Episode Christa
Blog, Podcast

How can Water Exercise and Aquatic Yoga help people with Arthritis and Rheumatic Diseases? Episode 25.

February 12, 2021
66 min read
FacebookXRedditPinterestEmail

In Episode 25 of the Arthritis Life Podcast (listen by clicking the “play” button in the image above), Christa Fairbrother shares her journey with Mixed Connective Tissue Disease (MCTD), lupus and rheumatoid arthritis (RA). She delves into why water exercise and aquatic yoga are particularly beneficial for people with rheumatic diseases such as rheumatoid arthritis, and connective tissue diseases such as MCTD. 

Christa Fairbrother is a skilled and experienced water aerobics and aqua yoga instructor who also lives with multiple chronic illnesses. For Christa, living with arthritis and teaching yoga are integrated.  She credits her lack of pain to aqua yoga practice.  Being passionate about aqua yoga, she wants to see aqua yoga in more communities worldwide.

Cheryl Crow is an occupational therapist who has lived with rheumatoid arthritis for seventeen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources. 

image

Here’s the show breakdown:

01:15 – Christa’s diagnosis journey: symptoms of RA and Lupus symptoms started at age 12, initial diagnosis of Mixed Connective Tissue Disease (MCTD) after the birth of her 2nd son.

05:05 – Christa’s MCTD symptoms (including Raynaud’s) and why it’s so hard to get this rare diagnosis.

8:00 – Christa and Cheryl reflect on what it’s like to live with multiple chronic conditions, not knowing at times what is causing which symptom.

10:40 – Christa’s up and down journey managing her conditions over many years.

15:30 – Cheryl and Christa explain what connective tissue and fascia are.

17:33 – Christa’s journey with yoga, which started when she had back pain being a farrier (a craftsperson who trims and shoes horses’ hooves). 

19:40 – After 20 years of doing yoga, Christa became a yoga instructor.

22:11 – What is aqua yoga, and how Christa discovered and fell in love with it.

25:33 – The numerous medical benefits of exercise in the water for healthy people and those living with arthritis. 

32:15 – Christa’s explanation of the offloading of gravity in the water due to buoyancy and how it gives your muscles a more balanced effort.

34:55 – Christa discusses how accessible swimming pools are in the US. 

38:55 – Thoughts around safety and germs with aqua yoga and swimming during the COVID-19 pandemic. 

41:55 – Interested in the Arthritis Foundation’s aqua therapy program? Here is how you can find it at a local water center!

47:43 – Cheryl and Christa’s insights on why group classes make people feel empowered, especially during COVID-19. 

44:40 – Christa describes what happens in an aqua aerobics class.  

50:56 – Cheryl and Christa’s views on how the sensory elements of water can help regulate our mood, from prenatal experiences to adulthood.

55:25 – Christa’s advice on what to do if your joints hurt in the water.

1:01:30 – Salt water pools VS. Chlorine pools and water safety advice that you may not be aware of. 

image

Episode links:

Medical disclaimer: All content found on the Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 

Full Transcript:

[00:00:00] Cheryl:
[Introductory note]

Hi there! I’m so excited to welcome you to The Arthritis Life podcast where we share arthritis life stories and tips for thriving with autoimmune arthritis. My name is Cheryl Crow and I am passionate about helping people navigate real life with arthritis beyond joint pain. I’ve been living with rheumatoid arthritis for 20 years and I’m also a mom, occupational therapist, video creator, support group leader, and I created the Rheum to THRIVE self-management program. 

I am so excited to help you live a more empowered life with arthritis. We’re going to cover everything from kitchen life hacks, to navigating the healthcare system, to coping with friends who just don’t get it. Seriously, no topic is going to be off limits on this podcast. My interviewees and I share our honest stories of how chronic illness affects our lives. This includes discussions about mental health, sex, shame, pregnancy, body image, advocacy, self-acceptance, and so much more. You’ll hear stories from all ends of the spectrum from a person who’s living in medicated remission from psoriatic arthritis to somebody living with severe mobility restrictions and severe pain from rheumatoid arthritis. 

You’ll hear how people manage their conditions in different ways like medications, mindfulness, movement, social support, work accommodations, and so much more. You’ll also hear from rheumatology experts who just get it. We’ll dive deep into the science behind chronic pain and what’s the latest evidence for lifestyle changes that can help you thrive with arthritis, including exercise, sleep, nutrition, stress reduction, and more. This is your chance to sit down and chat with a friend who’s been there. Ready to figure out how to manage your arthritis life? Let’s get started.   

Hi, my name is Cheryl Crow, and I am passionate about helping people navigate real life with arthritis. I’ve lived with rheumatoid arthritis for 17 years, and I’m also a mom, teacher, and occupational therapist. I’m so excited to share my tricks for managing the ups and downs of life with arthritis. Everything from kitchen life hacks to how to respond when people say, “You don’t look sick.” Stress, work, sex, anxiety, fatigue, pregnancy, and parenting with chronic illness – no topic will be off limits here. I’ll also talk to other patients and share their stories and advice. Think of this as your chance to sit down and chat with a friend who’s been there. Ready to figure out how to manage your arthritis life? Let’s get started.

All right! So, Christa, I’m so happy to have you on the podcast today. Can you let the audience know a little bit about where you’re from and what your relationship to arthritis is? 

[00:02:50] Christa:
Of course. So, thank you so much for having me, Cheryl. I’m excited to have this talk and I appreciate everything you do in the arthritis community to lift those of us with RA up. I grew up in California and I lived in Washington state, like you, for some time, and now I’m in Florida. But my diagnosis journey started actually when I was a kid. When I was around 12, my father decided, hey, let’s go skiing as a family. He had grown up skiing, but we lived in a coastal town by the beach. And so, it was a trek across the state, you know, to drive up to the mountains in California. So, it was just like, yeah, he wanted to get back to that. And, it was really fun. So, we did it, several years in a row. But even just one day on the slope on a nice sunny day is I would turn really red and be really uncomfortable and get really cold, just totally disproportionate to how cold it actually was ’cause you can get pretty warm skin. So, it became this family joke that I was just like ‘allergic’ to the cold and I’m putting ‘allergic’ here in air quotes for people on the podcast. And then, it just kind of went on. 

And then, I, as I got a little older, I graduated from high school and every time it got cold, my fingers would swell up. So, around 18, I went to see just my GP and of course they were like, well, you know, it’s probably not anything but we’ll run an RA test just to see. And that came back negative. So, then it was just, okay, I go through my adult life, I would go to the doctor’s office and get my regular blood draws and one teeny tiny little thing might be a little off, but it would get dismissed. I get much older, I have two kids, blood work again, little things and it’s like, oh, you probably had a cold. Well, no, not really, but okay, what else can you say? 

And it finally wasn’t until I had my second son that it was, like, I just had this crash. I started getting really bad migraines and things. With now, I have two kids and yes, I understand it’s hard to have two kids, but I was just so tired and just something really wasn’t right. So, I’ll go back to the GP. They were like, okay, well, this little weird stuff in your blood work’s been going on for a while, so let’s take it to the next level. So, of course they sent me to a hematologist. I have a strong family history of cancer and they were like, oh, we don’t like what your blood work’s doing. So, they determined really quick I didn’t have cancer. But the person was like, “I think you need to see your rheumatologist.” ‘Cause they had ran some more tests and it was like, this isn’t making sense. Go see the rheumatologist. Even though I’m seeing now the rheumatologist, they run more tests. They’re like, “Well, I don’t know, it’s just not quite right.” So, they give me a lupus diagnosis. 

