Chapter 9: Aquatic Exercise

Introduction

Aquatic therapy, the use of water for rehabilitation purposes, traces its origin back several centuries. The use of water for restorative purposes has grown in popularity and has gained increased use in facilitating therapeutic exercise. The unique properties of the aquatic environment provide clinicians with treatment options that may otherwise be difficult or impossible to implement on land. Using buoyant devices and varied depths of immersion, the practitioner has flexibility in positioning the patient (supine, seated, kneeling, prone, side-lying, or vertically) with any desired amount of weight bearing. Aquatic exercise has been successfully used for a wide variety of rehabilitation populations including pediatric,^{8,30,39,49,55,73,78,84} orthopedic,^{1,4,9,11,12,13,14,19,21,27,31,41,50,68,80} neurological,^{41,54,56,61,63} and cardiopulmonary patients.^23,48,77

Background and Principles for Aquatic Exercise

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.

Goals and Indications for Aquatic Exercise

The specific purpose of aquatic exercise is to facilitate functional recovery by providing an environment that augments a patient's and/or practitioner's ability to perform various therapeutic interventions. Aquatic exercise can be used to achieve the following specific goals:

• Facilitate range of motion (ROM) exercise^33,82

• Initiate resistance training^{25,50,66,76,81}

• Facilitate weight-bearing activities⁴

• Enhance delivery of manual techniques^5,69

• Provide three-dimensional access to the patient^16,69

• Facilitate cardiovascular exercise^17,58,59,72

• Initiate functional activity replication^53,57,76,82

• Minimize risk of injury or re-injury during rehabilitation^29,82

• Enhance patient relaxation^33,46

Although research studies support these goals for aquatic exercise, Hall and associates⁴¹ cited the need for more research with robust designs that address temperature, depth of immersion, and care settings.

Precautions and Contraindications to Aquatic Exercise

Most patients easily tolerate aquatic exercise. However, the practitioner must consider several physiological and psychological aspects of immersion that affect selection of an aquatic environment.

Precautions

Fear of Water

Fear of water can limit the effectiveness of any immersed activity. Fearful patients often experience increased symptoms during and after immersion because of muscle guarding, stress response, and improper form with exercise. Often patients require an orientation period designed to provide instruction regarding ...