aquatic exercise, 2012

Aquatic Exercise

Aquatic Exercise: Benefits and Principles for the EDS Population

Kathleen Zonarich, PT

Benefits of Aquatic ExerciseReduce stress on jointsIncrease muscle strength and toneDecrease painIncrease cardiovascular functionImprove balance and coordinationDecrease edemaImprove posture and trunk controlIncrease in limited range of motionImprove circulation due to hydrostatic pressure

Benefits of Aquatic Exercise (cont.)Warm water promotes relaxationImprove proprioceptionImprove kidney functionIncrease respiratory function - due to hydrostatic pressure

Fun

Water as a Medium for ExerciseBuoyancyDecreases the stress placed on joints resulting in less painAssists with movement by eliminating gravityResistanceAllows for increased resistance without the use of weights, limiting the distraction of jointsPressureHydrostatic pressure reduces joint and soft tissue swellingImproves joint position awarenessAssists with venous returnRelaxationWarm water allows for relaxation of muscles and blood vessels, improving blood flow

Physical Properties of Water Related to Aquatic Exercise

BuoyancyUpward pressure exerted by a fluid in which a body is immersed (Archimedes Principle)Buoyancy and gravity are antagonistsEquilibrium is reached when floating partially immersedUpright at neck level

Physical Properties of Water Related to Aquatic Exercise (cont.)

Buoyancy (cont.)Provides supportReduces effects of gravity on jointsDecreases strain on muscles and jointsProvides resistanceUsing flotation equipment


Hydrostatic pressure Fluid pressure is exerted equally on all surface areas of an immersed body at rest at a given depth (Pascals Law)The deeper the body part is in water, the greater the forceBenefits Returns blood to heart more efficiently e.g. - from legs to heartMild resistance of rib expansion- breathing in neck deep water is exercise in itself


Relative densityRelation of mass of object to mass of equal volume of liquid at standard temperature and pressureSink or floatObject more dense than water, will sinkObject less dense than water, will floatMuscle is more dense than adipose tissue (fat)


Fluid resistanceForce that opposes motion of an object through a fluidIt is necessary to push through water in order to move yourself, thus acting as resistanceSupports your body in water and assists you with holding your position


Fluid resistance (cont.)BenefitsImprove balanceIncrease sensory awarenessImprove reaction time in a gentle environment


Turbulence-Random motion of water as it responds to a disturbanceBenefitsSwirling of water against the bodyMassage Increase circulationDecrease painResistanceSensory inputOverpowers pain message to brain (like a TENS unit does)Change in speed or direction can alter turbulence forceIncrease turbulence with gloves, paddles, jets, and more people in water around you

Signs of Overuse in the EDS PopulationIt is normal for muscles to feel sore or tired for 24-48 hours after exercisingIt is not normal to have the following symptoms after exercising:Muscle cramps/spasmMuscle twitchingIncrease in muscle/joint painDecrease in range of motionDecrease in functional activityExtreme fatigue

Guidelines for the EDS PopulationIf you exhibit signs of overuse, you did too muchDecrease one or more of the variablesIf symptoms continue, discuss with your PT or doctorWater exercise can be deceiving, it may seem easy and that you can do more than you shouldThe first time you exercise in the water, stick with an easy workout, until you see how the water has affected youWarm water can increase fatigue, use cautionBe sure to hydrate you still sweat in waterWear pool shoes for better tractionYour body may be tired after water exercise, be sure to have a safe way to get out of the poolNEVER GO IN THE WATER ALONE

Types of Aquatic Therapy Ai ChiStrengthen and tone body while enhancing relaxationAquatic PNFProprioceptive neuromuscular facilitation which uses patterns of movement in different positions with specific exercisesBad Ragaz Ring MethodA series of movements while being supported by a ring or float at neck and hips

Types of Aquatic Therapy (cont.)Back HabWalking program using varying strides and stretchesUseful for individuals with back pain, hamstring injuries, or decreased abdominal strengthFluid Movements Individuals follow a series of movements based on early developmental stages of infancyHalliwick MethodRotational patterns are performed to improve balance and postural control

Types of Aquatic Therapy (cont.)