And I had that for several years. And this particular rheumatologist, while being very attentive and a good listener and everything, she always was just trying to put me in these other spots that it seemed like my symptoms weren’t going for me. I changed doctors, go and see new rheumatologists, they run lots more tests. And that person basically determined that I had mixed connective tissue disease. So, this entire time that I had both my lupus diagnosis, and this entire time in my life I’ve actually had mixed connective tissue disease. So, that is a combination connective tissue disease and it tends to pair up for most people. So, you get the lupus or rheumatoid arthritis combination, which is what I live with. And, but it also can include scleroderma and myositis. 

I’ve had tiny little bits of myositis. Personally, I haven’t had to live with anything with scleroderma. So, that’s my long story. So, in terms of age, because I know there’s, people ask when with rheumatoid arthritis, “Well, how long is it between symptoms and diagnosis?” So, I started showing symptoms basically about 12. I was diagnosed with lupus at 37, and I was diagnosed with mixed connected tissue disease at 41, and that was eight years ago. 

[00:07:00] Cheryl:
Wow. 

[00:07:01] Christa:
It’s been a really long time that I’ve been dealing with this. 

[00:07:05] Cheryl:
Yeah, it’s so — I, think one of the most underserved populations is the undiagnosed, and it’s just, it’s a conundrum because how do you help someone who doesn’t know yet what they have? They’re just suffering with no exact reason. And it’s always easy to connect the dots later on. But especially if it’s a — I mean, lupus is one of the most famously difficult to diagnose diseases. But I’m sorry that you had to wait so long to get an accurate set of diagnoses. And I’m curious just ’cause it’s not something I’ve covered in the podcast before, what are some of the symptoms of mixed connective tissue disease?

[00:07:45] Christa:
Yeah. Why it was so hard to get the diagnosis is it’s very rare. And what are the associations? Well, it turns out that pediatric Raynaud’s phenomenon, which is you swell up, change color, have a strange response to the cold; it’s a cold agglutinin response, which we all have when we get frostbite. But normal people, it doesn’t happen at 65 degrees, which if you have Raynaud’s, it did. So, it turns out now that, like you say, you get diagnosed and it makes sense looking back. Well, I had pediatric Raynaud’s, which is highly correlative with this mixed connective tissue disease. And like many autoimmune diseases, they look for one specific blood marker, which they would never run that test on a healthy person, right. So, it only becomes when you get that huge autoimmune panel. And they ran, it was one of those ones where on me, they just tick the whole box, ’cause they’re ticking all the boxes. It’s not even in the normal autoimmune panel.

[00:08:43] Cheryl:
Yeah. Yeah. 

[00:08:44] Christa:
And it is really rare. So, it also is a problem sometimes when you have even one of the more rare connective tissue diseases, you’re like, well, I wish I just had RA ’cause that would be so normal. And it’s not normal. And but it, but every conversation with a healthcare provider is always, well, is there any data about whatever they’re proposing and what you have? And there’s never any.

[00:09:09] Cheryl:
It’s all relative. I’ve definitely heard that before about rheumatoid arthritis. “Oh, well you’re lucky that you have rheumatoid arthritis ’cause at least some people know what it is.” It’s covered a little bit in some textbooks, even though a lot of providers don’t understand the systemic aspect of rheumatoid arthritis beyond joint pain. But still, you’re right that it is o overall there is more awareness in just in the world of rheumatoid arthritis than like mixed connective tissue diseases. 

[00:09:41] Christa:
But at the same time, it’s horribly unempathetic. You know, it’s not like you would ever say, “Oh, yes! You have rheumatoid arthritis,” but not at all. But I’m implying it’s that nobody wants these things at all. And the choice, the interesting thing as well is having the choice between lupus and rheumatoid arthritis, the lupus is way more scary and much harder to deal with than the rheumatoid arthritis, living with both.

[00:10:02] Cheryl:
Yeah.

[00:10:03] Christa:
I’m always going outta my way to keep the lupus at bay. The rheumatoid arthritis, it does express in a lot of joint damage and pain, not to say that I don’t have that, but the lupus is significantly harder to deal with. So. 

[00:10:16] Cheryl:
Yeah. And a lot of it just depends on how your body responds to the treatment options and I think, and one of these things that comes up a lot I’ve see on social media is almost, like, I call it Whack-A-Mole. When you have multiple diagnoses, different symptoms crop up, but you also don’t know if you’re fatigued, is it from the lupus, is it from the RA, is it from the mixed connective tissue? Is it just that you overdid it yesterday? So, it’s, really hard. And I am glad you brought awareness to Raynaud’s phenomenon. ‘Cause I also had that as a juvenile and I had, I thought it was normal. 

I just referred to it to someone, “Oh, you know how like when you get cold and then like your fingers get white, like your fingers just lose all circulation, and you have to go sit in the bath and warm ’em up?” And they’re like, what are you talking about? And I have vivid memories playing soccer. I just, I would wear gloves and extra socks and I would just be in tears after my game sometimes. But it’s ’cause I assumed it was normal. I didn’t, I don’t even know if I told my parents about it, you know? And anyway, definitely symptoms of lupus in particular, but also rheumatoid arthritis, prevalent symptoms of rheumatoid arthritis, but certainly can go along with it. So, yeah, that’s a long time, 25 years.

[00:11:26] Christa:
It’s a long time. And when you talk about like drug therapies and basically when I saw that second rheumatologist, they did a bunch of X-rays and they lay every, laid it all out, and it’s like, yes, I have erosions in every joint they imaged because I basically never got any care. So, and then, so like when you talk about from an OT perspective, since I know the — like, I’m not really that old, but I’ve started to get joint injections in my thumb. And I have a nose piercing. People on the podcast can’t see that. But for me, that’s the mental reframing that hopefully you learn some disease management skills, but instead of looking in the mirror and seeing all my sort of bony protuberances as being joint damage, I can look in the mirror and it’s my reminder to say, no, I’m resilient. I’ve dealt with this for a long time, not I’m damaged and I’m falling apart. 

[00:12:21] Cheryl:
I love that reframe. 

[00:12:23] Christa:
Yeah. Thank you. So, it’s a lot to deal with. And then, so many of your guests and listeners can speak to that medication journey. I have a laundry list of things I’ve tried that haven’t worked. Your symptoms change and your reactions to the medications change. And as soon as you think one thing’s figured out, it’ll just switch on you. 

[00:12:51] Cheryl:
It’s, yeah, the fluctuations is a really, is something that we have to learn to accept. ‘Cause if you grow up thinking of illness or health as like a acute model where you get sick, I got the flu where you get strep throat as a child, okay, I’m sick, I get antibiotics; or I get the treatment, I get better. But when you get diagnosed with, it’s really hard to understand when you get diagnosed with a chronic illness, what that really means, it really means you have it forever until there’s a cure. Even if you’re able to manage it effectively with medications or lifestyle factors. And that’s a harsh reality that, you know, that sometimes the best we can do is just manage and it’s not necessarily going to get healed or cured necessarily. We hope, we could always hold out hope for a cure, but yeah. I’m curious, when you got the diagnosis, was it like a mixed emotional reaction? ‘Cause I’m imagining part of you felt like relief to get a more specific diagnosis, but then also obviously potentially fear about what it actually meant for your life. 

[00:13:56] Christa
Yeah. For me actually, I think by the time I got the arthritis diagnosis, it was just like a shrug of like, oh, yeah, that would make sense. The lupus, it was, it’s a little scary in the sense of you get this very damaging diagnosis and it’s wow. And, at the time I was just struggling to take care of my kids, having two young kids and we all have our disease low points, as a patient you can speak to that one moment where you’re just like, oh, my gosh. And there was a day I took my kids to the zoo. It was beautiful day. 

