Benefits of deep water exercise for ambulatory impaired adults.

Ambulatory impairments result from injuries, disabilities, conditions, and/or diseases which restrict bipedal movement.

These include, but are not limited to, osteoarthritis, rheumatoid arthritis, spinal cord and head injuries, cerebral palsy, multiple sclerosis, muscular dystrophy, spina bifida, hip and knee replacements and injuries, lower back injuries, obesity, disease and injury to connective tissues, and degenerative bone diseases. In most of the foregoing situations, an individual's condition can be improved by a combination of exercise, therapy, and healthy lifestyle. Fortunately, aquatic professionals have effective exercise programs which address these needs. However, while considerable research and case studies have addressed benefits of water exercise programs for athletes and non-disabled populations, little attention has been devoted to adults with ambulatory impairments (AIA) (Leitner & Leitner, 1985).

AIAs and Aquatics

Deep water exercise for AlAs should be fun, physically and psychologically beneficial, and socially and emotionally satisfying. However, special consideration should be given to each participant's age, physical condition, and existing exercise routines. An individual already involved in an exercise program should quickly adapt to aquatic exercise within several hours of training and orientation. However, for a sedentary individual, a physician should be consulted before starting an aquatic exercise regimen.

Ideally, an indoor facility should be used when programming aquatics for AlAs. Of course, any body of water comfortable to the participant, which meets minimum criteria, can be utilized for deep-water aquatic programming.

Physiological Benefits of Deep Water Exercise

Deep water aquatic exercises are espoused by health, exercise, and leisure professionals as means for providing relaxation, increased cardiovascular endurance, muscle toning, flexibility, physical rehabilitation, and caloric expenditure (Elder & Campbell, 1993; McWaters, 1991; Ruoti, 1989). In addition, rehabilitation of knee, hip, ankle, and spinal joints can occur (McWaters, 1991). Muscle groups in the lower back, hamstrings, shoulder, hip, posterior, and gastrosoleus can be strengthened by deep water exercise (Daniel & Gorman, 1989; Fedesky & Brown, 1988). Furthermore, Moschetti (1991) proclaimed aquatic exercise could correct posture and increase range of motion and endurance. Moreover, Bishop, Frazier, Smith, and Jacobs (1989) indicated deep water exercise could effectively prevent deconditioning from occurring after injury, an important psychological, as well as physical benefit.

Physiological benefits provided by deep water exercise are similar to those gained from dry-land or shallow water exercises; however, water significantly reduces mechanical stresses on the body normally associated with dry-land exercise. For example, a participant fully immersed in water experiences approximately a 90% reduction in body weight. This eliminates jarring effects of exercise on the musculoskeletal system (Elder & Campbell, 1993). Pseudo-weight reduction results from the buoyancy effect provided by body composition and water density is the most significant beneficial factor of deep water exercise for AIAs.

While buoyancy reduces physiological workload on the participant, water resistance increases workload. Water is 12 times more resistant and 1,000 times more dense than air. Consequently, as an individual moves in water the body surface area produces drag which intensifies exertion level (Brown, 1988; Elder & Campbell, 1993). Therefore, resistance on the body as it moves through the water sufficiently counters the buoyancy effect and allows adequate mechanical work to provide an exercise with a suitable workload (Ruoti, 1989).

Deep water running/walking requires a body of water with adequate depth, temperature, and bottom structure. Depth of the water should be sufficient to permit a participant to exercise without touching the bottom. The deep end of most pools provides depth, surface, and sub-surface area to allow unrestricted leg movements.

Careful attention to both the age and physiological condition of the elderly participant must be of consideration when selecting an appropriate water temperature. Approximately 85 [degrees] F is an ideal water temperature; however, slightly cooler temperatures are acceptable. The temperature may be raised or lowered according to age and physical condition of the participant (see p. 24). Colder water may adversely affect arthritic patients or those with cerebral palsy, while warmer water may cause cardiovascular stress and exhaustion in obese or elderly participants.

Entrance and exit from the pool are important elements for AIAs participating in deep water exercise. If a pool has a gradually sloping bottom, participants can enter the shallow end and work toward the deep end. If this entry is unavailable, an assistant may help participants enter and exit the water or a mechanical assistance device may be used. Comfortable entry and exit from the pool will enhance the AIAs exercise experience and reduce anxiety and stress.

