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- 1. Aquatic Exercise By: Dr. Khazima Asif
- 2. • 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.
- 5. 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 reinjury during rehabilitation. • Enhance patient relaxation.
- 6. Precautions and Contraindications to Aquatic Exercise • Fear of water • Respiratory disorders • Neurological disorders • Cardiac dysfunction • Small open wounds and lines: tracheotomy, Hickman line suprapubic appliances.
- 7. Contraindications • Incipient cardiac failure and unstable angina. • Respiratory dysfunction. • Severe peripheral vascular disease. • Danger of bleeding or hemorrhage. • Open wounds without occlusive dressings, colostomy, and skin infections, such as tinea pedis and ringworm. • Uncontrolled bowel or bladder . • 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.
- 8. Properties of Water Physical Properties of Water Buoyancy : • Definition. Buoyancy is the upward force that works opposite to gravity. • Properties: Archimedes’ principle states that an immersed body experiences upward thrust equal to the volume of liquid displaced.
- 10. Clinical Significance • Buoyancy provides the patient with relative weightlessness and joint unloading by reducing the force of gravity on the body. In turn, this allows the patient to perform active motion with increased ease. • Buoyancy provides resistance to movement when an extremity is moved against the force of buoyancy. This technique can be used to strengthen muscles. • The amount of air in the lungs will affect buoyancy of the body. Buoyancy will be increased with fully inflated lungs and decreased with deflated lungs. • Body composition will also affect buoyancy. Obese patients will have increased buoyancy due to fat tissue having a lower specific gravity. Patients with increased bone density will have less buoyancy than those with decreased bone density. • Buoyancy allows the practitioner three-dimensional access to the patient.
- 11. Hydrostatic Pressure • Definition. Hydrostatic pressure is the pressure exerted by the water on immersed objects. • Properties. Pascal’s law states that the pressure exerted by fluid on an immersed object is equal on all surfaces of the object. As the density of water and depth of immersion increase, so does hydrostatic pressure.
- 12. Clinical Significance • Increased pressure reduces or limits effusion, assists venous return, induces bradycardia, and centralizes peripheral blood flow. • The proportionality of depth and pressure allows patients to perform exercise more easily when closer to the surface.
- 13. Viscosity • Definition. Viscosity is friction occurring between molecules of liquid resulting in resistance to flow. • Properties. Resistance from viscosity is proportional to the velocity of movement through liquid.
- 14. Clinical Significance • Increasing the velocity of movement increases the resistance. • Increasing the surface area moving through water increases resistance.
- 15. Surface Tension • Definition. The surface of a fluid acts as a membrane under tension. Surface tension is measured as force per unit length. • Properties. The attraction of surface molecules is parallel to the surface. The resistive force of surface tension changes proportionally to the size of the object moving through the fluid surface.
- 16. Clinical Significance • An extremity that moves through the surface performs more work than if kept under water. • Using equipment at the surface of the water increases the resistance.
- 18. Hydromechanics Definition. Hydromechanics comprise the physical properties and characteristics of fluid in motion. COMPONENTS OF FLOW MOTION: • Laminar flow • Turbulent flow • Drag Clinical significance of drag. As the speed of movement through water increases, resistance to motion increases. • ■ Moving water past the patient requires the patient to work harder to maintain his or her position in pool. • ■ Application of equipment (glove/paddle/boot) increases drag and resistance as the patient moves the extremity through water.
- 19. 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. • Properties. The rate of temperature change is dependent on the mass and the specific heat of the object. • Clinical significance: Water retains heat 1000 times more than air. Differences in temperature between an immersed object and water equilibrate with minimal change in the temperature of the water. 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.
- 20. Center of Buoyancy • The center of buoyancy is the reference point of an immersed object on which buoyant (vertical) forces of fluid predictably act.
- 21. Aquatic Temperature and Therapeutic Exercise • Temperature Regulation • Temperature regulation during immersed exercise differs from that during land exercise because of alterations in temperature conduction and the body’s ability to dissipate heat. With immersion there is less skin exposed to air, resulting in less opportunity to dissipate heat through normal sweating mechanisms.
- 22. 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.
- 23. 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 decreases heart rate.
- 24. Pools for Aquatic Exercise • Traditional Therapeutic Pools • Individual Patient Pools
- 25. Special Equipment for Aquatic Exercise • Collars, Rings, Belts, and Vests
- 26. Swim Bars
- 27. Gloves, Hand Paddles, and Hydro-tone® Balls
- 28. Fins and Hydro-tone® Boots, kickboards
- 29. Pool Care and Safety • Therapeutic pools require regular care and cleaning to avoid Pseudomonas aeruginosa (an infection causing folliculitis). • Cleaning should occur at least twice weekly, and chlorine and pH level tests should be done twice daily. • All walking surfaces near and around the pool should be slip- resistant and free of barriers. Water splashses should be dried immediately to prevent slips and falls. • Safety rules and regulations are a must, as are emergency procedures, and should be posted and observed by all involved in therapeutic pool use. • Life preservers should be readily available and at least one staff member who is CPR certified should be present at all times.
- 30. Aerobic Conditioning • Treatment Interventions: • Deep-water walking/running: Deep water walking and running are the most common vertical deep water cardiovascular endurance exercises. • Alternatives include cross-country motions and high- knee marching. • Deep-water cardiovascular training, which may be used as a precursor to mid-water or land-based cardiovascular training, eliminates the effects of impact on the lower extremities and spine.
- 32. • Mid-water jogging/running (immersed treadmill running). Mid-water aerobic exercise, which may be used as a precursor to land training, lessens the effects of impact on the spine and lower extremities.
- 33. Physiological Response to Deep-Water Walking/Running • Cardiovascular response. Patients without cardiovascular compromise may experience dampened 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. • 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
- 34. 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.
- 35. 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.
- 36. Exercise Monitoring • Monitoring intensity of exercise.