{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T01:34:33Z","timestamp":1772760873011,"version":"3.50.1"},"reference-count":38,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T00:00:00Z","timestamp":1684454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Rheumatoid arthritis (RA) is characterized by low physical fitness, pain, and depression. The present study aimed to examine the effects of a supervised aquatic exercise program on physical fitness, depression, and pain in women with RA and determine whether decreases in pain mediate depression. Methods: Forty-three women with RA, divided into an experimental group (EG; n = 21) and a control group (CG; n = 23), participated in a 12-week exercise program. Treatment effects were calculated via standardized difference or effect size (ES) using ANCOVA adjusted for baseline values (ES, 95% confidence interval (CI)). A simple panel of mediation was executed to determine whether changes in pain mediated improvements in depression after controlling for confounding variables, such as age, physical activity, and body mass index (BMI). Results: The aquatic exercise program had trivial and small effects on physical fitness, large effects on pain, and moderate effects on depression. The mediation model confirmed the indirect effect of pain on the decrease of depression in the participants of the aquatic exercise program. Conclusions: Participants with RA in the aquatic exercise program experienced improvements in physical fitness, depression, and joint pain. Moreover, the improvements in joint pain mediated improvements in depression.<\/jats:p>","DOI":"10.3390\/ijerph20105872","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T00:55:29Z","timestamp":1684457729000},"page":"5872","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effects of Aquatic Exercises for Women with Rheumatoid Arthritis: A 12-Week Intervention in a Quasi-Experimental Study with Pain as a Mediator of Depression"],"prefix":"10.3390","volume":"20","author":[{"given":"Miguel A.","family":"Perez-Sousa","sequence":"first","affiliation":[{"name":"Department of Physical Education, Faculty of Education, University of C\u00f3rdoba, 14071 Cordoba, Spain"},{"name":"Epidemiology of Physical Activity and Fitness across Lifespan Research Group, University of Seville, 41004 Seville, Spain"}]},{"given":"J\u00e9ssica","family":"Pedro","sequence":"additional","affiliation":[{"name":"Departamento de Desporto e Sa\u00fade, Escola de Sa\u00fade e Desenvolvimento Humano, Universidade de \u00c9vora, 7004-516 Evora, Portugal"}]},{"given":"Rocio","family":"Carrasco-Zahinos","sequence":"additional","affiliation":[{"name":"Faculty of Education, Psychology and Sport Sciences, University of Huelva, Avenida de las Fuerzas Armadas s\/n, 21007 Huelva, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9753-8381","authenticated-orcid":false,"given":"Armando","family":"Raimundo","sequence":"additional","affiliation":[{"name":"Departamento de Desporto e Sa\u00fade, Escola de Sa\u00fade e Desenvolvimento Humano, Universidade de \u00c9vora, 7004-516 Evora, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), University of \u00c9vora, 7004-516 Evora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5254-7409","authenticated-orcid":false,"given":"Jose A.","family":"Parraca","sequence":"additional","affiliation":[{"name":"Departamento de Desporto e Sa\u00fade, Escola de Sa\u00fade e Desenvolvimento Humano, Universidade de \u00c9vora, 7004-516 Evora, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), University of \u00c9vora, 7004-516 Evora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7780-3942","authenticated-orcid":false,"given":"Pablo","family":"Tomas-Carus","sequence":"additional","affiliation":[{"name":"Departamento de Desporto e Sa\u00fade, Escola de Sa\u00fade e Desenvolvimento Humano, Universidade de \u00c9vora, 7004-516 Evora, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), University of \u00c9vora, 7004-516 Evora, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/S0140-6736(10)60826-4","article-title":"Rheumatoid Arthritis","volume":"376","author":"Scott","year":"2010","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1002\/art.24385","article-title":"Quantitative Heritability of Anti-Citrullinated Protein Antibody-Positive and Anti-Citrullinated Protein Antibody-Negative Rheumatoid Arthritis","volume":"60","author":"Toes","year":"2009","journal-title":"Arthritis Rheum."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.reumae.2012.06.007","article-title":"Tobacco and Other Environmental Risk Factors in Rheumatoid Arthritis","volume":"8","year":"2012","journal-title":"Reumatol. 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