CARDIORESPIRATORY RESPONSES TO Authors: Jane Hall and Jim Gran

AQUATIC TREADMILL WALKING IN Publishing Journal: Physiotherapy Research

International

PATIENTS WITH RHEUMATOID ARTHRITIS By: Oluwakemi Akomolafe

RHEUMATOID ARTHRITIS
RA is an inflammatory disease that
occurs when your immune system
mistakenly starts attacking healthy joints,
causing symptoms that may include pain,
swelling, stiffness, and loss of physical
function.
Symptoms:
•Weakness
•Flu-like symptoms, including low-grade
fever
•Worse joint stiffness after sleeping or
•prolonged sitting
•Walking outdoors on flat ground
•Running errands or doing chores
BACKGROUND
• The primary purpose of the present study was to compare the relationships between heart
rate (HR), and ratings of perceived exertion (RPE), with speed during land and water
treadmill walking in patients with RA. Hydrotherapy was also used to increase gross and
fine motor skills on land and in their everyday lifes.
• Patients with RA have reduced muscle strength and may be unable to achieve a walking
speed commensurate with an aerobic training effect because the resistance to movement
increases with speed in water.
• Hydrotherapy is popular with patients with rheumatoid arthritis (RA). Its efficacy as an
aerobic conditioning aid is equivocal.
METHODS
The study design used a two-factor
within-subjects model. completed three
consecutive bouts of walking for five
minutes at 2.5, 3.5 and 4.5 km/h–1 on
land and on water treadmills. Expired
gas, collected via open-circuit
spirometry, (HR) and RPE were
measured.
SUBJECTS
• Fifteen female patients, aged 30–60
years with functional Class I or Class II
RA.
• A pilot study ascertained that patients
required 30 minutes’ instruction and
practice on the water treadmill to feel
comfortable and be consistent in their
technique. Practicing land treadmill
walking required 10 minutes. The first
visit therefore lasted approximately 2.5
hours.
MEASUREMENTS
• Expired gas was collected for the final minute of each exercise bout via open-circuit
spirometry by use of a Hans–Rudolph valve
• Ventilation (V ˚ E) was recorded using a dry gas volume meter (Havard Apparatus,
UK). Ideal for measuring the volume of expired gases collected in Douglas Bags or
the volume of gases drawn through a system
RESULTS
• Fifteen female patients completed the study.
• Fourteen patients belonged to functional Class II and one to functional Class I
• The study showed that prescribing and monitoring exercise intensity based on land-
derived values of HR during water treadmill walking in patients with RA will
underestimate exercise intensity.
• HR and RPE increased on land and in water as speed increased. Below 3.5 km/h
and they were able to move more efficiently after the 7 week study using
hydrotherapy as the therapeutic modality.
CONCLUSIONS
• The primary purpose of the present study was to compare the relationships between
heart rate (HR), and ratings of perceived exertion (RPE), with speed during land and
water treadmill walking in patients with RA.
• The study showed that the metabolic demand of walking at 4.5 km/h–1 was
sufficient to stimulate an increase in aerobic capacity. The use of landbased
prescriptive norms would underestimate the metabolic cost in water. Therefore, in
water HR should be increased by approximately 9 beats/min–1 to achieve similar
energy demands to land treadmill walking.
LIMITATIONS
I feel as though the author did a really good job in comparing your heart rate and
the intensity of which you exercise for patients with RA, but I wish the article would
have had two separate studies testing individual walking on land and walking in
water to see if there would be an improvement with overall fine and gross motor skills
and also range of mobility to see the different improvements with walking on land
and hydrotherapy thread mill walking with the symptoms of having RA.
QUESTIONS TO DISCUSS
• Do you feel like hydrotherapy is the best modality to use for patients with RA why or
why not?
• Do you feel as though patients with RA should be allowed to vigorous activity that
may cause more pain to their joints why or why not?
REFERENCES
Home. (n.d.). Retrieved February 11, 2018, from http://childcarelaw.org/

Robertson, T., & Long, T. (2008). Foundation of Therapeutic Recreation.

Physiotherapy Research International, 9(2) 59–73, 2004 © Whurr Publishers Ltd

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