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Upon completion of this chapter, the student should be able to demonstrate the following competencies and proficiencies concerning aquatic exercise:

  • Describe the physical properties of water and how they can be utilized in the rehabilitation process

  • Understand the indications, precautions, and contraindications of aquatic exercise

  • Be aware of local codes and regulations for the use of aquatic therapy

  • Describe the advantages of aquatic exercise

  • Describe the different methods of aquatic exercise

  • Know how to use the different pieces of aquatic equipment

  • Design an aquatic exercise program for the upper extremity, lower extremity, and spine incorporating range of motion and strengthening exercises

  • Design an aquatic exercise program for patients from special populations


Aquatic exercise or therapy has been utilized in the rehabilitation of injuries for many years. This exercise medium was traditionally used for hot and cold whirlpool treatments and wound care. Today it has evolved into an exercise modality that is utilized in all stages of a sound rehabilitation program. Aquatic exercise, which is commonly used with disabled or injured populations, has recently been implemented in exercise protocols aimed at improving cardiovascular health and athletic performance.1–4

Aquatic exercise, or pool therapy, incorporates exercises or exercise programs that are performed in varying depths of water. It is a form of therapeutic exercise that is useful for a variety of musculoskeletal injuries and medical conditions.

As with any other form of exercise, aquatic exercise has advantages and disadvantages. Because of the buoyant effect of water, the aquatic environment provides a patient the ability to perform exercise quicker that they would be able to perform on land. It also allows the clinician the ability to apply weight-bearing or non weight-bearing exercise earlier in the rehabilitation process. Further, many of the benefits of land exercise can be accomplished in water, such as range of motion, strengthening, stretching, and cardiovascular conditioning.5,6 Some disadvantages of aquatic exercise include a risk of infection to open wounds, the cost of maintaining and purchasing a pool or aquatic exercise tank, and finding qualified instructors.6

Clinical Pearl 12-1

Exercises that are performed on land may be easier or harder in the aquatic environment depending on patient positioning and velocity of movement.

The clinician's personal expertise and experience are an important factor in determining if aquatic exercise is an appropriate exercise option for a patient. Exercises that are performed on land may be easier or harder in the aquatic environment, depending on patient positioning and velocity of movement. For example, the faster a limb is moved in water, the more resistance is felt by the patient,7 whereas on land the opposite is true. (Refer to Chapter 7 to review the relationship between force and velocity.) Moving the legs and arms on land places less demand on trunk-stabilizing muscles than do the same ...

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