aquatic exercises

1. DEFINITION
 Aquatic exercise refers to the use of
multidepth immersion pools or tanks
that facilitate the application of various
established therapeutic interventions,
including stretching, strengthening,
joint mobilization, balance and gait
training, and endurance training.
 Properties of water such as buoyancy,
hydrostatic pressure, viscosity, and
surface tension have a direct effect on
the body in the aquatic environment.

2. Buoyancy
 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.
Clinical Significance:
 Buoyancy provides the patient with relative
weightless-ness and joint unloading, resists
or assists movements.

4. Hydrostatic Pressure
 Pressure exerted 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.
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

5. Viscosity
 Friction occurring between molecules of
liquid resulting in resistance to flow.
Properties:
 Resistance from viscosity is proportional to
the velocity of movement through liquid.
Clinical Significance:
 Water’s viscosity creates resistance with all
active movements.
 Increasing the velocity increases resistance.
 Increasing the surface area of movement
through water increases resistance.

6. Surface tension
 Surface of a fluid acts as a membrane under
tension. Surface tension is measured as force
per unit length.
Properties:
 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.
Clinical Significance:
 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.

7. Hydromechanics
 Comprise the physical properties and
characteristics of fluid in motion.
Components of Flow Motion
 Laminar flow. Movement where all
molecules move parallel to each other,
typically slow movement.
 Turbulent flow. Movement where molecules
do not move parallel to each other, typically
faster movements.
 Drag. The cumulative effects of turbulence
and fluid viscosity acting on an object in
motion.

8. Clinical significance:
 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/her
position in pool.
 Application of equipment
(glove/paddle/boot) increases drag and
resistance as the patient moves the
extremity through water.

9. Thermodynamics
Specific Heat
 Specific heat is the amount of heat
(calories)required to raise the
temperature of 1 gram of substance
by1°C
 Center of Buoyancy
 The center of buoyancy is the
reference point of an immersed object
on which buoyant (vertical) forces of
fluid predictably act.

10. Center of Buoyancy
 Definition. The center of buoyancy is
the reference point of an immersed
object on which buoyant (vertical)
forces of fluid predictably act.

11. Thermodynamics:
 Aquatic exercises, including flexibility,
strengthening, gait training, and relaxation,
may be performed in temperatures between
26 C and 35 C.
 Cardiovascular training should be
performed in water between 26 C & 28 C,
helps to maximizes exercise efficiency,
increases stroke volume, and decreases
heart rate.
 Exercise performed in warm water (33 C)
may be beneficial for patients with acute
painful musculoskeletal injuries due to the
effects of relaxation, elevated pain

12.  Centre of buoyancy is located in sternum.
 Generally use immersion times of 20mins
slowly increasing from 10mins.
 Temperatures between 36C and 37 are
considered high and used for RA patients
excluding acute stage.
 Temperatures greater than 37 C increases
cardiac output significantly and raises the
core temperature.
 Temperatures less than 25 C also
considered critical as it doesn’t help to
maintain normal core temperature.

13. Goals
 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

14. Indications
 Decreased range of motion
 Increased muscle tone
 Reduced cardiopulmonary
endurance
 Decreased functional activity
 Muscle weakness

15. Contraindications
 Incipient cardiac failure and unstable
angina.
 Respiratory dysfunction; vital capacity of
less than 1 liter.
 Severe peripheral vascular disease.
 Danger of bleeding or hemorrhage.
 Severe kidney disease
 Patients are unable to adjust to fluid loss
during immersion.
 Open wounds, colostomy, and skin
infections such as tinea pedis and
ringworm.

16. Contraindications
 Uncontrolled bowel or bladder: Bowel
accidents require pool evacuation, chemical
treatment, and possibly drainage.
 Water and airborne infections or diseases:
Examples include influenza, gastrointestinal
infections, typhoid, cholera, and
poliomyelitis. Uncontrolled seizures:
 They create a safety issue for both clinician
and patient if immediate removal from the
pool is necessary

17. Precautions
 Fear of water
 Neurological disorders
 Respiratory disorders
 Cardiac dysfunction
 Small open wounds and lines

18. Traditional Therapeutic Pools
 Traditional therapeutic pools measure
at least 100 feet in length and 25 feet
in width.
 Depth usually begins at 3 to 4 feet
with a sloping bottom, progressing to 9
or 10 feet.
 ■ This larger type pool may be used
for groups of patients and the
therapists conducting the session
while in the pool.

19.  Entrance to larger therapeutic pools
includes ramps, stairs,ladders, or
mechanical overhead lifts.
 These pools have built-in chlorination
and filtration systems

20. Individual Patient Pools
 Pools designed for individual patient use are
usually smaller,self-contained units.
 These self-contained pools are entered via a
door or one to two steps on the side of the
unit.
 The therapist provides instructions or cueing
from outside the unit.
 ■ In addition to built-in filtration systems, these
units may include treadmills, adjustable
currents, and varying water
 depths.

21. BEFORE ENTERING THE POOL
 Utilize the washroom
 Shower
 Wait until your physiotherapist directs
you to enter the pool

22. AFTER THE HYDROTHERAPY
SESSION
 Should shower
 Have a drink
 Rest for several minutes
 Tell your physiotherapist if you unwell
or light headed.