And here in Florida, we had a great day, but I was so tired driving home, I literally chewed a bloody hole in my cheek driving home. It’s only 40 minutes, but I was so tired from spending probably four, only four or five hours at the zoo. I’m like catatonic and dangerous to my kids. And that’s just like, this is not okay. And then, with these migraines, I went to the grocery store once. I’m like fine. I’m walking through the store. I’m literally in the checkout aisle with the kids, and all of a sudden the room just is spinning, And I’m like, and I feel like I’m just gonna vomit all over everything. And then, that stops, and then I get optical migraines. So, then I start getting the stuff in an eye and I can’t see outta one eye. 

And so, I become scared to drive, because between the fatigue and the scary migraines, I don’t feel very safe. So, getting that lupus diagnosis, it was scary, but it was also okay, well, now maybe I can get some tools to deal with this. At the time, of course, I was naive and thought that there was more available, that as you spoke to that whole, the medical model of disease compared to the wellness continuum which is medical professionals do their best to keep us from dying and out of the hospital and from not getting, as you spoke to, acutely injured. But when we’re on this long-term journey, we have to start looking for a few more ways to stay on the continuum of wellness, which is little more than beyond just not dying and staying outta the hospital, please.

[00:16:13] Cheryl
Yeah. My wild life goals include a little bit more than just surviving until I die. 

[00:16:17] Christa
Exactly. So, having to learn those skills and find those medications that will kind of help get you back there. So, getting that diagnosis really helped to get me back on track a little bit in terms of, okay, well what are migraine triggers? What do I need to do to manage this so that I don’t get in that place again? I sleep with little kids, you’re like doing your best to get some sleep. Oh, my gosh. And then, getting that arthritis diagnosis, it was like, oh, well this actually almost makes more sense. 

Because I’d had so many injuries along the way that the lupus didn’t explain. Like, I tore cartilage in my shoulder as a teenager and I herniated, I have five herniated discs it turns out, and it was like, I only remember doing one. So, it’s like, how could I have managed to make it through life for herniating four discs and never even knowing, right? It’s supposed to be a lot of pain. And the one that I’m aware of, it did hurt, but so, all these really connective tissue type issues damage that I faced that made a lot more sense. Once I got that rheumatoid arthritis diagnosis, it’s like, oh, okay, this is making a little more sense. 

[00:17:29] Cheryl
Yeah. And the connective tissue is the kind of thing, and this is gonna be like the nerdiest thing, but it’s kinda like your lymph system, it’s like a big part of your body that you don’t even, that you take for granted. You don’t think about it. You think, like, I have, I have skin, I have heart and lungs and all these really important things, but connective tissue connects the pieces of your body that move, that allow you to move. So, it’s extremely important if you plan on moving in your life. So, and that’s what rheumatologists and a lot of people don’t realize that they specialize in disorders of musculoskeletal and connective tissue. Yeah. It’s all a long, detailed thing, but yeah. I think you have a lot, you have a lot going on. So, I’m really curious, I know now you’re quite active with things. I’m learning about, like, aqua aerobics, aqua yoga. I’m curious, how did you get involved with like aquatic exercise?

[00:18:21] Christa
Yeah. So, that actually goes with my life journey and my transitions here. So, just to circle it back around, ’cause you, the thing you said about the connective tissue, I just wanna kind of transition into where we’re going with this yoga, but exactly. Connective tissue is part of your whole fascia system and you have fascia everywhere. Every single one of your organs is surrounded by fascia. Every single one of your muscles is surrounded by fascia. There is no part of your body that is not impacted by connected tissue. So, fascia is basically the little lining that surrounds stuff, right? Fascia, it’s just a fancy word for it’s the outside edge. So, so if you think about, okay, well, you have a bone, that as you spoke to. Okay. Musculoskeletal people are gonna help us with our bones and they’re gonna help us with our muscles, but we have stuff that connects those muscles, connect bone ligaments, and then muscles connect to muscles with tendons. But where does that muscle end and the tendon begin and then the next muscle start? Well, that fascia is part of the whole system. 

So, then when we talk about, okay, well, today we’re gonna talk about aqua aerobics and aqua yoga. Well, if you think about these modalities, and I know you’ve had other guests that talk about yoga. So, any modality that can help you manage this fascia connective tissue system that is being damaged by your unfortunate autoimmune disease, that can really become a management tool. So, my aqua yoga journey started with my yoga journey because I was a farrier. So, for those who don’t know what a farrier is, it’s not somebody who drives the ferries in Washington. It’s somebody who shoes horses. So, somebody still has to put horses on the old-fashioned way in the sense of hammer and nails. No machine can do that. 

So, I did that for 10 years on Whidby Island. And it is not good for your back. If you’ve, if you don’t know what being a farrier is or what it looks like, Google it. You have to bend over and pick up, you know, a quarter of a horse. So, for those listening, I’m a relative — I’m a lot shorter than I used to be, but I’m a relatively petite gal and I used to shoe draft horses, so it is not good for your body. And I’ve heard somewhere that yoga was, so we had on the island a sort of semi-retired, very highly qualified yoga teacher, and I signed up for yoga with her thinking, oh, it’d just be good for my back. It wasn’t like I was some yoga person; it was just like, oh, this is gonna be good for me. But I actually ended up really liking it. 

So, I did yoga with her for five years. I developed a home practice where I would get up half an hour early because I felt so much better going to work after having done a little bit of yoga again. Now that I’ve talked about my diagnosis story, everybody’s probably nodding their head like, well, of course you needed to warm up before you would go do this heavy physical activity because your body’s not so happy. And I’m out in the cold in barns outside. After about 10 years it was, I physically couldn’t take it anymore. Again, largely ’cause of the cold. I love the job, but being out in the barns and the rain and the wind, it was just, it just was really getting to hurt in the winter. Not, again, the job, but it was just like the whole management of it all. So, I decided to go back to school. I did that. I went to graduate school and I moved. And so, during the whole course of this time, I continued that yoga practice on my own. And after moving, I started classes again. I have my kids. And finally, after I had the two kids, and the second one, he is back in school, it was like, well, I think I’ll go to yoga teacher training. Like, I’ve now been doing yoga for 20 years. This has been this huge thing of my life and I think I now have the time and the space to do it.

So, I went into yoga teacher training with that lupus diagnosis here in my diagnosis journey, I came out of yoga teacher training with the mixed connective tissue disease diagnosis. So, that diagnosis came about in that six-month span. And there’s a lot more to yoga than moving your body. There’s a philosophy that comes with yoga that does require a lot of self-reflection. And so, in that process of thinking about, well, how had I managed to do all these heavy physical things throughout my life and yet not known I had this quite severe disease, it’s like, well, I think really frankly, the yoga was really one of the perfect self-management tools I could have found. And that really inspired me to help other people with arthritis and connected tissue diseases manage their health and wellness through yoga. 

So, I immediately went on to do yoga for arthritis teacher training. The Yoga for Arthritis program was developed by Dr. Stephanie Munoz at John Hopkins. And it was a clinical trial which resulted in some really solid research about the benefits of yoga for people who live with arthritis. At that teacher training, one of the other people who was there was like, well, we do, we have this lady’s yoga wine pool night. And it was like, oh, my God, why has no one ever told me about this? ‘Cause I love being in the pool and I love yoga. So, then it was just like, oh, my gosh, I have to know about this. So, I literally, while I’m at yoga teacher training for yoga for arthritis, I google aqua yoga and like immediately, less than like within weeks after coming home, found the one. And as much as I love yoga, it was the aqua yoga where I was just like, okay, this is me. This is what I’m doing from here on out. So, that was five years ago, and that’s what I’ve been doing ever since. So, aqua yoga, it’s just simply yoga in the pool. 