Swim strokeUsing a variety of stroke formsTask type trainingUse of functional activities in waterWatsuMoving the body in a way that enables one part of the body to be stretched at a time

Aquatic Exercise EquipmentAssistiveFloatsNoodlesVestsBeltsDumbbellsWebbed glovesFlippersKickboards

Aquatic Exercise Equipment (cont.)ResistiveWebbed glovesFoam dumbbellsPaddlesFlippersJets

Initial considerations:

Get approval from your doctor or physical therapist before starting any exercise program.If there are any cardiac/vascular issues, please discuss appropriate exercise levels with your doctor, specific to you.This presentation is only meant to serve as a general template. The specific exercises mentioned are not intended to be used by everyone. (consult your PT/doctor)Never exercise in water alone.

Components of Aquatic Exercise

Warm up5-10 minutesGentle movementsAdapt to being in waterWalking

Components of Aquatic Exercise (cont.)Stretching and ROMCan be used as part of the warm upRange of Motion (ROM) should only be done within the normal rangeStretching should focus on any areas that are tight and should only be done within the normal ROMWarm water will relax the muscles, enabling muscles to stretch easierThis can lead to overstretching/hyperextension in the EDS population which is contraindicated. Use caution.

Components of Aquatic Exercise (cont.)Strengthening/ToningVariables that impact strengthening/toningBuoyancyResistance Surface areaTurbulenceLever arm lengthSpeedDepthFrequencyRepetitions

Components of Aquatic Exercise (cont.)

Depth of Water as it Relates to Weight BearingThe deeper the water, the less force will be placed through your jointsIf you are at C7 (neck level), you are at 10% of your body weightIf you are at the xiphoid process, you are at 33% of your body weightIf you are at the level of your belly button, you are at 50% of your body weight


Strengthening/ToningUse of buoyancy to supportFloating position on backMove arms and legs in a way that the water supports you


Strengthening/Toning (cont.)Use of buoyancy to assistPositioning self in a way that the water will assist with the movementIn neck deep water, palm on thigh Allow water to assist hand coming to surfaceLonger lever arm will increase ease of movement


Strengthening/Toning (cont.)Use of buoyancy to resistUse of the water to resist your movementNeck deep - palm on surface of water and pull down to thighSame exercise can be made harder with the addition of a floatation device such as a Styrofoam dumbbellLonger lever arm is going to increase difficulty


Strengthening/Toning (cont.)ResistanceIncrease the resistance by increasing the speedDecrease the resistance by decreasing the speed


Strengthening/Toning (cont.)TurbulenceMovement of water around you will challenge your balance and strengthWater propelled by jets will increase the turbulence of the water and increase the challengeMoving against turbulence will be the greatest challengeOnly progress through these levels when you are able to successfully perform at each level.The more people in the water, the more the turbulence


Strengthening /Toning (cont.)Surface area Increasing the surface area of the water being displaced by movement will increase strengthOpen hand with fingers spread apart will be easier than closing your hand and moving through the waterMoving through the water with the side of your palm cutting through the water will be easier than if you move through the water with your palm flatThis applies also to the concept of surface tension


Aerobic/ exerciseWalkingSwimmingDeep water bicyclingDeep water joggingTreadmill walking/running10-20 minutes is the goalMay need to start at 2-3 minutes and gradually work up to longer time frame


Cool down5 minutes of relaxing movement Slow walking Gentle swimming/floating

Additional Components of Aquatic ExerciseBalance - floats assist, turbulence challengesTrunk control/Strength - turbulence will challengeProprioception Ankle weights assist (but not recommended in this population) Buoyancy will challengeWater takes away visual accuracy - improves prop.CoordinationMore challenging with resistance of water

Water TemperatureRecommendations:85-88 degrees for active/aerobic exercise

88-92 degrees for passive or gentle active exercise

Over 95 degrees at risk for excessive fatigue and dehydration

Aquatic Exercise Precautions for POTS/ VEDSPOTSMovement will minimize issuesIssues can result fromChange of position (supine to stand)Static postures (sitting /standing for longer than 20 mins.)Water temperature should be less than body temp

VEDSLow impactMinimal aerobic exercise (Dr. Tinkle)

