A collective “ahhh” emerges from the group of women who step slowly into the pool. Laughter, light conversation, and vigorous yet nimble movements create an experience of shared joy.
Together, they’ve discovered a private liquid weight room that offers natural support for freedom of movement. The resistive and supportive environment also provides a time-efficient exercise modality for cardio-resistance training with the fear of falling washed away.
Current public health trends, such as rising obesity rates, coupled with an aging population and climbing health care costs signal a call to new action. We all know that exercise is essential, but some people may have chronic or age-related conditions that limit their ability to perform physical activity on Land.
Barriers to exercise include fear of falling, pain, discomfort, and not being fit enough to participate. Aquatic exercise has shown promise as an effective, comfortable, and safe option for people who are unable to perform traditional physical activity. Water’s natural resistance and buoyancy allow people with physical limitations to take charge of their own health by adopting exercise as medicine.
Water Exercise Solutions for Health
More scientific research is needed, but there is already promising evidence that supports aquatic exercise for health. The comfort, safety, and effectiveness of water can help people overcome some barriers so they feel confident to use exercise as medicine for both treatment and prevention of a variety of conditions. The following studies show the value of aquatic exercise in key areas.
Weight management. The properties of water make it a safe, effective environment in which to build muscular endurance and expend kilocalories for energy. By minimizing the pounding impact of gravity against the joints, water provides a more comfortable setting for vigorous exercise. This makes the aquatic workout an excellent option for many older adults, including those focused on weight loss or maintenance.
In the water, the cost of energy rises as the speed of movement increases, making water exercise an efficient mode for spending stored energy. For example, running in shallow water at maximal effort can burn an estimated 17 kcal per minute. To sustain this level of intensity for a longer period, one must develop muscular endurance. Short running bouts added to water programs increase the kcal cost of any workout, while muscular endurance gradually improves.
In one study, healthy older women (average age 66.4) performed shallow water exercises at intensity levels recommended by the American College of Sports Medicine (ACSM), and achieved positive training results for cardiorespiratory conditioning and weight management. In another study, researchers combined diet plus water exercise and land-based walking for a weight loss program. Forty-four obese, sedentary women with a BMI of 34.9, (mean age 40), were randomly assigned to an aquatic exercise and walking on land combination group or a land walking only group for 16 weeks. In the combination group, total body weight, cardiorespiratory fitness, flexibility, strength, and health-related quality of life significantly improved over time similar to the land-only walking group. Slightly greater non-significant losses in body weight, improvements in flexibility, greater attendance rates, and significantly greater enjoyment scores were reported for the combination groups.
This suggests that aquatic exercise in combination with walking can serve as an alternative to walking alone for women during periods of weight loss, and leads to improved functional status.
Deep water running using a buoyancy device for support may provide an effective and comfortable alternative to land-based walking or running. It is a non-impact option for vigorous exercise that contributes to total exercise energy expenditure for weight management, cardiorespiratory conditioning, and muscular endurance all during one session. Estimated kcal expenditure for deep water jogging ranges from 8-16 kcal/minute based on intensity. This range compares to running on land at a pace of 8-11 minutes per mile.
Healthy hearts and bodies. Aquatic immersion decreases circulatory resistance and improves heart contraction efficiency. Patients participating in aquatic exercise were found to have significantly improved muscle function and exercise capacity while reporting nearly a 40% improvement in quality of life.
In one study, older adults (60 to 75 years of age, average age 68) experienced a 6% improvement in back extension strength by performing self-paced, vigorous shallow water exercise that included walking backwards for 60 minutes per session, 3 days per week for 12 weeks.
Additionally, the subjects improved significantly in cardiorespiratory endurance and body composition, muscle power for knee extension/flexion, vertical jumping, and side-step agility.
In other research, a 16-week U.S. pilot study included women (60 to 89 years of age) who self-selected to an aquatic exercise group or a control group. Replicated in Japan, women ( 50 to 80 years of age) volunteered to participate in an ongoing community-based program, self-selecting to attend 1, 2, or 3 days a week. In the United States, the exercise group improved sit-to-stand performance by 31 % and walking speed by 16%, while the control group did not change significantly. In Japan, sit-to-stand improved by 22% after 52 weeks of training and walking speed improved by 9% after 40 weeks of training. Neither group reported any injuries.
