Question 18

Several suggestions were made for aquatic exercise, primarily for balance and strengthening. How would you progress these exercises from easy to difficult (depth of water change, other changes)? Would they be easier or harder in deeper water?

The exercises will be easier in deep water when thinking about Joe's balance, because he'll have the water around him to help keep him steady and it may be harder in deep water because he'll have more water resistance with the strength exercises. They could be easier in shallow water, cause he'll have less full body water resistance. But then the balance exercises in shallow water will be harder because he'll have less pressure around him without the water to help keep him balanced. [Amanda]

Water challenges balance and coordination because it provides an unstable working enviroment. Because of the unstable environment, the patient has to recruit their core muscles in order to stay upright. When changing water depths, running in deep water is an adquate method of cardiorepiratory training whether it is being used for an injured runner or as a different form of training. If in the water, the patient has to reduce the speed of the movements performed to approximately 1/2 to 1/3 slower than movements on land for the same amount of energy expenditure. Once the patient is trained, they can be challeneged with increasing water resistance just as is done in strength and conditing programs. Equipment overload and speed adjustments need to be applied progressively though. (Melissa) * This information came from my community fitness book from undergrad

A. Balance in pool while standing
Balance can be improved in the pool in deeper water initially. The water surround more of his body surface will help Joe be more aware of how he positions himself and what he needs to do to steady himself. This website I found explains very well how the pressure makes Joe sensitive to wear he is exactly which helps enforce Joe's proprioception ultimately helping balance.

B. Lower extremity strengthening

When trying to increase LE strength it would be best to start in deeper water so to reduce the weight of the legs and then gradually put the patient in more shallow water. Water that is neck deep can decrease the LE weight to 10% which would require less effort to use the legs. Chest-deep water reduces the weight bearing to 25-30% of body weight and gradually increases while decreasing the amount of water that the patient is in.
( (Sara)

C. Upper extremity strengthening

Specifically relating to UE strengthening, exercises would be best done in deeper water to allow some resistance to the UE. Once they have gained strength using water resistance alone, adding extra resistance such as using foam dumbbells that float in the water could be the next step in UE aquatic strength training for a patient. (Laura)

I agree with Laura about deeper water and then adding foam dumbbells. From past experience at the Waterford I know that the people that attend the water sessions get a kick out of using them. :) (Denise)

When doing UE strengthening, the patient should be standing in the pool to maintain balance and safety during the exercises. Therefore, I think the exercises should be done in shallower water that is only up to Joe's shoulders. This way he will still be using the resistance of the water to strengthen his UE, but he will feel safe and comfortable during the exercises. When he gains strength, I agree with Laura, and he should add weight to his exercises by using foam dumbbells or other water tools that increase the resistance to his movements. (Britt)

D. Walking or Marching

I feel as if the walking and marching would be easier in the shallow water due to the fact his weight is being supported by touching the ground, but he will still have resistance from the water espescially moving the knees upward in a marching motion. Moving Joe to the deeper water would make this exercise much more difficult because he would have to support his weight in the water while trying to walk/march against the resistance making it more difficult. If you wanted to make this exercise even more difficult in both depths, adding ankle weights would be the way to do it. This would increase LE strength along with his core stability. (Sarah K.)

I agree with Sarah that walking/marching would be more difficult in deeper water but to help Joe a little if he is not quite strong enough, you could allow him to use a water jogging belt. It would help him to maintain an upright position while working in the deeper water. (Betsy)

I do feel that shallower water would be the better place to start and you could have Joe go at varying speeds (fast vs slow), stride lengths (long vs short), and patterns (high knees vs butt kicks) to make it more difficult. (Denise)

Another way to perform a walking/jogging/marching motion would be for Joe to support himself on the edge of the pool so that the water came up to his chest level. At this time Joe would orientate his lower body so that it was closer to a parallel position with the surface of the water. The exercise comes as Joe begins to move his lower body as if he were walking/running/kicking. In this exercise he has no impact with a ground surface of any kind and varying his speed of movement, duration of movement, and rest times between movements are ways of progression from easy to hard. A benefit of this kind exercise is that it requires no certain depth of water, just as long as it is deep enough to allow safe, full range of movement. (Tyler)

E. heel raises

I believe that heel raises would be easier to perform in deeper water because of water's buoyancy and its ability to reduce the weight of submerged objects. Therefore, to progress Joe with heel raises I would gradually transition him into more shallow water so that both his balance and strength would be further challenged as he would now need to lift more of his actual weight. (Mandy)

F. Squats

The squats would be easier to perform in deeper water than shallow due to the deeper water providing more of an unweighting effect. Thus it would be a good idea to start deep and see how he progresses with deep water exercise. If he needed more of a challenge you could bring him shallower. Not only would the exercise be beneficial to Joe, but also less strain would be placed on his joints so that Joe doesn't develop inflammation in his joints and we don't add to his diagnoses. (Luke)

Once he is in shallow water, weights could also be added to make it even more difficult before progressing to squats or any LE exercises on land. (Amber)

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