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| me in my swim suit |
Oho my gosh its great. I am just walking around the pool trying to build up to an hour and build speed. But I feel great afterwords!
Dont be afraid of looking silly its well worth putting on the speedos and the sun block.
(oh and the hot tub after is heavily!))
Here is an article with scientific support
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| you can lift under water! |
By Nancy Walsh, Staff Writer, MedPage Today
Published: December 22, 2011
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Starting aquatic therapy early led to better physical function in patients having total knee replacement, although early water-based exercise did not appear to be beneficial in patients undergoing hip arthroplasty, a German randomized study suggested.
Early institution of the pool-based therapy after knee replacement was associated with improved physical function, with effect sizes ranging from .22 after six months (absolute difference d=3.9, P=0.45) to .39 after two years (absolute difference d=6.9,P=0.12), according to Thoralf R. Liebs, MD, of the University of Schleswig-Holstein in Kiel, and colleagues.
But for hip replacement, improvements were greater if aquatic therapy was delayed until after wound healing, with effect sizes ranging from .01 at three months (absolute difference d=.30,P=0.80) to .19 six months later (absolute difference d=3.1, P=0.52), the researchers reported online in the Archives of Physical Medicine and Rehabilitation.
Action Points
Explain that a randomized study found improved patient satisfaction and self-report of function for patients undergoing total knee replacement who began aquatic therapy at six rather than 14 days postop.
Note that the same effect was not observed for patients undergoing total hip replacement.
While these differences were not statistically significant, the results of early therapy after knee replacement were considered "clinically important," because the effect sizes were similar to those seen in a meta-analysis for the use of nonsteroidal anti-inflammatory drugs in osteoarthritis, Liebs and colleagues explained.
Aquatic therapy is popular in Europe for patients undergoing joint replacement, and is thought to help patients regain balance and muscle strength.
Several studies have confirmed these benefits, but whether starting earlier than the conventional time of 14 days after surgery has been uncertain.
To explore this, Liebs and colleagues conducted a multicenter study that included 465 patients undergoing total knee or hip arthroplasty (280 hip, 185 knee).
Patients randomized to treatment beginning on day six wore waterproof dressings over the wound, and all participants spent 30 minutes, three times weekly, for a month doing pool-based exercises.
Two-thirds of the patients were women, and mean age was 68.
The primary endpoint was patient-reported physical function as measured on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) after three, six, 12, and 24 months.
Secondary endpoints included stiffness and pain, also measured on the WOMAC, the short form-36 health survey, and patient satisfaction.
Among patients who had knee replacement, scores were higher on all measures in the early-treatment group except for the WOMAC stiffness score at 12 months, which showed a slight benefit for delayed treatment, with an effect size of .03.
In contrast, after hip replacement, WOMAC scores consistently favored delaying treatment until after wound healing.
Among the knee replacement group, five in the early-treatment group and one in the late-treatment group were readmitted to the hospital within three months for reasons including inadequate range of motion and intra-articular effusion.
Three of the hospitalizations in the early-treatment group and the one from the late-treatment group were considered possibly related to the treatment.
For patients who had hip replacement, ten in the early group and four in the late group were rehospitalized within three months, for adverse events such as hip dislocation, dehiscence of the wound, and pulmonary embolism.
Two events in each group were judged to be possibly treatment-related.
The researchers noted that many factors can influence the quality of life following joint replacement, including patient age and sex, other baseline characteristics, and comorbidities, none of which can be altered by caregivers.
"Therefore, this is one of the few studies demonstrating a clinically important effect on the health-related quality of life after [total knee replacement] by a factor that can be influenced by healthcare professionals," they stated.
As to why the benefits would be seen only for knee replacement, they suggested that the degree of patient satisfaction and clinical improvement is so high already after hip replacement that little further improvement can be expected which they deemed a "ceiling effect."
Many patients are less than satisfied with the results after knee replacement, however, allowing for further benefit with aquatic rehabilitation, they added.
"Therefore, further research is warranted to identify the optimal time frame for the start of aquatic therapy after [total knee replacement] in order to exploit the potential of aquatic therapy for improving clinical outcome," they stated.
For hip replacement, "the results of this study indicate that early aquatic therapy should be avoided," they added.
Limitations of the study included patients lost to follow-up over time and the inclusion criteria being limited to primary joint replacements.
In addition, the study did not compare early or late aquatic therapy with no aquatic therapy, because in Germany patients expect this during rehabilitation after joint replacement.