Professionals wishing to incorporate use of deep water exercise equipment need not worry about prohibitive costs. Presently, a belt-type buoyancy device costs approximately $40.00, while a vest-type is approximately $130.00. Most participants choose the belt-type due to the less restrictive design.

Psychological and Social Benefits

For many AIAs aquatics may be the only exercise program in which they can effectively participate. Buoyancy provided by the specialized equipment allows participants to keep their heads above water during exercise and facilitates comfortable communication with other participants. This is just one social benefit of deep water exercise for the AIA. Often, AIAs suffer emotional and psychological distress and social alienation as a result of their conditions. Deep water provides an exercise medium conducive to social interaction and may assist to reduce an AlAs trepidation toward exercise.

A significant positive correlation between regular adherence to an exercise regimen and water exercise was found, in part, as a result of programs which offer socially pleasing atmospheres (Robertson, 1989). Minor (1990) found participants remained in aquatic exercise programs longer than dry land exercises, thus promoting greater social interactions. Paramountly, maintenance of a regular exercise regimen is necessary to treat AIAs conditions effectively. Therefore, programs which allow participants to talk with one another during exercise and to exercise at their own pace with their peers, are ones likely to foster continued participation. For example, over time (3-6 months), a social network forms and the reasons participants exercise are equal between physiological improvements and social interactions (Minor, 1990). In addition to social benefits, deep water exercise increases self-image and decreases anxiety and depression, both important psychological considerations (Daniels, 1988). Psychological benefits have a powerful affect on AIAs self-esteem and help promote active participation in exercise.

Interestingly, social and psychological benefits may superseded physiological benefits of AIAs. Facilitating self-actualization through deep water exercise may be the greatest benefit available to AIAs and should have high priority by researchers in the leisure and health professions.

Deep Water Exercises for AIAs

Exercises in deep water may be executed equipment free; however, using one of the previously identified aquatic exercise flotation vests or belts allows for increased comfort, stability, and security. These items are designed to provide neutral buoyancy to enable a participant to maintain an ideal run/walk position (a slight forward body lean), and proper leg motions (striding as opposed to cycling or circular treading motions). Wet Vest, AquaJogger, and AquaBelt are commercially available for assisting in deep water exercises. However, personal flotation devices (PFDs) or ski belts are acceptable. PFDs are attractive because they are relatively inexpensive and can provide face-up flotation in case of an emergency.

Deep water exercise may be performed while static in the water or while moving through the water. Regardless, the key for a successful program is to provide a body of water with sufficient depth to prohibit the participant from touching the bottom. Static exercises are good for flexibility, range of motion, and warm-up; however, they have limited potential for a cardiovascular workout. Ideally, static drills should precede more strenous deep water exercise and conclude exercises as a warm down.

Running/jogging in deep water assists in the rehabilitation of injuries and relieves effects of chronic illnesses--without trauma to the musculoskeletal system (Brown & Henderson, 1989; Elder & Campbell, 1993; McWaters, 1991; Ruoti, 1989). By utilizing an exaggerated running stride an AIA can significantly increase rang of motion in all joints from the lower back to the ankle. By increasing leg speeds the participant can reach a target heart rate and maintain the exercise intensity for a much longer period of time. This fact alone makes deep water exercising an invaluable treatment modality for AIAs.

Aqua-aerobics in deep water provide the greatest physiological benefits as they involve more muscle groups, joints, and actions (Elder & Campbell, 1993). AIAs who have progressed to an advanced cardiovascular level can benefit greatly from this exercise. Aqua-aerobics can be performed to music, cadence, or without audio stimulus; however, most participants prefer a contemporary music program. Aqua-aerobics can be performed alone although most participants require a knowledgeable instructor who can customize workouts to facilitate the greatest benefits possible.

Several exercises in addition to running/jogging and aqua-aerobics may be performed in deep water. Cross-country skiing technique, spread-eagles, leg flexion and extensions, toe rises, V-sits, trunk rotation, swimming strokes, and lunges are examples. Specific exercises may be adjusted to provide physical revitalization and increased cardiovascular endurance dependent upon the AIAs specific condition. Fortunately, deep water exercise can account for varying degrees of mobility and skill. Experimentation and innovation are certainly warranted when incorporating deep water exercises and equipment.