[00:24:11] Cheryl:
And your head is out of the water? 

[00:24:13] Christa:

Exactly. Yes. I get that question. So, I’ve never drowned anyone. It’s just deep water. We can do inversions like you might have seen on the cover of yoga journal at the grocery store, you know, people standing on their head and stuff. Adults don’t really like to do that. The kids love to do it in aqua yoga. Yeah. But I haven’t been able to convince m, students that would be fun. I do think it’s fun to play around with, and obviously I do it with my kids, but in class we’re head out all the time.  

[00:24:41] Cheryl:
Yeah, that’s so, so cool. Actually, speaking of John Hopkins, I wanted to say, I wanted to get the medical definition of fascia just in case anyone’s like wanting to nerd out on that. And it says, ‘Fascia is a thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve, fiber, and muscle in place’. I always forget that fascia holds the nerve fibers as well, which, that’s incredible. So, ‘The tissue does more than provide internal structure. It also has nerves that make it almost as sensitive as skin’. And something I learned when I got in a car accident and started getting massages. ‘Cause I had not, I didn’t like getting massages before, like relaxation massages ‘cause I always felt worse after. And I guess it happens to some people with autoimmune diseases. 

But these kind of medical massages that were really tailored to that, not like full body relaxation but tailored to my neck were fine. And my massage therapist taught, I had learned about fascia in OT school, but she also taught me more about it, and how these tightenings of the fascia can also contribute to pain, even if it’s unrelated. Like, I had tightening of my, fascia around my muscles ’cause I was holding them weirdly around my neck ’cause of my pain in my neck. And so, if we start holding, let’s say our hands for rheumatoid arthritis or elbows or wrist, we start holding our body differently. That also affects the fascia independent of a disorder like mixed connective tissue disease.

[00:26:05] Christa:
There’s really good data about how massages can be beneficial. Not for everyone. Again, there’s so many caveats here. Yeah. But there’s lots of data for the exact reasons you just talked about, is it really can release some of the — they often call them adhesions in the fascia. And a man named Tom Myers and his Anatomy Trains program has done amazing work on fascia. And you can just Google or you, or look it up on YouTube. But there’s these amazing videos about watching the fascia in your body slide around. And if you think about, okay, I have rheumatoid arthritis and maybe that’s affecting my posture or how I’m carrying myself. And then, I amplify that through time. And now, how that shortening of one side of my body is gonna impact the lengthening of the other side. And then, what does that do to my balance long term and so, anything we can do, whether it’s massage, yoga, rolfing, a lot of these body-based strategies really help us manage our disease long-term; just as something as simple as just trying to keep us in the bodies we were meant to have.  

[00:27:16] Cheryl:
Oh, beautifully said. And I think that leads right to what are some of the benefits of doing exercise or yoga in the water specifically that are different than doing those kind of activities on land?

[00:27:32] Christa:
Yes. So, the water. There’s some real distinct benefits to immersion, and this is for people who are — everybody, not just people who live with arthritis — but then those of us who live with arthritis, we get some kind of twofers out of it because of what we have to live with it. So, if you get in the water to that mid-chest height, which you would do in an aqua aerobics or aqua yoga class, you’ve got the hydrostatic pressure of the water on you. So, when you remember getting in the water, you know how it felt, almost like you had a little body sock? ‘Cause the water’s pressing it, pressing in on you. So, that’s the hydrostatic pressure of the water, which makes your heart work more efficiently. Your blood’s not pooling in your feet.

[00:28:13] Cheryl:
Oh!

[00:28:14] Christa:
Yeah. ‘Cause of the pressure. 

[00:28:16] Cheryl:

I didn’t think about that. Yeah. 

[00:28:17] Christa:

Right. The blood’s not pooling in your feet and your body naturally has an immersive reflex that it brings the blood more up into your torso. So, it’s making your heart more efficient, so it lowers your blood pressure. So many people who live with these autoimmune disease have a lot of comorbidities. And rheumatoid arthritis, as you know, makes us at more at risk for heart disease, independent of factors like weight and age and diet. It’s just not good for our hearts. So, anything that we can do to keep our blood pressure down. And that immersive effect actually lasts for a couple hours after you get out of the water. So, the, hydrostatic pressure is really good for your blood pressure. 

And then, when you get in the water, you’re more buoyant, right? It offloads about 70% of your weight. That’s why they train for space in water, right? So, you, if you think about it, it’s okay, I’ve got all this weight on my joints and we’ll talk about, yeah, we’ll, talking about skeletal joints here, I don’t know if we’re gonna talk about hands, but if you think about, okay, I’m immersed at mid-chest height. My knees are literally taking 70% less weight. So, from an arthritis perspective, the most common form of arthritis is osteoarthritis, and then the most common site is the knee, right? So, it goes a little beyond just your audience with rheumatoid arthritis, who also might have trouble with their knees. But if you think about, okay, so now that joint is bearing 70% less weight, wow, that’s really gonna take some pain off. And because it has lightened my load, it literally gives me 30% greater range of motion in my joints on average. These, this mass, all on average here. 

[00:30:02] Cheryl:
It kind depends on the joint. Yeah. You’re not gonna suddenly, your neck depends on the joint, right? It’s depends, depends on the person. It depends on how much — but the point is improved range of motion. 

[00:30:11] Christa:
Yeah. Improved range of motion. So, even if you’ve got some damage in that joint, so maybe you’ve got some either erosions or some spurs happening, right? If you’ve got now a little more range of motion, that’s gonna take some pain off. Kind of caveat there, that 30% range of motion is dangerous for people who are hypermobile. So, if you’ve got like Ehlers-Danlos or in yoga, especially to being an awkward yoga person in yoga, we really — what would you say? Celebrate people who are a little hyperflexible. If you are already prone to that and then you get in the pool and you have more range of motion, little caution here. So, if you have a joint with a lot of damage that’s got a lot of instability, that’s where you wanna be careful. So, more range of motion, there’s the flip side there. It’s good and bad depending on where you’re at. 

And then, when we talk about pain in general, being in the water alters your pain response system. So, you have a greater pain tolerance and you have your pain. All your whole pain system is basically modulated down because that hydrostatic pressure is dampening your nerve response. So, you’re gonna perceive less pain and you’re gonna be able to take more pain. It also, the water reduces exercise-induced inflammation. So, we exercise and part of the benefit we get outta exercising is that tiny little bit of damage we cause ourselves. That’s how we build muscles. We actually tear them a little bit, right? But that causes inflammation. If we have an inflammation driven autoimmune disease like rheumatoid arthritis, we don’t wanna have a lot of systemic inflammation or even localized, especially if it’s in a joint that hurts. So, in a modality that’s gonna reduce that inflammation. 

And a lot of that is the byproduct — say, like, the byproducts, I didn’t talk about, so the hydrostatic pressure also makes your kidneys more efficient. That’s why you have to get, go to the bathroom immediately after you get in the pool. It’s everybody, right? It makes your kidneys more efficient. Well, your kidneys being more efficient is gonna cycle waste body products in your body faster so that lactic acid, which is the byproduct of your muscles working and what makes you sore the next day after you exercise. Your kidneys are clearing that faster. And so, that’s part partly what’s increasing that clearance of those toxins, and therefore you have that less inflammation from exercise the next day, so you’re less likely to be sore. 

