying the benefits of systematic exercise. Many community centers, YMCA's and YWCA's have water exercise classes developed for people with arthritis. These classes can be modified for students with JRA by adding more playful activities.

Water exercise can be used by adapted physical educators, physical and occupation therapists, or therapeutic recreation specialists in school, hospital, or community-based programs.

A quality water exercise program can reduce joint pain and stiffness, increase flexibility, muscle strength and endurance. The water helps support the body while joints are moved through the full range of motion. The buoyancy of the water places less stress on the hips, knees, and spine and other joints, as well.. Individuals with JRA can enjoy swimming, shallow and deepwater aerobics, deep water running or specially designed classes.

Types of Exercise in Aquatics

Aquatics offer an excellent combination of following three recommended types of activities.

  • Range of Motion exercises help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain and increase flexibility.
    • Examples: Slow kicking movements and walking in shallow or deep water aerobics. Extending arms in breaststroke or backstroke motions. Deep water running with minimal impact of gravity.
  • Strengthening exercises help maintain or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
    • Examples: Kicking, controlled jumping, walking, jogging, sculling and special strengthening exercise in aqua aerobics. Participants work, essentially,with 30% of body weight affected by gravity. Therefore, there is minimal impact on joints.
  • Aerobic Endurance exercises improve cardiovascular endurance, help control weight, and improve overall body function. Some studies show that aerobic exercise can reduce inflammation in some joints.
    • Examples: Aqua aerobics, water walking, deep water running and swimming are extraordinary programs that can improve aerobic endurance while putting little stress on joints.


Individuals with JRA can use aquatic equipment such as Hydrofit dumbbells or floatation devices, running belt, water resistance gloves, water shoes (reduce risk of slipping and provide skin protection), kick board or water "noodles". Music is strongly recommended. The music should be age appropriate and motivating for the participants.


Swimming is an excellent type of exercise for students with juvenile rheumatoid arthritis. It puts virtually no strain on the joints. Students can join their peers and improve their fitness levels. This may also contribute to the improvement of self-esteem.

Considerations for Swimming

  • Always consider students individual needs and limitations.
  • Modify the breast stroke by using the breast stroke arm pull with a flutter kick. [Note: The whip kick puts a great deal of strain on the knees.]
  • If the swimmer's shoulder joints and neck are involved, an underwater arm recovery in the front crawl or back crawl might be indicated.
  • Eye Care: Several forms of eye inflammation are associated with various forms of juvenile arthritis, therefore, the swimmer should use swimming goggles and possible eye drops (after consultation with ophthalmologist).
  • Access to the pool: Make sure the participant can comfortably enter and leave the pool. Assess these needs and keep them in mind for programming.
  • Schedule swimming for later hours when the individual does not suffer from typical morning stiffness.

Recommended Water Temperature

  • Warm water ?86-90 degrees?aquatic exercise can help to relax muscles,  decrease pain, and increase circulation.

This page was created by Martin Kudlacek,
Doctoral Student in Adapted Physical Education at Texas Woman's University,
as part of requirements for
"Aquatics for Special Populations", Huettig, Summer, 1999.

page last updated 1/3/2017 1:00 PM