Directions for the Future

Additional research must be performed to determine specific benefits of aquatic exercise for AIAs. Special attention should be given to providing equal emphasis on physical, psychological, and social benefits of deep water exercise for the AIA. Moreover, research to determine differences between aquatic exercise and dry land exercise should be undertaken so as to provide a basis of comparison. Aquatic exercise equipment should be specifically developed for AIAs and extensively studied by researchers to determine equipment responses to various physiological requirements of AIAs.

While practical applications and case studies have begun to address the needs of AIAs, continued attention from both leisure and health professionals must be nurtured to insure additional meaningful and enjoyable exercise programs are created. Meeting aquatic exercise needs of AIAs is dependent upon the commitment of professionals to the development of innovative and dynamic programs. Aquatic exercise is an old idea which as reemerged as a valuable treatment modality for persons with ambulatory and other special needs. Insuring their rights to a healthy and long life, full of social interaction and self-esteem is every health and leisure professional's responsibility.

RELATED ARTICLE: Cautions to be Considered

When Programming for AIAs

* Water warmer than 80 [degrees] is dangerous for participants with multiple sclerosis. Although there is a cooling effect on body heat producing mechanisms during water exercise, research has demonstrated that it will not adequately lower the body temperature of subjects with MS while they exercise in water (Ponichtera, 1990). Therefore, over-heating may occur. Obviously, MS participants should be carefully monitored regardless of water temperature.

* Deep water exercise equipment items should not be considered as personal flotation devices. They will maintain a participant's body position in the water without conscious effort; however, they were not designed to maintain the head above water in the event a participant would become unconscious.

* Hydrostatic pressure of water exerts upon all body surfaces and acts as an auxilliary heart pump which reduces the number of beats the heart must accomplish to supply blood to the tissue. Self-monitored heart rates for deep water exercise will be approximately 10% lower than those of similar dry land exercise; however, the exertion will remain approximately the same as dry land exercise. Careful monitoring of heart rate in older participants is strongly recommended. An easy method of determining heart rate is to utilize a visible clock with a second-hand and each participant can check the carotid pulse by counting for six seconds and multiplying this number by ten. Approximately 75-85% of a participant's maximum heart rate should be maintained by a minimum of twenty minutes for an effective cardiovascular workout after acclimation to the program. Approximately 6-8 leg cycles every five seconds should maintain this heart rate for the majority of participants.

* Water will absorb body heat twenty-five times faster than air (Elder & Campbell, 1993). Conduction, convection, evaporation, and radiation all act upon this heat removal. As a result, water effectively lowers body temperature during exercise. This may cause participants to falsely believe they are not working out at a sufficient exertion level.

* Deep water exercise eliminates jarring stress on the musculoskeletal and cardiovascular system, propagating a false perception by the participant that exertion level is reduced. This perception encourages individuals to exercise longer and with greater intensity which could strain the cardiovascular system beyond suggested levels. This may be a potentially dangerous situation with some participants, expecially senior citizens with medical conditions requiring carefully monitored heart rates. By contrast, dry land running/walking results in fatique signaling the participant's body that the exercise has begun to affect the condition, most notably heart rate, and that exertion should be reduced.

* Lifeguards and trained supervisors should be persent at all times. In addition, medically trained individuals should be present for programs involving AIAs who are over 75 years of age, or who are cardiac rehabilitation participants.

* Emphasis must be placed upon actual heart rate and not participant perceptions of intensity of the workout. Combining the preceeding factors may cause participants to overexert (exceed a 75-85 percent maximum heart rate exercise level) in a deep water run/walk program. Regular pulse rate monitoring should be incorporated into all deep water exercise programs, and a doctor's approval should be mandatory for all participants.

Kim Beason is an assistant professor in the Leisure Management Program at the University of Mississippi in University, MS. He is interested in the social and psychological benefits of leisure activities, particularly aquatics, for various populations and has worked in aquatic settings over the past 15 years.

Jim Gilbert is an associate professor in the same department and is interested in recreation and leisure activities for the elderly and institutionalized.

Selected References

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