The Unique Benefits of Water
According to Carol Kennedy-Armbruster, lecturer and former program director of fitness and wellness at Indiana University, “Water should be regarded as any other resistance device. To not include water as part of the training program means that you’re leaving out a piece of equipment important as a training choice. At Indiana University, learning how water fits into a resistance progression program is part of the training for all personal fitness trainers. Along with bands, balls, machines, and weights, water should be considered as part of the exercise repertoire of every trainer. Let’s examine some of water’s unique benefits in this regard.
Water provides a private and safe multi-dimensional environment, in which lifetime exercise skills (e.g., walking) are developed and can be performed as your body changes over time. Swimming skills are not necessary with vertical water exercise, but participants will need to learn how to coordinate arms and legs to work effectively through water’s resistance and buoyancy.
Buoyancy encourages freedom of movement, without the fear of falling down. Participants practice large ranges of motion and challenge both balance and recovery-to-stand skills with ease and support. Higher intensity jump training, especially for athletes, can be performed in water with lower risk of injury.
Beginning exercisers, participants with balance problems, or those who need to limit impact can easily adjust intensity according to personal need by working in shallow (navel to nipple depth), transitional (shoulder depth), or deep water (fully suspended without feet touching the bottom).
Hydrostatic pressure pushes against the chest and body. This helps strengthen the breathing system, and as a result, breathing on land becomes easier. Hydrostatic pressure aids venous circulation and contributes to reduction in edema or swelling, and is especially helpful for prenatal participants.
Aquatic therapy has been documented to be beneficial for functional rehabilitation resulting from injury or disease. However, if rehabilitation is required, the services of physical or occupational therapists or other health care providers will be necessary to design specific progressions so that participants continue their exercise program using the gentle buoyancy of water to modify, protect, and help heal the affected area.
• On-Demand Resisted Movement
Liquid resistance surrounds the body during water-based exercise, providing on-demand work in many planes of movement, overloading and mimicking real life movements. The “liquid weight machine” of water, along with a variety of equipment for overload, allows participants to individualize resistance work while exercising in a group.
• Time Efficient, Integrated Cardiorespiratory Resistance Training
Integrated cardiorespiratory and strength classes are a top fitness trend. Water provides an opportunity for time efficient training during a single session with crossover training. For example, muscular conditioning exercises for the upper body can be designed to use the lower body vigorously enough to contribute to cardiorespiratory work.
The harder and faster you push through water, the greater the resistance is against the body. Because speed is used to increase resistance, water is also an effective modality for power training. Tmportant power muscles used during walking, such as the gastrocnemius, were shown to have greater activity during water walking when compared to walking on land at the same speed.
Individualized Progressive Training
Intensity progressions are individual, and intensity is regulated “on demand” using variations in speed, surface area, equipment, and water currents. Group exercise resistance classes can be “individualized” in the pool by allowing participants to choose their own equipment, regulate their own speed (by not working on the beat of the music), and by working either in a stationary or traveling mode.
Compound Movement Patterns
Compound patterns, such as lifting a load while jogging, can be safely overloaded at slower speeds (1/2 to 1/3 compared to land) for training proper biomechanics during functional living patterns (e.g., walking, gripping/releasing, and balancing all at the same time).
Intensity and Volume Without Risks
By using buoyancy and resistance, participants may be able to pace themselves as they gradually increase the volume and intensity of training, while working more comfortably with less impact and without increasing risk of orthopedic injury.
Water currents work constantly against the body while immersed in water to continuously challenge the trunk core muscles to maintain proper alignment, stop, start, and change directions during a movement. The abdominals work throughout the class, functionally vertically!
People of many ages, fitness levels, and abilities can put water resistance and buoyancy to work, mimicking fun sports drills. Water’s buoyancy allows participants to pretend they are skiing moguls by lifting both legs off the bottom, or playing volleyball by running, scooping arms under for a serve, and then jumping for a block! In addition, water minimizes impact while slowing movement speed to check form and provides overload through the entire pattern of movement
The YMCA of the USA recommends having an appropriate number of life-guards on duty during any activity in the pool area. During a water fitness class, it would be the sole duty of the lifeguard to supervise participants; a water exercise instructor, even if certified as a lifeguard, should not assume both duties. As an instructor, be sure to comply with the regulations in your area concerning pool safety standards and required supervision during your activity classes.
