The medical community has used water as a medium to treat injuries and rehabilitate patients for many years. Aquatic exercise classes have attracted individuals with special needs such as senior adults, pregnant women and those who do not tolerate land-based exercise well. Exercising in water decreases pain and stiffness and is particularly desirable for clients with arthritis and orthopedic conditions of the hips, knees, ankles, feet and spine.
Incorporating aquatic workouts is an excellent way to diversify your programming and attract new clients while motivating the ones you have using the pool for alternative or cross training activity.
In order to design safe and effective exercise in the water it is important to understand several basic principles. Although this list is not inclusive, these basic principles will effect the exercise design.
1. Resistance-The viscosity of water is 12 times greater than the air; therefore, it provides greater resistance as a limb moves through the water. The surface area, size of the movement, speed of the movement, turbulence, drag and the length of the lever all effect resistance.
2. Speed of movement-Due to greater viscosity it is more difficult to move the body as quickly through water as it is through air. For water walking or jogging, only one -half to one-third the land speed is necessary for the same energy expenditure.
3. Buoyancy-In water to the chin the body looses 90 percent of land weight. Gravitational forces are suspended and impact on the weight-bearing joints is minimized greatly.
Types of Aquatic Exercise
There are four predominate types of water exercise. They are water walking, resistive exercise, water aerobics and lap swimming.
1. Water walking-Water walking is ideal for any level exerciser, and those with physical limitations or special exercise needs. Easy walking can be used as a warm-up or as general conditioning. Walking and jogging can be added to upper body moves or can be used as all or part of the cardiovascular segment of the workout. Walking can be forward, backward, or side to side and performed in a large circle, crossing the pool, in individual space or with a partner. Walk or jog steps can be performed on tiptoe, heels only, with a bent knee, forward/backward lean position, with large steps, small steps, slow or fast.
2. Resistive exercise-The increased resistance provided by water is an excellent workout for the muscles. Conditioning should include overall strength and endurance work for the large muscle groups and major joint movements. Always begin with large muscle work, such as water walking and then work the smaller muscles of the upper body and lower legs.
3. Water aerobics-Water aerobics is performed in the shallow end of the pool and may be done with music if acoustics permit. Exercises and movement pattern should be designed to use all parts of the body and the physical properties of water.
4. Lap swimming-Lap swimming is an excellent cardiovascular exercise for a competent swimmer. However, lap swimming can be somewhat frustrating, energy draining and unsafe for individuals with poor swimming skills.
Exercise Design Considerations
The following factors should be considered when designing water exercise for clients:
1. Water temperature-Water temperature should be between 82 and 88 degrees Fahrenheit for most exercise sessions. For more therapeutic exercise the temperature should be between 92 and 96 degrees Fahrenheit. Pools heated over 90 degrees F should not be used for aerobic activities pool temperatures under 80 degrees F present risk of body cooling when the activity slows or ceases. A body in water cools four times faster than a body in air. Always keep the lower body in motion during even brief pauses or breaks in the exercise. Air temperature in an indoor pool should be 2-4 degrees higher than the water temperature and humidity approximately 60 percent.
2. Water depth-Ideal water depth is upper abdominal to armpit level. This allows for arm movements to assist or resist movement and experience enough body weight to produce overload.
3. Safety-Safety for the participant is always a number one priority. Clients should refrain from rough play in and around the pool. The use of AquaSocks or other footwear in and around the pool is recommended. The pool deck should be clear of equipment and items that could be tripped on by participants.
4. Pool entry and exit-Pools with wide steps, handrails, or ramps are obviously easier to enter and exit than those with only ladders. The Arthritis Foundation and YMCA Aquatic Exercise Program suggests individuals with orthopedic conditions should always descend ladders or steps leading with their weaker or most painful leg. When ascending the steps or ladder, lead with the stronger leg and ascend and descend one step at a time.
5. Movement considerations – Correct body positioning and a neutral spine should be encouraged in all maneuvers.
? Since overuse of the hip flexors can contribute to back discomfort, avoid excessive abdominal exercises that involve single or double leg lifts while hanging from the side of the pool.
? Slow controlled movements are preferred over jerky, ballistic or bouncy movements. Keep the knees soft rather than locked. Design class movements with less bouncing and more traveling and walking patterns.
? To avoid injury or unnecessary joint discomfort begin by using short levers and progress to using longer levers. For example, begin with bent arm or leg movements and progress to straight arm or leg exercises.
? Take extra care to prevent tightly gripping on flotation devices, railings, the pool wall or gutter. This can contribute to pain and deformity in arthritic hands and fingers.
6. Varying intensity-Participants may increase or decrease exercise intensity by varying movement size, direction, speed or number of repetitions. Small fast movements and sustained over-the-head movements increase isometric work and heart rate, but not aerobic conditioning. These movements should be used sparingly.
To increase exercise intensity
? Maximize leg movements which involve large muscle groups.
? Use movements that travel a minimum of 6 to 12 feet to maximize turbulence and drag.
? Use larger movements at one-half to one-third the land speed.
? Change directions, start then stop, and restart the movement again.
? Use slow upward motions and increase the speed on downward motions.
? Remember, work intensity is directly proportional to the surface area in motion.
To reduce exercise intensity:
? Use a short versus long lever arm and shorten the distance moved.
1. Warm-up(5-10 minutes)-The thermal(musculoskeletal) warm-up includes easy water walking and slow moves that imitate the strength moves later in class. Use short levers and reduced range of motion (ROM) to stimulate joint lubrication. Progress to longer lever and larger, fuller ROM movements.
2. Pre-Stretch(3 minutes)-Include short(5-10 seconds) stretches for major muscle groups to be used in class. Calves, hip flexors, quads/hamstrings, gluteals, pectorals, shoulders, and low back should be included.
3. Pre-Cardio(3-5 minutes)-Water walking and larger movements with increased intensity prepare the cardio-pulmonary system for the workout to follow.
4. Cardio (20-30 minutes)-The aerobic portion incorporates increased dominance of large muscle activity, of the leg, thigh and hip muscles, in activities such as walking, jogging, skipping, and jumping. Arm movements should be at or below shoulder level. Research has shown that for decreasing body fat, rhythmic water exercise is comparable to land-based programs.
5. Cool down(5 minutes)-Activities mimic the pre-cardio.
6. Strength(5-15 minutes)-Part of the strength work, especially the large lower body and trunk muscles, can be incorporated into the cool down. This is followed by smaller muscle work. Equipment props add surface area and increase the intensity of the work.
7. Flexibility/Relaxation (5 minutes)-This section is an extension of the previous two. Plan more prolonged flexibility exercises for the areas stretched in the warm-up.
Any fitness practitioner who wishes to work with individuals in the aquatic environment should be networked with his/her local Arthritis Foundation and Arthritis Foundation-YMCA Aquatic Instructors program.