Aquatic exercise can be very beneficial for a variety of patients: seniors, athletes needing injury rehabilitation, and pregnant women are just a few of the groups that aquatic exercise can benefit. Few practitioners know what to look for when they refer their patients to an aquatic exercise program, though. Most usually tell their patients to ?join a water aerobics class? and leave it at that, without really knowing what the patient may be getting into. Below are some of the things health practitioners should consider when referring their patients for aquatic exercise.

Referring Patients for Aquatic Exercise
? Observe classes in your area.
? Know the pool temperature. (86? or higher for arthritics, 79-82? for lap swimming)
? Know the special needs accessibility of the pool and locker rooms
? Check on third party payer reimbursement.
? Think of your patient. Would you send a 70-year-old to a class at a mirror-clad health club, or to a YMCA? Does a 20-year-old athlete need to be in an Arthritis Foundation level class?

Safety Issues
? Is a lifeguard present?
? How comfortable is the patient in the water?
? Is there food available in the area for diabetics if necessary?
? Is there a first aid kit?
? Is there a backboard?
? Is there a phone?
? Is there a defibrillator on the premises?
? Are the instructor and lifeguard aware of your patient?s particular problem?
Aquatic Exercise Design
? Water affects each body type/design/fat distribution differently. For example, males will have a harder time in deeper water than will females due to wider shoulders and narrower hips. Pear-shaped patients will have a harder time keeping their legs from floating, due to their fat distribution, so they will need to exercise more abdominal control.
? The same exercise will work different muscles, depending on the depth of the water.
? Changing the speed of the exercise changes the amount of friction, which changes the resistance.
? Currents change proprioception, stability, and level of control.
? Water at neck level supports 90% of the body?s weight; water at mid-torso level supports 75% of the body?s weight, and water at waist level supports 50% of the body?s weight. How deep the patient should be depends on their individual needs.
? In most aquatic exercises, there is frequent use of the abdominals to maintain position, without doing sit-ups/crunches.
? Emphasize posture and body position to get the most benefit from aquatic exercise.
? Start easy to avoid discouragement.

Intensity of Aquatic Exercise

? Intensity should not be based on heart rate. Heart rates are only valid of they correlate to oxygen consumption. Heart rates will be lower in the water because water dissipates heat more effectively than air, so the heart doesn?t beat as fast to cool the body; decreased gravitational pull eases venous return; and hydrostatic effects shift blood volume from the extremities to the thorax. In the water, heart rates on average are decreased 13% or 17 bpm from those on land.
? Intensity must also take into account the effects of medications or specific disease conditions.
? To increase the heart rate, use shorter levers and less elevation of movements.
? Using the arms overhead increases the heart rate, but not the stroke volume, so the cardiac output may not be enough to achieve cardiovascular fitness.
? You cannot use sweat to correlate to exercise intensity. You may sweat in the water without knowing it.
? New exercisers must be taught the difference between ?bad pain? and ?good pain? (from exercising).

Aquatic Exercise and Pregnancy

? Benefits of aquatic exercise during pregnancy:
? decreased impact.
? decreased gravitational pull.
? cooling effect of water prevents overheating.
? heart rate doesn?t increase as much as with land exercise.
? hydrostatic pressure pushes excess fluid into the bloodstream, decreasing edema.
? less of a heavy, clumsy feeling in the water.
? feel like they can move with more grace.
? Safer.
? Emphasize simply maintaining their current fitness level instead of trying to improve it.
? Pregnancy may be the first time she considers fitness, so she may need more feedback from the instructor.
? Special needs for pregnant patients in aquatic exercise:
? longer warm-up and cool-down
? gradual intensity changes and longer transition times
? simple choreography
? caution against overstretching
? good chance to educate on proper nutrition and hydration
? Pregnant women can safely perform supine abdominal exercises in the water because there is no pressure on the vena cava like there would be on land. (Must check for diastasis recti, though.)
? Intensity should reflect how they feel today, not how they ?usually? exercise.
? If a pregnant woman is in a mixed class, do not single her out. Talk to her about special precautions either before or after class.

Strength Training in the Water

? Of all the body systems, the neuromusculoskeletal system can demonstrate the most visibly dramatic difference between a completely sedentary person and a person who conscientiously trains.
? A 1990 study of 86-96 year olds in long term care facilities with only 8 weeks of aquatic strength training to their knee extensors there was an average strength increase of 180%. Some subjects in the study were even able to eliminate their use of canes when walking.
? Aquatic strength training does not increase the number of muscle fibers, but does increase their size, the number of fibers activated, the number of capillaries going to the muscle fibers, and the mitochondrial efficiency in the muscles.

For More Information:
? Arthritis Foundation--www.arthritis.org
? American Red Cross--www.redcross.org
? YMCA--www.ymca.net
? Aquatic Exercise Association?(813) 486-8600 or www.aeawave.com
? American Alliance for Health, Physical Education, Recreation, and Dance?(703) 476-3400 or www.aahperd.org
? United States Masters Swimming?(804) 355-6588 or www.usms.org
? United States Swimming?(719) 578-4578 or www.usswim.org
? USA Triathlon--www.usatriathlon.org
? National Sports Center for the Disabled--www.nscd.org
? Wheelchair Sports USA--www.wsusa.org
? Special Olympics?(202) 628-3630 or www.specialolympics.org

Dr. Heller is a chiropractor and certified strength and conditioning specialist (CSCS), practicing in Wauwatosa, Wisconsin. She has extensive experience teaching fitness classes, including aquatics, to all age groups and abilities. http://www.healthritellc.com

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