Choosing pool depth
Participants can work in three depths of water: (a) shallow (navel to nipple), (b) transitional (nipple to top of the shoulder), and (c) deep (any depth at which the feet cannot touch bottom). The depth you choose depends on your facility, the objective of the workout, equipment availability, the skill level of your participants, and their body composition. Each person responds differently to water based on body composition and body fat deposition. Teach Dumbbells-Buoyancy-resisted proper neutral stance (ears, shoulders, and hips lined up) and remind participants frequently to correct alignment as needed, since buoyancy pushes and pulls on the body. Additionally, participant comfort and safety is essential basic safety skills, such as recovering from a fall to a stand in shallow water or moving from horizontal to a vertical position in deep water, must be mastered for safety and confidence!
A person who needs to reduce impact (perhaps due to an injury) may want to work out in deep water using a buoyancy belt for support. On the other hand, a participant who wants to improve a functional skill, such as speed walking, would most likely choose shallow water, which more closely mimics land activity. Each water depth requires unique exercises designed specifically for that depth.
The temperature of the water will dictate exercise design. Cardiovascular work cannot be safely performed in water that is too warm, while gentle range of motion work would be uncomfortable for participants when the water is cold. Thermal regulation must be considered during your exercise and program design. For example, in warm water, low-intensity exercises with frequent water breaks may be appropriate. When the water is cool, having clients jog during upper body muscular work may help keep them warm. An appropriate water temperature for most fitness classes is 83-86° F (29-30° C), with 84° F (29° C) as an approximate neutral temperature at which most people can balance heat loss with heat production during exercise for comfort.
Individualized Intensity Regulation
Participants need to develop skills to help them feel the water and discover their own resistance levels by practicing movements through progressions. Speed, surface area, water’s currents, and buoyancy are used to target both work and rest. Research indicates that since water is resistive, interval training may create the most effective cardiorespiratory workout. Equipment can be used to target appropriate muscular overload, and different devices may be needed for different muscle groups. For example, webbed gloves may be sufficient overload for triceps work, while the biceps may require the larger surface area of a fitness paddle.
In the water, iron weights are replaced by foam dumbbells and some gravity-based tools, where poundage is replaced by resistance and gravity. Instructors need to understand the purpose of the equipment, and how it affects both exercise design and safety skills for participants. Each tool offers its own unique program.
Surface area equipment provides resistance in all directions through the water, and along with speed, can dramatically affect overload. Examples of such equipment include (a) webbed gloves, (b) fins, (c) non-buoyant dumbbells, and (d) parachutes.
Buoyancy equipment enhances the buoyancy of the limbs or body and includes buoyancy dumbbells, belts, and noodles. The body and/or limbs arc assisted upward while movements downward are resisted (the opposite effect of gravity on land).
Buoyancy/surface area combination tools are bulky enough to provide effective surface area drag, and include kick boards (held sideways), buoyant dumbbells, and ankle cuffs. Resistance can now be experienced in both upward and downward directions in relation to the water’s surface.
Gravity-based equipment, such as the aquatic step, enhances gravitational load on the lower body. Participants experience more gravity overload while working on top of the step in the shallower water (with buoyancy effect decreased). lumping movements can be performed faster off the top of the step, creating greater drag resistance against the body, and participants can land either on top of the step for high-intensity work or away from the step (in the deeper water) for lower-intensity drills.
Tubing, tethers, and DynaBands are elastic equipment that can be added to increase eccentric work, to further challenge the core stabilizers, and to create fun and safe tether-together team drills, especially popular for sports cross-training.
Designing Water Exercises for Health
All movements should be designed with regard to the water’s effects of buoyancy and resistance acting on the body. With that in mind, we can think of the pool as a liquid weight machine that provides resistance in most directions. Buoyancy assists movement upward and supports the body. Progressive exercises can be designed by making small variations in movement speed and range of motion, by working in either a stationary or traveling mode, and finally by adding equipment to increase overload. Participants can choose to work anywhere within the progression that fits their fitness level. Below are some sample shallow water exercises and their progression.
Conditioning Segment with Warm-Up
- Buoyancy and Cardiorespiratory Warm-Up
Review personal skills, such as sculling and recovery to a stand. Cue a basic move, such as jogging, to warm up the body, gradually increasing heart rate, and adjust the body to buoyancy.Progression: Begin jogging slowly and gradually increase the range of motion of the legs, then the speed, and finally travel through the water for the highest intensity. Check intensity using the talk test (i.e., being able to speak an entire sentence without gasping) and rate of perceived exertion.