And all of this contributes to why people actually like aquatic exercise better. If you take somebody with arthritis and you say, “Okay, I’m your doctor. I’m forcing you to go to exercise and I’m gonna put you in a land class,” and then the other doctor says, “I know you have arthritis and I’m forcing you to go to aqua class.” If you make those, then people come together and say, okay, now you get to switch. They like the aquatic exercise better. So, if you live with arthritis, you are more likely to like aquatic exercise because of all those things. It’s just, this is just better. It feels better. Yeah. It doesn’t hurt. It’s more fun. It can be a little social. Nobody yells at me if I talk to my neighbor. 

[00:33:23] Cheryl:
Yeah. And I’m realizing that so many of us with rheumatoid arthritis enjoy like a hot bath. You know, like, lot of people talk about a hot bath and I’m realizing now, I always thought it was just simply the heat modality. I knew that the buoyancy of the water was going to help a little bit, but when you’re in a bath, it’s not like that much. But I didn’t think about all the other pressure things you were talking about, how that could really relieve the full effect. And I think something that I learned in occupational therapy school, how strong a force gravity really is. 

And the thing I always tell people is, if you’re not sure about how strong a force gravity is, just try to hold your arm straight out in front of you for five minutes. Like, you’ll realize pretty quick, like, all the time, gravity is, in layman’s terms pulling down. It’s really literally. Yeah. And so, when you live with a disease that causes pain, let’s say at the joints, like arthritis that you’re just, as you move your body around the world, whether you’re sitting in a car or you’re sitting in at a computer, or you’re standing, or you’re walking your dog, you are fighting gravity constantly, but that you’re relieving that amount of gravity when you’re in the water. It’s like you said, the 70% less — what did you say? 70%. 

[00:34:36] Christa:
The buoyancy, you basically offload, right? So, at your, belly button, it’s half your weight, at mid-chest it’s 70%, and then at your neck it’s 90%. So, that’s why when you get up to your neck in the water, you’re like, I can barely walk because literally you’re not stuck to the ground and that offloading of gravity. Another interesting aspect of that, when you exercise in the water is like you spoke to, okay, if you’re gonna hold your arm out, and most of us know like a bicep curl, right? You curl your hand into your shoulder and we call it a bicep curl ’cause that’s the muscle we’re working, right? We’re working that muscle against gravity. So, we’re gonna build a bicep. 

Except when we get in the water, okay, now gravity isn’t a big deal, but now I’ve got the viscosity of the water. So, I’m actually gonna get more balanced muscular effort and work my triceps more in the water than I’m going to on land. So, if we talk about arthritis and a joint that is suffering, it’s known now not as much of a constant exercising one side of that joint and the muscles that are on only one side of that joint. So, I’m gonna get more balanced muscular effort and support that joint better because one of the few things we can do when we have arthritis is build, strengthen our muscles because strong muscles support weak joints. 

So, the more we can build muscle on both side of a joint, the more we’re gonna help art — arthritis, excuse me, and the more efficient we’re gonna be on our exercise. So, that’s another thing that we get out of the water is that, but beyond the offloading is this idea of the water’s viscosity helps us get that more balanced effort. 

[00:36:19] Cheryl:
It’s incredible. You’re blowing my mind here. And I think, a lot of people with, let’s just say osteoarthritis, even though that’s not my primary audience, but they might have come over here and said, “Arthritis Life! I wanna hear this.” But it’s very common for people to get frustrated by the recommendation that they lose weight, you know, because it’s can be hard to be told you’re in a lot of pain now, just go exercise and lose some weight. That’s hard when you’re in pain. But you do have to recognize that the reasoning behind that is just the physics of how much load your joint takes when you have a bigger body mass. 

But again, all these points about the benefits of aqua exercise are that, you know, it’ll help take some of that weight off your joints as you’re doing it. So, it’s like it enables you to do the exercise that is so much harder because of your greater body mass. It’s just like, yeah, I think it should really be more recommended more often, but I think it can just be maybe the access issue, access to a pool and maybe it’s difficult in certain parts of the country and or parts of the world, I guess, depending on where you live.

[00:37:26] Christa:
Yeah. In the States here, we’re really blessed. I know access is a problem and but at the same token, we have 10 million backyard pools. But that’s more than anywhere in the world, right? We have so many more pools. And there’s, I think it’s something like 30,000 municipal pools, right? So, access is a huge, can be a huge problem, but we also have some really great organizations that really try very hard to make it accessible, namely the YMCA and also JCCs, the Jewish Community Centers. They usually have scholarship programs. Most of them participate in the Silver Seniors program, which is for seniors, part of the government over 65 with your Medicare. A lot of them will offer free swim lessons as well. I know we’re talking, mainly about arthritis for adults, but we have to keep in mind, in the water there is a safety concern and that’s tough for some people. A lot of their resistance to getting in the water is not these ideas. They love the ideas, but they’re scared of being in the water because of lack of access to swim lessons when they were a kid. 

And there’s been a lot, especially here in Florida, we have a lot of past discrimination regarding access to swimming pools that have really impacted coming forward here in the years of who feels comfortable being in the water. So, it’s important to say those organizations offer free swimming lessons so that we can grow up to be comfortable in the water. And what you were speaking to with, medical professionals saying, “Well, you need to potentially lose some weight to take a load off these joints.” We get in that pain cycle, which I know you’ve talked about with your guests in terms of you, you’re in pain so you don’t exercise; and since you don’t exercise, you’re in more pain. And then, it just goes on and on and on. 

So, anywhere we can break that cycle, whatever it is for you, even if it’s something as simple as, “Well, I don’t have access to the pool right now because it’s January, but in March I will, so I’m gonna do some meditations for the next six weeks to get me ready for being in the pool,” right? Anything you can do to break that pain cycle there somewhere will, really help. So, yeah, keep in mind, whatever you can do to get transportation to the pool, if it’s maybe work a trade, somebody you know, who has a, a backyard pool, it often falls down into that ‘If there’s a will, there’s a way’ category. If you put as much effort into getting in the pool as you put into securing your medication, you’d probably make it happen. Like, if the one takeaway you get at today, it’s like I really have to get in the pool. 

[00:40:02] Cheryl:
[Intermission begins]

Hi, everyone. I’m interrupting really quickly to remind you that this podcast is brought to you by The Rheumatoid Arthritis Roadmap. It’s a comprehensive online education and support program that I created from scratch to help people learn how to live a full life despite rheumatoid arthritis. In the course, you get to learn how to manage everything from physical symptoms like pain and fatigue, to social and emotional aspects of living with rheumatoid arthritis. I even cover the logistics of things like how to track symptoms and how to advocate for yourself in medical appointments. To learn more, go to myarthritislife.net. 

[Intermission ends]

What are the kind of thoughts around safety in terms of germs and such? 

[00:40:44] Christa:
Yes. The CDC actually has some information about Covid and pools. The chlorine in the water kills all the Covid germs, so you cannot get Covid from, being in the pool where you really need to be safe in the locker room. Yeah. So, it’s like any other aspect of Covid is you just need to be safe around other people. So, most pools, for example, are no longer providing gear just in case there’s that transfer of germs by touching. But you would wanna wear your face mask in the locker room area. A lot of pools have gone to an appointment only basis right now to accommodate Covid. So, you would, of course, if you’re motivated, oh, I’m gonna go to the pool now, please call them first so that you’re not disappointed about a Covid restriction that we didn’t talk about. So, you might need an appointment if you’re working with an aquatic therapist or that’s coming up, they will probably wear like a face shield in the water with you because it’s not safe to wear masks in the pool because — even they do sell waterproof masks and they’re out of swimsuit material and those are less restrictive. 

But we didn’t talk about the breathing aspect of hydrostatic pressure. It makes your respiratory muscles work harder, especially on the inhale. So, if one of your comorbidities is something like COPD or asthma, and you’re now suddenly having to put on a mask and work two times the harder of just being in the water, olus with the mask, that would be a really unsafe place to be. And so, you can choose to wear a mask in the pool if you’re gonna do head out of water exercise, obviously not the case for swimming. A lot of pools have gone to only one-person in a lane at a time for lapse swimming, for example. And then, aqua aerobics classes, best practice is to maintain that six-foot distance. So, a lot of times the class limits are smaller than they used to be. So, just, yeah, make sure you call and I will get you that CDC link for anybody who has any questions about that. 

[00:42:37] Cheryl:
That’s super, super helpful. And I’m gonna say one thing from my own past experience, I was definitely a land athlete growing up, and I did not like the smell or the feeling of chlorine, especially in my eyes. I was always really sensitive to that. So, what is enticing me about this is the idea that my head could be out of the water the whole time. I could even have my, I could still have my glasses on. I don’t have to deal with contacts. I could just keep my head outta the water and then all I have to do is rinse off my body. That seems like a better deal than, than like a swim, full swim workout when your head’s under the water. So, I try to anticipate people’s objections. You try to, like, anticipate the things they’re gonna say, “Oh, I can’t do it. There’s no pools.” ‘Cause I’m visualizing what you’re talking about ‘cause I’ve, received aqua physical therapy before. Can you kind of walk me through group aqua classes? What is it kinda like? 

[00:43:35] Christa:
Yeah, The Arthritis Foundation, because there’s such good data and awareness about this idea of aquatics for arthritis. The Arthritis Foundation created this program. It’s the Arthritis Foundation Aquatics Program. The Arthritis Foundation has actually now handed it off to the Aquatics Exercise Association. It still bears the Arthritis Foundation’s name. So, if you’re looking for it at a center, it might say the abbreviation is AFAP, or it might say Arthritis Foundation Aquatic Exercise, something like that the, it came out of the program through the Arthritis Foundation, and they used to train people. Now it’s gone in the aquatic exercise. 

[00:44:13] Cheryl:
Thank you for that clarification. ‘Cause I actually was confused about that prior to talking to you. 

[00:44:17] Christa:
And it can be hard. It is now, it’s getting harder and harder to find on the Arthritis Foundation website. However, if you look through their exercise finder, they have that really great — The Arthritis Foundation has a ton of resources on their website, one of them is the, in the resource finder, it’s to find exercise. In that exercise finder, they do list the classes very well, however, if you wanna find the background information about the program, that’s really tough. So, the good news is you can go to the website and plug it in to try and find it near you, you’ll be able to find it. You just won’t be able to find, well, what is this about and why? So, we’ll talk about that a little bit today. Your state health department might actually have a really nice PDF on it because a lot of health departments still really recommend the program. 

So, when you go to the program — I should also preface it by saying, as we’ve hinted at as we were talking, osteoarthritis is the most common kind of arthritis. And the incidence of that goes up significantly as we get older, right? So, this Arthritis Foundation program is really designed for older adults. It will accommodate, of course, everyone who has arthritis. But it also is quite friendly to people who don’t have arthritis, but maybe have some physical limitations, such as MS. Or I’ve had people come to class that were blind or hearing impaired or after a stroke. So, it is a gentle aquatics class. That being said, if you have RA, that might be a great place for you to start. Or perhaps you might like a little more aggressive aquatics class, and then you just work with the instructor to say, hey, I have this going on. This is what’s, you know, can you give me a flag or something if there’s anything in particular we’re gonna do that I should sit out. So, there’s that element also of the Arthritis Foundation program to know about. 

So, knowing that is it’s a very gentle warmup that try and takes people through the range of motion, basically starting head working down. So, you would move your neck through its res of motion, move your shoulders, get your hands going. There’s always an element of just literally walking through the water. Walking through the water is really very healthy. If everybody’s listening to this and they’re like, well, this is all lovely, but we don’t have a single aquatics class where I live. It’s just a pool and there’s only lap swimmers. Fine. Get in and walk. Especially walking backwards, there’s lots of data about the benefits of walking backwards because it really builds your back muscles. If you have back pain, it builds your extensor muscles, it builds your balance. I don’t mean get in the water and bob around, walk backwards as if you’re on land. Hugely beneficial. 

So, of course they incorporate that into the Arthritis Foundation program walking forwards and backwards. And then, within that warmup, then it moves into more range of motion. So, you might do, for example, like a leg lift that’s gonna ask your hip to come into a little larger range of motion work with the water. And then, there’s that balance component. Now you’re standing on one leg. Every class is gonna have an aerobics component because it is a class designed for older adults that aerobics work is, stays pretty attached to the pool floor. We have what we would call levels and aerobic exercise, and the levels correspond with basically jumping up off the pool floor and doing suspended moves, which the water lets you do, but they’re much more demanding of your joints, your balance, your physical abilities. You don’t do any of that suspended higher level work in the arthritis foundation class. So, it’s very basic aqua aerobics exercises such as you jogging in place or jumping jacks, which you might know, which do get your heart rate up and provide some aerobic exercise, but doesn’t have quite the demands of the higher level classes.

And then, they encourage a mindfulness component. So, I’ve mentioned there’s some chatting, there’s that idea of, okay, well can you focus on what’s going on now and notice how this feels within your own body. There’s some breath work exercises. Some classes will incorporate some components of singing which is really good for memory as well. So, there can be that element. And then, there’s always a cool down and some programs do a little more of about education as well. Like, you might be working with an instructor who’s really focused on helping people lose weight. And so, there might be a little educational component about, okay, we’re gonna do a little extra in this one particular area because it is, Healthy Heart Week or so. Ideally, there’s some health education in the classes as well. 

[00:49:08] Cheryl:
Okay. Wow, that sounds really great. Do you also sometimes do private lessons sometimes as well?

[00:49:17] Christa:
It depends on the instructor. And then, the facility. Yeah, so you can — there’s, and you have mentioned it, you said as an OT, you have done aquatic therapy. So, there are people who are aquatic PT’s. There’s an organization called the Aquatic Therapy and Research Institute. They do not certify PT’s in aquatic therapy, but they provide continuing education. Aerobics or aquatics professionals and PT’s, doctors, anybody who wants to learn about aquatic therapy, they provide a continuing education for that. So, if you’re perhaps a PT or worked with them, you might work more therapeutically with people one-on-one, you can go to group classes, you can have a private group class, so you could hire an aqua aerobics instructor to come to your house and do a class just for you. It’s not therapy, it’s just your own aquatic class. There’s that. And then, some pools have people on staff to do private sessions with people as well.

[00:50:17] Cheryl:
That’s really nice. I do think that sometimes people can feel a little intimidated, so maybe like kind of get them excited and comfortable and then the next time they come into the group class, and so, it’s nice to maybe sometimes to feel like, okay, I because the water people can feel a little bit, in their bathing suit, they can feel a little bit, like, self-conscious. But I think if you’re in a group sometimes that can help. ‘Cause it’s like, oh, yeah. We’re not like a bunch of supermodels, we’re just normal people trying. Yeah. And I think something that I’ve really noticed as a patient and as a provider is that the group process can be so powerful. Like, just simply getting people together. Even if you don’t have the world’s most perfect program, I’m sure this Arthritis Foundation, the program is wonderful. I know it is. And you said it’s based on evidence, but even if not, like I’ve thought sometimes to myself, like just the power of getting people together who have a similar challenge, you know, or who maybe all have a chronic disease or who are just dealing with the normal pains of aging, it’s just —have you seen that in your classes? Like, the people —

[00:51:19] Christa:
Oh, absolutely. And there’s, that’s definitely a component. And so, I mentioned like every class would have an element of walking to it. Well, then it just devolves into socializing, which isn’t bad from the perspective of what you just said. That’s why you’re going to a group class. You could walk in the pool by yourself. But to have that social interaction. And aquatic classes are often more social than other exercise forms. And they’ve done good research on that in like community dwelling, older adults. They have aquatics class, but they can go and do a puzzle. Or if you’re in assisted living, there’s lots of social things for you. But they still find more benefits out of the social aspect of the aquatics because you’re socializing and exercising. So, you know, you’re getting the both, plus the power of being in the water. And some other examples that you just spoke about is group classes are really great for men. There’s this perception that aquatics is just for like little old ladies. 

