aquatic exercise (week 14)

Definition of Aquatic Exercise

The use of water to facilitate the application of therapeutic interventions

Goals aquatic exercise

Facilitate ROM

Increase strength, cardiovascular func, respiratory func, balance and coordination, and sensory processing

Management of tone

Facilitate weight bearing activities

Minimal risk of injury or re-injury

Enhance relaxation

Physiological effects of water

Decreased perceived exertion

Decreased heart rate

Decreased edema

Decreased pain

Increased stroke volume

Increased cardiac return

Increased circulation

Increased respiration

Hydrostatic pressure stabilizes joints

Increased blood flow to the kidneys

Precautions to Aquatic Exercise

Dehydration

Fear of water

• Muscle guarding, stress response, improper form

Neurological disorders

• Ataxia, vertigo

• MS

Respiratory disorders

• Inhibited lung expansion due to hydrostatic pressure on the chest wall

Cardiac dysfunction

• Angina, heart disease, abnormal BP, or compromised pumping action

Small open wounds and lines

• Need to be covered with a waterproof dressing

• Clamp tubes

Contraindications for Aquatic Exercise

Develop heart failure, unstable angina or BP

Respiratory dysfunction or tracheostomy

Severe PVD

Unstable fractures

Danger of bleeding/hemorrhage

Severe kidney disease

Skin infections

Incontinent of bowel and/or bladder

Menstruation without internal protection

Water and airborne infections – influenza, GI infections

Uncontrolled seizures

Properties of Water

Physical properties

• Buoyancy

• Hydrostatic pressure

• Viscosity

• Surface tension

Hydromechanics

Thermodynamics

Center of buoyancy

Physical Properties-
Buoyancy

Upward force that works opposite to gravity

• Provides weightlessness and joint unloading

• Provides resistance

• Amount of air in lungs will affect buoyancy

• Affected by body composition

Physical Properties-
Hydrostatic pressure

Pressure exerted by the water on an immersed object is equal on all sides

• Increased density and depth of immersion will also increase hydrostatic pressure

• Increased pressure also increases circulation and decreases peripheral edema caused from venous or lymphatic insufficiency

• Allows patients to do exercise easier when closer to the surface

Physical Properties-
Viscosity

Friction occurring between molecules of liquid resulting in resistance to flow

• Resistance from viscosity is proportional to velocity of movement through the liquid

• Viscosity creates resistance with all active movement

• Increased velocity, increased resistance

• Increased surface area moving through water, increased resistance

Physical Properties-
Surface tension

Surface of a fluid acts as a thin elastic membrane under tension

• Resistive force of surface tension changes proportionally to the size of the object moving through the fluid surface

• Using equipment at the surface of the water increases the resistance (exercise weak muscles under the surface of the water)

Hydromechanics

Involves the physical properties and characteristics of fluid in motion

3 factors affect flow

• Laminar flow

• Turbulent flow

• Drag

Thermodynamics

Water temperature affects the body and will impact performance

• Specific heat

• Temperature transfer

Temperature Regulation

Cooler temperature for higher-intensity exercise

Warmer temperature for mobility, flexibility, and relaxation exercises

Air temperature should be 37.4*F higher than the water temperature for patient comfort

Patient’s can’t maintain adequate core warmth during immersed exercise at temperature less than 77*F

Exercise at temperature greater than 98.6*F may be harmful if prolonged or high intensities are sustained

Hot water immersion may increase the cardiovascular demands at rest and with exercise

Mobility and Functional Control Exercise

Aquatic exercise temperature between 78.8* and 95*

Aerobic Conditioning

Cardiovascular training and aerobic exercise should be done in temperature between 78.8* and 82.4*

Pools for Aquatic Exercise

Traditional Therapeutic Pools

Individual Patient Pools

Special Equipment for Aquatic Exercise

Collars, Rings, Belts, and Vests

Swim Bars

Gloves, Hand Paddles, and Hydro-tone® Bells

Fins and Hydro-tone® Boots

Kickboards

Deep Water Equipment

Flotation belt

Vests

Flotation dumbbells

Noodles

Fins

Specially designed boots

Buoyant dumbbells

Mid-Water Equipment

Specially designed socks

Forced current

Elastic tubing

Noodles

Kickboard

Stretching Techniques

Spine

Shoulder

Hip

Knee – can use the pool steps

Manual Resistance Exercises

Practitioner Position

Patient Position

• Buoyancy-supported (BS) supine

Hand Placement

• Stabilize proximally while the patient moves distally

• Stabilize distally while the patient moves proximally

Direction of Movement

• Depends on what muscle group your working on

Special techniques

Ai Chi

Watsu

Bad Ragaz

Watsu

Therapeutic technique that incorporates principles and stretches of Zen Shiatsu to water exercises

Done in warm water

Uses continuous movement that flow into the next movement and uses rocking to move of the whole body while stretching an extremity

Benefits: increase strength, increase flexibility, increase ROM, increase relaxation, restores nerve flow in the body

Precautions: Too much vestibular movement, emotional response, body mechanics

Watsu Technique

Physically close to patient – skin to skin, cradling

Freeing of the spine is the focus at the beginning of each session

No jewelry, loose hair

Warm water pool at 90-96*F and 3-4’ depth

Bad Ragaz

Use buoyant rings or other floatation devices to float a person in the water

Progressive resistive exercises

Pool should be 92-94*F

Uses approximation and traction

Benefits: strengthening, muscle reeducation, trunk elongation, relaxation, tone inhibition

Bad Ragaz techniques

Isometric – patient holds position while therapist moves patient in water

Isotonic – graded resistance controlled by therapist; therapist stabilizes but will move as patient is moved through water

Bad Ragaz

Too much vestibular movement

Painful acute conditions

Body mechanics

Over doing exercises

Upper and Lower Extremity Manual Resistance Techniques

Move UE and LE in all directions

Can do PNF patterns with one limb or both at the same time

Can do exercises in different positions like sitting, supine, sidelying

Dynamic Trunk Stabilization

Frontal Plane

Multidirectional

Independent Strengthening Exercises

Extremity Strengthening Exercises

• UE – shoulder level water

• LE - mid-trunk level water

Lumbar Spine Strengthening

• Spine stabilization – shallow, mid-depth, deep water levels

• Neutral spine while doing functional activity or moving extremities

Trunk-Strengthening Exercises

• Standing

• Semi-reclined

• Supine

• Prone

• In deep water

Physiological Response to Deep-Water Walking/Running

Cardiovascular Response

• May get less response than on land if no previous cardiovascular compromise

Training Effect

• Carry over gains to land

Proper Form for Deep-Water Running

Instruction for Beginners

• Use correct form

• Neutral cervical spine and slightly forward flexed trunk with arms at sides, hips flexed to ~80*

Accommodating Specific Patient Populations

• Buoyancy belt posteriorly helps maintain a slightly forward flexed position for spinal conditions

• Buoyancy belt on the opposite side of an amputation will help patient stay vertical

Exercise Monitoring

Monitoring Intensity of Exercise

• Rate of perceived exertion

• Heart rate

  • If immersed to neck level, lower the maximum heart rate range

Monitoring Beginners

• May have higher levels of perceived exertion and VO2 max than on land

• Monitor new patients and especially with cardiac, pulmonary, or peripheral vascular disease