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Aquatic exercise complete notes

1. Aquatic Exercise Chapter 9

2. BACKGROUND AND PRINCIPLES FOR AQUATIC EXERCISE

3. Definition of Aquatic Exercise Aquatic exercise refers to the use of water (in multidepth immersion pools or tanks) that facilitates the application of established therapeutic interventions, including stretching, strengthening, joint mobilization, balance and gait training, and endurance training.

4. Goals and Indications for Aquatic Exercise Facilitate range of motion (ROM) exercise Initiate resistance training Facilitate weight-bearing activities Enhance delivery of manual techniques Provide three-dimensional access to the patient Facilitate cardiovascular exercise Initiate functional activity replication Minimize risk of injury or re-injury during rehabilitation Enhance patient relaxation.

5. Precautions to Aquatic Exercise Fear of Water Neurological Disorders Respiratory Disorders Cardiac Dysfunction Small, Open Wounds and Lines

6. Contraindications Incipient cardiac failure and unstable angina Respiratory dysfunction, vital capacity of less than 1 liter Severe peripheral vascular disease Danger of bleeding or hemorrhage Severe kidney disease (patients are unable to adjust to fluid loss during immersion) Open wounds without occlusive dressings, colostomy, and skin infections Uncontrolled bowel or bladder (bowel accidents require pool evacuation, chemical treatment, and possibly drainage) Menstruation without internal protection Water and airborne infections or diseases (examples include influenza, gastrointestinal infections, typhoid, cholera, and poliomyelitis) Uncontrolled seizures during the last year.

7. Properties of Water Buoyancy: Buoyancy is the upward force that works opposite to gravity. Hydrostatic Pressure: Hydrostatic pressure is the pressure exerted by the water on immersed objects. Viscosity: It is friction occurring between molecules of liquid resulting in resistance to flow. Surface Tension: The surface of a fluid acts as a membrane under tension. Surface tension is measured as force per unit length. Hydromechanics: Hydromechanics comprise the physical properties and characteristics of fluid in motion.

8. Thermodynamics: Water temperature has an effect on the body and therefore on performance in an aquatic environment. Specific Heat: Specific heat is the amount of heat (calories) required to raise the temperature of 1 gram of substance by 1°C. Temperature Transfer: Water conducts temperature 25 times faster than air. Heat transfer increases with velocity. A patient moving through the water loses body temperature faster than an immersed patient at rest.

9. Center of Buoyancy The center of buoyancy is the reference point of an immersed object on which buoyant (vertical) forces of fluid predictably act. Properties. Vertical forces that do not intersect the center of buoyancy create rotational motion. Clinical significance. In the vertical position, the human center is located at the sternum.

10. Aquatic Temperature and Therapeutic Exercise Temperature Regulation Mobility and Functional Control Exercise Aerobic Conditioning

11. Temperature Regulation Water conducts temperature 25 times faster than air more if the patient is moving through the water and molecules are forced past the patient. Patients perceive small changes in water temperature more profoundly than small changes in air temperature. Over time, water temperature may penetrate to deeper tissues. Internal temperature changes are known to be inversely proportional to subcutaneous fat thickness. Patients are unable to maintain adequate core warmth during immersed exercise at temperatures less than 25°C.

12. Exercise at temperatures greater than 37°C may be harmful if prolonged or maintained at high intensities. Hot water immersion may increase the cardiovascular demands at rest and with exercise. In waist-deep water exercise at 37°C, the thermal stimulus to increase the heart rate overcomes the centralization of peripheral blood flow due to hydrostatic pressure. At temperatures greater than or equal to 37°C, cardiac output increases significantly at rest alone.