- Cardiorespiratory Endurance
Cardiorespiratory endurance exercises focus on working the large muscles of the lower body. A simple basic move, such as a scissors or cross-country ski, can be varied by changing the “working positions” of the body vertically.Progression: Arms and legs work in opposition for balance. Intensity can be changed by choosing a working position of level I: neutral (feet tap and slide along the pool bottom for support, chest and arms are submerged); level 2: rebound (push forcefully off the pool floor for a jumping-type movement); and level 3: suspended (feet never touch the bottom, mimicking deep water work). Monitor intensity by using the talk test and perceived exertion.
- Muscular Endurance
Participants may choose to use various surface area equipment to provide the right amount of overload for them. Remember-the larger the piece, the greater the resistance. ACSM guidelines recommend 8-15 repetitions for each major muscle group.Progression: Stabilize in a lunge and slowly practice full range of motion, targeting the rotator cuff. Check for proper alignment (ears and shoulders lined up, shoulders down and back, wrist in line with the forearm). Add force through the movement, increase the force, and travel backward to increase intensity again. Jog for warmth and release your grip on equipment between sets.
- Cardiorespiratory/Resistance Combination Cardiorespiratory and resistance work can be targeted in water by combining high-intensity leg and upper body exercises.Progression: Stabilize seated position, by cueing tight abdominals, shoulders down and back, and chest up. Slowly practice fin kicking and then add the arm work for the upper back (arms move from front to the side and allow the currents to float the arms back to the front for a passive recovery). Increase intensity by kicking harder, traveling with greater speed, and by pushing faster during arm work.
- Functional Training for ADL
Participants can improve gripping and releasing, walking and balancing by performing exercises that target multiple tasks.Progression: Grip and release a small sponge ball while walking forward and backwards. Increase difficulty by working the squeeze/release as the arms change positions, from overhead to under the water to diagonals, and increase the size of the stride and the speed of the walk as you change directions (forward and backwards, then on diagonals and sideways).
- Sports-Based Team Training
Team training is fun and effective for participants who like competition and partner work. Tethered together, each of two partners alternates between being the runner (dragging his or her partner as resistance equipment) for cardiorespiratory work, and being the “human parachute,” opening and closing arms and legs for hip adductor and pectoral muscle endurance work.Progression: Runner runs faster, then zig zags the pattern, while the “human parachute” can spread the fingers of the webbed gloves, and open the arms and legs more fully and close them more forcefully.
- Warm-Down (Water Cool-Down) and Flexibility: Buoyancy Assisted Stretching.
Buoyant dumbbells help assist a chest and shoulder stretch, and support the body to allow the legs to work a bicycle pattern, keeping participants warm.Progression: Open the arms wider, bicycle faster to increase the effects of water currents that enlarge the range of motion of the arms.
Designing a Class
Basic class formats are similar to those designed on land. Participants should understand the objective of the set and be allowed to use progressions to regulate intensity. A sample framework could include an orientation to water, safety and basic skills review, followed by a thermal and cardiorespiratory warm-up. The conditioning segment can alternate cardiorespiratory and muscular endurance sets (circuit style), or as continuous segments of each (but remember to use intervals throughout to provide rest). Additional sets can be included that target sports or functional ADL drills (sit to stand, stair climbing), dynamic flexibility patterns (reaching, leaping), or a fun play set (choreography, noodle tug of war). A warm-down completes the class to prepare participants for land.
Build an Amphibious Team
A combination of land and water programs targeting health objectives can provide a lifetime of balanced exercise options. Market your water and land programs together as healthy lifestyle activities that complement each other. Cross-train yourself professionally by learning to teach both land and water classes effectively, and understand the benefits of each mode, helping participants develop a balanced exercise program.
New developments offer more opportunities and accessibility to aquatic exercise. Pools with smaller footprints use a smaller space at a reasonable cost. These small pools that accommodate one to eight people can include in floor treadmills to adjust speed, adjustable water depth with zero-depth entry, multi-directional jets for functional overload resistance and massage, and underwater cameras that allow trainers to view underwater body mechanics from the deck. Small pools can broaden the variety of training options available for a more diverse population.
Trainers can integrate water exercise into an overall program that addresses safety and individual needs.
Water-based exercises can safely provide training choices for people who need to work at a lower intensity and/or impact than land exercise, or those who are at high risk of falling.
Programs that encourage people to go at their own pace and those that provide safe and effective protocols based on current scientific evidence hold the most promise. