The following article has been written for Yoga for Arthritis by Christa Fairbrother. See exciting changes announced on February 4th, 2020 by the AEA here.
As a Yoga for Arthritis teacher and former staff member, I’m passionate about helping people with arthritis gain more comfort and movement in their lives. I do that through sharing yoga and especially aqua yoga.
The Arthritis Foundation’s Exercise Program was taken over by the Aquatic Exercise Association(AEA) several years ago. Being a YFA instructor, an AEA instructor, and so passionate about aqua yoga for arthritis, I needed to step up and take the Arthritis Foundation Aquatics Professional training offered through AEA. I was really curious about how the different perspectives on arthritis and movement on land vs in water were expressed in the training.
These are some observations I had, in case you’re thinking this training represents learning potentials for you as well or are looking for larger perspective on movement for arthritis.
First some general background on the Program. The Arthritis Foundation Exercise Program is a group exercise program for seniors living with arthritis. The classes are usually offered at community/rec centers, senior centers or YMCA’s. There are land-based and aquatics-based classes in the Program.
Some background information and research support on the land component of the Program can be found at HERE.
To become a trained instructor for the AF Program, the AEA offers a training course for people who are already trained fitness professionals. After finishing the course, upon passing the exam, you’re either an AFEP (Arthritis Foundation Exercise Professional for the land component) or an AFAP (Arthritis Foundation Aquatics Professional for the aquatics component). I participated in the online training course and will be addressing my comments towards that. Because YFA instructors are interested in the land-based exercise component of the program I’m just speaking to that here.
The purpose of the AFEP program is to increase or improve the participant’s: balance, coordination, cardiovascular endurance, flexibility and ROM, muscular strength and endurance, posture, relaxation and weight bearing of participants.
It does this through an exercise program that can be done freestanding or in a chair.
The AFEP training course teaches the Program through a manual and video instruction. The manual has been recently redone and is very well illustrated and referenced. The videos cover individual exercises as well as background videos on the purpose of the program, information about arthritis and teaching tips.
“Only use the exercises or combinations of exercises included in the AFEP/AFAP manual. Remember to STICK TO THE BOOK”. The capitalization is mine to highlight that the Program emphasizes exercises over exploration. The yoga idea of teaching to the purpose of the pose versus achievement of form has no room here. The program is about achievement of form.
As yoga teachers we see people move in unergonomic, habitually poor movement patterns all the time. Getting people to move more efficiently for their bodies helps people get out of pain. If someone moves in the same old poorly aligned, inefficient way, big surprise it might hurt. Trying to get people moving with better alignment is one way of the ways we can help people reduce pain as yoga teachers. The AFEP program stresses exercises over ergonomics or customization so it doesn’t allow room to develop the svadhyaya of better ergonomics.
“Don’t allow participants to ‘invent’ their own exercises or perform exercises they may have learned elsewhere.” Unfortunately, that undermines people’s ability to develop self-knowledge, awareness, and agency which are integral to the eight limbs of yoga.
A huge plus of the Program is its emphasis on breath and mindfulness which is often not included in fitness programs. It encourages deep breathing for relaxation. They encourage body check-ins and awareness in a mindful way. They advise including a relaxation component in every class such as deep breathing, progressive relaxation, visualizations and guided imagery, or autogenic training.
The Program doesn’t address some of the more current theories in pain research such as the impact of pyscho-emotional states on pain or how chronic pain transforms our neural networks. As yoga teachers we’re looking to address pain on all the koshas; this Program focuses on the traditional interpretation of pain as a static physical concept.
“Stop an exercise if it increases knee/hand/back (there’s a long list of body parts here) pain”. As yoga teachers we don’t want to cause or increase people’s pain. That’s a given. But the AFEP Program doesn’t address two big elements of living with chronic pain that people with arthritis face.
If you’re in pain all the time and you move a painful joint and it’s painful, does that really mean it’s making anything worse? Chronic pain rewires our circuitry to be overly sensitized to pain. New movement needs to be introduced with caution walking the fine line of ahimsa vs tapas. The encouragement to really get to know your pain and get creative in your relationship with it to help you manage better in all aspects, not just exercise, isn’t addressed.
We’re not blobs and we can’t sit around and do nothing ever again because it hurts to move. Getting ‘fit” is about overtaxing something and causing the appropriate amount of stress for growth. Living with arthritis isn’t any different. We need strong muscles to support weak joints. It might be a little uncomfortable in the moment to do a new exercise but where is it uncomfortable? We don’t want joint pain or joint stress; we want to develop muscles. We need to develop some discernment around our pain to be able to separate where the pain is occurring. The AFEP Program doesn’t emphasize body awareness enough to drill down into this idea of good pain that’s helping me get healthy/fit/more limber/build cardiovascular endurance vs bad pain which is aggravating swollen/damaged joints.
The course does include a great diversity of arm movements you can include in chair yoga classes and is quite extensive for an online program. It’s a great introduction to the fitness needs of people living with arthritis for fitness professionals who’ve worked with more able-bodied adults or who want to start teaching these types of classes at gyms or senior centers.
As a yoga teacher, I’m obviously biased towards the benefits and structure of yoga, however I do think as yoga teachers we have some real advantages compared to other fitness professionals.
Yoga provides us with a clear scope of practice, the 8 limbs. Those 8 limbs provide us with a wealth of resources to help people beyond physical movements. Not everyone is willing to go to a yoga class and this program is a great, safe substitute, but there’s a lot more power in the full Yoga for Arthritis program for this population. Yoga for people with arthritis empowers them to live fully in their bodies in all its aspects, including the ones that hurt, not just move their limbs.
Aquatic Therapy Rehab Institute Certified
Aquatic Fitness Professional & AFAP
Autoimmune Yogi Warrior
Lover of tea and books
Certified Aqua Yoga Specialist
Certified Yoga for Arthritis Instructor