And it’s like, no, there’s actually quite a lot of men who come. So, if any man is listening to this, I don’t know, there are really quite a lot of men who go. There are men who teach aqua aerobics. So, don’t feel self-conscious. There’s that element. And then, whether you’re a man or a woman, I’m not remembering his last name — it’s Dr. Vivek, he’s the former surgeon general of the United States. He just came out with — it’s basically, loneliness is killing us. It’s worse than heart disease. It’s worse than arthritis. It’s really bad. So, if you, especially now in times of Covid, we’re all really struggling and if you feel like aquatic exercise is a safe way for you to get some community, even if you’re six-feet apart from someone, ’cause it’s outdoors. Especially if you have access to an outdoor pool here as we come into spring, or if you’re like me in Florida, we in theory have 365 days a year, then take advantage of it as part of your Covid community plan.

[00:53:16] Cheryl:
I love that. Yes. So, many people are feeling socially isolated right now, so being able to socialize in an in-person safe way sounds like the best of all worlds. And I think as an occupational therapist, actually, a lot of my previous experience was with in pediatrics with children with like developmental differences. And there’s definitely a sensory element to being in the water. So, not just from the physics of it, but from a standpoint of with sensory integration, sensory processing. And there’s a lot of children, for example, who are hypersensitive to certain kinds of input, hyposensitive to others. And so, many children I work with, for example, on the autism spectrum, loved the water. Now some of ’em hated it, but there were so many children and their parents would say, if I could — I remember one of the children’s parents said, “If I could just have a bath at the school for my child when they’re having a meltdown and they get in that in the water, they just calm immediately and they feel so much more centered.” And so, I don’t, I don’t know any hardcore evidence on this, but it is fascinating to me to think about like how, when we are infants or when we are neonates in the womb, we’re in water, we’re in our mom’s uterus. And it’s interesting to think about, there’s maybe some primal association we have maybe with water for some.

[00:54:43] Christa:

Yes. Yeah. It’s, we don’t even lose — when we’re about six weeks old, we lose that ability to close our throats and not with little tiny babies, you know, you dive them in, maybe people have seen them with water covered, and they’re like, “Oh, my God, the baby’s under water!” If they’re under six-weeks old, your throat still shuts down because, like you said, your first environment is water. So, we come out of that. So, and there is that element of spiritual aspect of water and what that has met through centuries. And you spoke to, the sensory processing nature of water and there is some research out there for autism.

[00:55:23] Cheryl:
Oh, good.

[00:55:24] Christa:
And what it does for kids of different abilities. Yes. And the same impacts that the water gives those kids helps adults with Parkinson’s. So, there’s a lot of, like you say, physics to the water. There’s a lot of — because of what it’s doing basically to your nervous system, there’s a lot of emotional stuff. It really does improve your mood, right. If you look at quantitative data rather than — excuse me, qualitative.

[00:55:51] Cheryl:
Qualitative, yeah. 

[00:55:52] Christa:
Yeah. But quantity is numbers. For those who are like, why did I bumble that?

[00:55:56] Cheryl:
Oh, yeah. No, they start with the same sound. Yeah. 

[00:56:00] Christa:
Right. Quality is about how we feel about something. It’s our opinions, measure our opinions, lots of that on what it does for our mood. And so, we get into that kind of emotional aspect of what the water does for us. And if you think about, well, why do you always wanna go to the ocean? Look at the waves, you know, why is beachfront property always more valuable in every country than living in the valley, right? We all wanna be around the water. It is very innate. 

[00:56:27] Cheryl:
It’s so — and I’m sure that there are obviously exceptions to people who’ve had a trauma or who have had, like we mentioned earlier, adverse experiences around the water or just are fearful of it. I know there’s many children who grew up in the eighties like me and watched Jaws, and then we’re like, I’m never going in the water. But yeah, like in general, like you’re saying, across cultures, there is this overall global kind of association with water. So, yeah, that is, oh, my gosh, we could talk about this all day, but is there anything else you wanted to say about the response to aquatic yoga and aquatic exercise from your clients or from your own life?

[00:57:03] Christa:
I would just encourage people to really try it. If they’re, you know, you’re listening to this and you’re like, “Ah, I don’t, I don’t know about if I suit, I don’t know,” call a buddy. Get an accountability buddy because that helps in all aspects of exercise disease management, right? Call whoever your accountability buddy is and say, “Hey, I just heard this really great thing about getting in the water and I want you to hold me accountable ’cause we can’t, maybe can’t do it this week or because of Covid or whatever, but bring it up again in six weeks,” or something. So, whatever you can do to get an accountability buddy or put it on your calendar or do something so that even if you can’t do it now, you can do it in the spring. So, that is my final thought is just, do it sometime. Please try to do it sometime. And if it’s not now, that’s okay. Do it sometime. 

[00:57:52] Cheryl:
That’s great. Yeah. Maybe I’ll make it by the end of 2021. Oh, something just flooded into my mind. I do wanna mention, I did pursue swimming as an exercise when I was working for a university that had a pool on campus, which was so great. And as an employee, I got the benefit of being able to join the fitness center at the University of Washington. And one of the things I found, and this totally maybe that I was doing it wrong, but when I was trying to do the crawl stroke, having rheumatoid arthritis, the resistance of the water actually felt a little hard on my joints. Is that a typical for people with rheumatoid arthritis? This is not for water aerobics or water yoga, but for the actual swimming. 

[00:58:34] Christa:
Right, that speaks to, basically it’s your fitness level. So, as we talked about — 

[00:58:40] Cheryl:

Sorry I was laughing myself. 

[00:58:41] Christa:
It’s more dense, right? You’re not, you’re moving. Try to think about if you swam in maple syrup, right? Water isn’t maple syrup, but it gives you that, oh, my gosh, that would be really hard, right? And so, for you to say, oh, it was hard, that front crawl, it’s really hard for my joints, that’s telling you your muscles aren’t developed enough to take the amount of effort you were putting them through, right? That water’s, I think it’s 800-times more dense than air, right? So, your muscles are literally not used to making this action. And then, as we were talking about that pull on both directions. You whipped it out through the air ‘cause you’re used to that and then it’s like, oh, my gosh, it’s moving through the water and this is so hard, right? 

So, for all people living with rheumatoid arthritis who has stuff going on in their joints, you always — this is a great point to end on as well — you always clear any kind of exercise with your healthcare provider so that they know what you’re doing and that they can tell you it’s appropriate for them. Any time you’re working with an instructor or getting some help from a professional, you would wanna tell them so they’re aware of what’s going on and can guide you in appropriate ways. And then, number one, independent of all those other professionals is you’re most responsible for yourself. ‘Cause you go home with you. Those professionals don’t go home with you and your body. 

Your body is about you and you’re doing all this to benefit you. So, one thing we all struggle with rheumatoid arthritis is walking that fine line between challenging yourself appropriately and challenging yourself too much, right? So, you have to listen to your body and get really good, and that’s why partly why I love yoga is it helps you develop that discernment. So, you can walk that line a little better of this is too much, this is appropriate, this is me dialing it in. 