These recommendations were made by Dr. Tinkle34

Precautions for Aquatic Exercise

Fear of waterImpaired mobility getting in and out of poolSignificant balance or vestibular disorderOrthostatic hypotensionRecently healed surgical incisionAbsent or impaired peripheral sensationDiabetesRespiratory dysfunctionColostomyDifficulty with bowel or bladder controlSeizure disorder controlled well by medicationsTracheotomy tubeCompromised vision without corrective lensesCompromised cardiac or respiratory system (poor endurance or asthma)

Contraindications for Aquatic ExerciseCardiac failureFeverInfectionUrinary infectionsOpen woundsInfectious diseasesContagious skin rashExcessive fear of waterSeverely weakened or deconditioned stateUncontrolled seizuresBowel or bladder incontinenceColostomy bag or catheter used by patientCognitive or functional impairment that would create a hazard to the patient in the poolPoor enduranceAbnormal toneSevere or decreased range of motion that limits function

Case Study 145 year old patient that has HEDS Occasional aches and pains that generally resolvePatients goal is to increase general strength/tone Otherwise uncomplicated medical history

Exercises for Case Study 1Warm upGeneral water movements- walking 5 minStretchingAny tightness, working only within normal range of motionStrengtheningUpper Extremity exercises- gloves for resistance in shoulder height waterLower Extremity exercisesdeep water using hydro beltCore exercisesdeep water using hydro-beltAerobic exerciseSwimmingDeep water jogging with hydro beltCool down- 5 minTai chi exercises

Start with reps of 10, progress to 30 then increase resistance while droppings reps back down to 10 and building back up to 3038

Case Study 212 year old child with frequent joint dislocations/sub-luxations in knees, SI joint, elbows, shoulders, fingersDecreased muscle tonePain in feet limiting activitySignificant joint laxity in all gross jointsUnable to participate in sports/PE

Exercises for Case Study 2Warm up- 5 minWater walking at chest height with arm on dumbbells for supportStrengthening exercisesNo resistive toolsUpper Extremity exercisesWater at shoulder heightMay use dumbbells to support arms while doing exercises on surface of waterLower Extremity exercisesDeep water exercise or standing ex in shoulder height waterSupine float for exercises as wellCore ExercisesSupine floating on surface with supportsDeep water with hydro-belt

Exercises for Case Study 2 (cont)Aerobic ExerciseNoodle jogging in deep waterSwimming laps Swimming underwater for ringsTag (sharks and minnows)BasketballCatch Cool down- 5 minTai chiWalking while playing game

Case Study 325 year old with significant pain in shoulders, neck and back Has tried land based therapy 3 times with no success in resolution of painSpends day at desk working on computer

Exercises for Case Study 3Warm up- 5 minWater walking at chest heightFloating on back with supports at neck/pelvisStretchingOnly areas of tension working within normal range of motionStrengtheningUpper Extremity (UE) exercisesNo resistance, slow movements, use of buoyancy to support/assistLower Extremity (LE) exercisesNo resistance, decreased speedMay use buoyancy to support/assist if need due to back issuesCoreCo-contraction of core muscles to be used while doing UE/LE exercises

Exercises for Case Study 3 (cont)Aerobic ExerciseChest height water walking (support arms if need)Supine back glides using Bilateral Arms and legsSupine/prone swimming using kickboard to support UE while LE kicks slowly or as back toleratesCool down -5 minGentle supine float with flotation device with gentle movementWater walking at chest height

The End

Bibliography "Aquatic Precautions." Message to the author. 19 June 2012. E-mail.Google.images.com 05 August 2012.Henley, Cynthia, and Kathryn Wollam. "Benefits and Techniques of Aquatic Therapy." Reading. Post-polio.org. 23 Apr. 2009. Web. 06 June 2012. Understanding Aquatic Therapy." Advance for Physical Therapy and Rehab Medicine. N.p., 2010. Web. 06 June 2012. Wolfe, Krista and Kathleen Zonarich. "Aquatics." Therapeutic Exercise: Aquatics. Central Penn College, Summerdale, PA. 06 June 2012. Lecture.

aquatic exercise, 2012

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