Avoid Illness While Doing Water Exercises for Arthritis

Healthy Swimming Habits Are Essential

Three senior women in pool.
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People with arthritis are encouraged to pursue pool therapy and water exercise. The buoyancy of the water and warmth of the water make it a great way to exercise for people with joint pain and physical limitations.

It's important to know how to stay healthy in a pool or hot tub environment. Awareness can help you avoid illness associated with contaminated water. Most recreational water illness is diarrheal illness, which is spread by swallowing contaminated water.

In addition, swimming in contaminated water can also cause infection in the eyes, nose, as well as in open wounds, cuts, or scrapes. It can cause skin rashes or respiratory infection.

Pool water is shared by everyone who uses the pool. If someone with diarrhea contaminates the water, swallowing the water can make people sick. Recreational water can also be contaminated by fecal matter rinsed off of the bodies of swimmers. Also, lakes, rivers, and the ocean can be contaminated by sewage spills, animal waste, and water runoff.

Diarrrheal accidents are not easily noticed and as a result could contaminate even the best maintained pool. Plus, some germs like Crypto (short for Cryptosporidium) are resistant to chlorine and can live in even the best maintained pools for several days.

Can swimming pools spread head lice?

Unlikely. Lice survive by holding onto hair and are not likely to let go when someone's head goes under water.

It would be rare to find lice floating in pool water. It is more likely that head lice are spread by sharing towels or other items that have been in contact with an infested person's hair.

Can people get a recreational water illness from swimming in the ocean?

Recreational water illnesses have been associated with swimming at ocean beaches.

Some common germs can live for long periods of time in salt water. Swimmers should always avoid swallowing the water where they swim.

Can people get a recreational water illness from swimming in fresh water lakes and rivers?

Yes. Lakes and rivers can become contaminated with germs from sewage, animal waste, water runoff, direct human contamination from fecal accidents, or germs rinsed off the bottoms of swimmers. Avoid swimming in areas that have been identified as unsafe by health departments. Contact your state or local health department about germ testing results for local recreational water.

Some germs that live in fresh water normally don't infect humans. For example, Naegleria is a germ that is found throughout the world. Naegleria is found in warm, stagnant bodies of water and can cause severe illness. Naegleria enters the body through the nose when you are swimming underwater or diving into water. Persons can prevent Naegleria infection by not swimming in small shallow ponds or areas posted by local health authorities as "No Swimming."

Can people get a recreational water illness from using hot tubs and spas?

Yes. Skin infections are the most common recreational water illness spread through hot tubs and spas. Given that hot tubs and spas have warmer water than pools, chlorine or other disinfectant levels evaporate faster. For that reason, it is important that chlorine or disinfectant levels in hot tubs and spas are checked even more regularly than in swimming pools.

Doesn't chlorine kill all germs found in swimming pools, hot tubs, and spas?

Yes, chlorine does kill all germs but it takes time. A few germs can survive in chlorinated water for several hours to several days in pools, hot tubs, and spas and you can therefore get infected. It is important to maintain proper levels of chlorine to kill germs. However, be aware that even the best maintained pools can spread illness.

Why do many recreational water illnesses go undetected?

People do not think that pool water can make them sick. It can take several weeks before the germs in the water cause illness, so people often don't connect their illness with swimming. In addition, because diarrhea is so common, most people don't seek medical attention for it, so outbreaks of illnesses often don't get reported to health departments. The longer the time period between swimming and illness the less likely people are to think that they became sick from swimming. For all these reasons, many outbreaks go undetected.

Should some people be more concerned than others about the spread of Crypto (short for Cryptosporidium)?

Yes. Every swimmer should be concerned, but those living with a compromised immune system should be even more concerned. They should realize that accidentally swallowing Crypto-contaminated water can cause illness. Children, pregnant women, and people with compromised immune systems can suffer from more severe illness than others. Arthritis patients treated with immunosuppressants must be aware of the concerns.

What should I do if I see fecal matter in the pool?

Immediately notify the pool attendant or lifeguard. Pool staff should ask swimmers to leave the water immediately. The pool water may be tested and the chlorine levels raised, depending on the policy and initial chlorine level at the pool. The wait between the closing and re-opening of the pool can be frustrating. Be supportive of pool management.

Should I think the water is safe if I don't see fecal matter in the pool?

No. Just because you can't see these germs doesn't mean that they are not present. Even the best maintained pools can spread illness. Therefore, the safest pools are pools that are not only well maintained, but also have the commitment of all patrons to practice healthy swimming behaviors.

How can I protect myself from getting sick?

Healthy swimming behaviors are needed to protect you. Here are 3 "P-L-E-As" for everyone:

  • PLEASE don't swim when you have diarrhea. You can spread germs into the water and make other people sick.
  • PLEASE don't swallow the pool water. In fact, try your best to avoid even having water get in your mouth.
  • PLEASE wash your hands with soap and water after using the toilet or after changing diapers. You can protect others by realizing that germs on your body end up in the water.


Centers for Disease Control and Prevention, Healthy Swimming, Questions and Answers for Swimmers. Updated 2/5/2015.

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