[01:00:30] Cheryl:
Yeah. Oh, such a good point. And yeah, I will say, for the record, this me trying to swim as exercise was before I became an occupational therapist. So, yeah, I think I probably wasn’t as attuned to the idea of really listen to your body and the idea of giving yourself, in OT we call it the Just Right Challenge, you know, that challenge is just outside your ability zone. If you’re trying to improve on something, you wanna get a little bit towards the edge of it, but not push so far that you then — I was probably just pushing way too hard, and I think, okay, my joints weren’t, my muscles weren’t ready for that yet. 

[01:01:06] Christa:
Yeah, it makes total sense. Yeah. And, if any time we have a weakness, any kind of weakness in our body, if it’s an injury or a chronic disease, and if we do something that is not in great form, it’s gonna amplify it. So, something else about living with a chronic disease, if you’re trying a new skillset, getting help, the advantage to that is it shortens your learning curve and you’re less likely to hurt yourselves because somebody’s spotting you. If you’re doing something with poor form and it’s aggravating a sore joint, that’s gonna make it even worse compared to somebody saying, hey, if you just move it in a little bit, your form’s gonna be better. You’re gonna be more efficient. 

So, that’s the other thing is speaking to, it’s not just fitness. Form can really help. And so, if you’re really committed to something and it’s really not working for you and you’re doing it on your own, try and get some professional help. ‘Cause that can sometimes really make the difference. And this is what you do as a living as an OT, people are doing stuff with their joints they shouldn’t be, and wearing them out and you helping them get good forms. So, that’s exactly what you do. 

[01:02:11] Cheryl:
Oh, thank you. It is different to do it on yourself though. I always — it’s like they say that if you’re a therapist, you still need to have a therapist. You know what I mean?  And we need an outside perspective sometimes. I definitely benefit from that. But yeah, this is so, so helpful. I’m super jazzed. I’m like, just gonna go call up the swim school that I had my son’s swimming pool that we had him enrolled in before Covid, we just stopped everything with Covid. We’re like, nothing. Everything’s canceled. But to know these, this data about the safety makes me feel a little bit more comfortable, so I’m really excited. But I’m guessing people are gonna want to follow you on social media or maybe find your website. I’m gonna put that all in the show notes, but do you wanna share for those of you people who might just wanna hear it right now? 

[01:02:54] Christa:
Sure. Yeah. Just the easiest way to do it is just Google my name. So, my website is christafairbrother.com. That’s where I am on Facebook. Instagram, it’s a little harder. It’s @AquaContentYogi, but just Google my name and aqua yoga and I’m all over the internet since that is really my thing. I got lots of pictures out there and I would be happy to answer any questions. And I hope this was inspiring to get people in the water. As my son says, “It is the best thing ever.” 

[01:03:22] Cheryl:
I’m really grateful for you for taking the time to share with us. ‘Cause yeah, I, certainly learned a ton. And I apologize to any of my former professors if they’re listening, they’re like, we told you this in OT school. If you don’t use it, you lose it sometimes. I didn’t remember any of these statistics of how, what the water does other than it just, the buoyancy is good for exercise. I knew that takes the weight off, but some of these really specific elements of how to fix your breathing and, like, your heart rate and stuff. I’m like, oh, my gosh, this is so cool. I wanna tell everyone now! I drunk the Kool-Aid. 

[01:03:52] Christa:
Yeah. Good! Excellent. That’s what I wanna hear. That’s my mission in life is to get everybody to think this is the best thing ever, right. So, I wish — mission accomplished. I wish it were more available in communities worldwide. Yeah. ‘Cause it’s just so, so beneficial. 

[01:04:05] Cheryl:
Oh, and there are, by the way, if you are also have some sensory aversions to chlorine, at least in Seattle. Now, I don’t know about the Covid aspect. There are a couple pools that are salt water, so I don’t know how normal that is, but. 

[01:04:18] Christa:
So, salt water, it’s, a new system that for the pools and they’re not actually chlorine free. It’s just how the chlorine is kind of filtered and derived. Oh, so there’s significantly less chlorine. So, that’s what it’s about. But yeah, we can’t get outta the chlorine because you don’t wanna swim in a Covid pool. No, not ’cause of Covid. It’s like a green pool is all filled with all kinds of germs that we don’t want even before Covid. So, water quality is very important. If you think about like, why — so, for example, why the pools all have the sign up that says ‘Please shower before you get in the pool’, that’s actually because the chlorine interacts with all the stuff on you. 

The sweat, your shampoo, your body products. It does its little chemistry thing, turns into chloramines, which are actually what you smell and that’s the bad stuff. So, please always shower before you get in the pool. Nobody wants to swim in your bathtub, right. Don’t take your shampoo or anything to the public pool and make it a personal care routine. Try and be as clean as possible. Always use the bathroom, right? Just like they don’t want little kids having accidents in the pools, right? We don’t want it as adults either. So, that is a big contraindication for swimming. And that, actually, it becomes one of the main reasons people have to give up their aquatics practice is because of incontinence in some capacity.

So, and then as a OT, you know, working in a slightly more medical environment, if you’ve got any kind of wound care issues, you gotta address those. So, you can’t have open wounds there, in a therapeutic environment. There are ways you can get those covered, but you would need to educate yourself on the products and have a team help you learn to take care of that before you get in the water. So, a few more little water safety things. 

[01:06:09] Cheryl:
Whoa. I’m really glad you told me that about the rinsing off. I didn’t realize that was why. I thought it was maybe for like makeup and stuff, but I didn’t realize even just your own sweat. 

[01:06:20] Christa:
Even just your own sweat and it’s, they often only have cold water and it’s miserable. You’re like, the pool isn’t gonna be this cold. Why do I have to take this s cold shower? Yeah. And it really helps. It helps everybody. And lifeguards actually, ’cause they’re exposed to so much more chlorine, have a higher incidences of some kind of cancer from being around the chlorine all the time. And so, it really, it helps us all. So, take that shower. It makes a difference. 

[01:06:44] Cheryl:
Okay. Well, geez, so many nuggets. Thank you so much again. This is so, so great. And I would love to hear from the audience, if anyone ends up doing an aerobic, class water aerobics, or water yoga, please let me know at info@myarthritislife.net. And I’ll tell Christa too, so we can see if we’ve started a movement here. 

[01:07:44] Christa:
Excellent. I love it. 

[01:07:05] Cheryl:
Yay. Thanks again. 

[01:07:07] Christa:
Thank you so much.

[Ending note] 

Thank you so much for listening to another episode of the Arthritis Life Podcast. This episode is brought to you by the Rheumatoid Arthritis Roadmap, an online course that I created from scratch to help people live a full life with rheumatoid arthritis, from social and emotional aspects of coping with rheumatoid arthritis to simple physical strategies you can use every day to manage things like pain and fatigue. You can find out more on my website, myarthritislife.net, where I also have lots of free educational resources, videos, and more. 

Thank you so much for listening to another episode of the Arthritis Life podcast. This episode is brought to you by Rheum to THRIVE, an educational program I created from scratch to help you go from overwhelmed to confident, supported, and connected in a matter of weeks. You can go through the pre-recorded course on your own, or you can take the course along with a support group. Learn more at the link in my show notes, or you can always go to www.myarthritislife.net. That’s life.net. And if you like this podcast, I would be so honored if you took the time to rate and review it. I also encourage you to share it with anyone, who might benefit from it. I also wanted to remind you that you can find full transcripts, videos, and detailed show notes with hyperlinks for each episode on my website, www.myarthritislife.net. If you have any ideas for future episodes, or if you want to share your story or wisdom on the podcast. Just shoot me an email at info@myarthritislife.net. I can’t wait to hear from you.