13. Mobility and Functional Control Exercise Aquatic exercises, including flexibility, strengthening, gait training, and relaxation, may be performed in temperatures between 26°C and 35°C. Therapeutic exercise performed in warm water (33°C) may be beneficial for patients with acute painful musculoskeletal injuries because of the effects of relaxation, elevated pain threshold, and decreased muscle spasm

14. Aerobic Conditioning Cardiovascular training and aerobic exercise should be performed in water temperatures between 26°C and 28°C. This range maximizes exercise efficiency, increases stroke volume, and does not elevate the heart rate to the extent that warmer water does.

15. Pools for Aquatic Exercise Traditional Therapeutic Pools Individual Patient Pools

16. Traditional Therapeutic Pools This type of pools measure at least 100 feet in length and 25 feet in width. Depth usually begins at 3 to 4 feet with a sloping bottom, progressing to 9 or 10 feet. These pools have built-in chlorination and filtration systems. Entrance to larger therapeutic pools includes ramps, stairs, ladders, or mechanical overhead lifts. This larger type pool may be used for groups of patients and the therapists conducting the session while in the pool.

17. Traditional Therapeutic Pools

18. Individual Patient Pools Pools designed for individual patient use are usually smaller, self-contained units. These self-contained pools are entered via a door or one to two steps on the side of the unit. The therapist provides instructions or cueing from outside the unit. They have built-in filtration systems, these units may include treadmills, adjustable currents, and varying water depths.

19. Individual Patient Pools

20. 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

21. Collars, Rings, Belts, and Vests

22. Swim Bars

23. Gloves, Hand Paddles, and Hydro-tone ® Bells

24. Fins and Hydro-tone ® Boots

25. Kickboards

26. Pool Care and Safety Pseudomonas aeruginosa (an infection causing folliculitis). Cleaning and pH Level Tests (at least twice weakly) Walking Surfaces should be slip-resistant. Safety Rules and Regulations Life Preservers and CPR should be present all the time

27. EXERCISE INTERVENTIONS USING AN AQUATIC ENVIRONMENT

28. Manual Stretching Techniques Patient Position Buoyancy-assisted (BA) seated or upright Buoyancy-supported (BS) supine

29. Self-Stretching With Aquatic Equipment

30. Manual Resistance Exercises

31. Dynamic Trunk Stabilization

32. Independent Strengthening Exercises

33. Aerobic Conditioning

34. Physiological Response to Deep-Water Walking/Running Cardiovascular Response Training Effect

35. Cardiovascular Response Patients without cardiovascular compromise may experience reduce elevation of heart rate, ventilation, and VO2max compared to similar land-based exercise. During low-intensity exercise, cardiac patients may experience lower cardiovascular stresses. As exercise intensity increases, cardiovascular stresses approach those of related exercise on land.

36. Training Effect Patients experience carryover gains in VO2max from aquatic to land conditions. Additionally, aquatic cardiovascular training maintains leg strength and maximum oxygen consumption in healthy runners.

37. Proper Form for Deep-Water Running Instruction for beginners. Proper instruction is important to ensure correct form because many beginners experience a significant learning curve. Once immersed, the patient should maintain a neutral cervical spine and slightly forward flexed trunk with the arms at the sides. During running the hips should alternately flex to approximately 80° with the knee extended and then extend to neutral as the knee flexes.

38. Proper Form for Deep-Water Running Accommodating specific patient populations For patients with positional pain associated with spinal conditions, a posterior buoyancy belt helps maintain a slightly forward flexed position, and a flotation vest helps maintain more erect posture and a relatively extended spine. Patients with unilateral lower extremity amputations may have difficulty maintaining a vertical position. Placing the buoyancy belt laterally (on the contralateral side of the amputation) allows the patient to remain vertical more easily.

39. Exercise Monitoring Monitoring Intensity of Exercise Rate of perceived exertion Heart rate Monitoring Beginners

40. Equipment Selection Deep Water Equipment Flotation belt Vests Flotation dumbbells Fins Specially designed boots Bells Buoyant dumbbells Mid-Water Equipment Specially designed socks Forced current Elastic tubing Kickboard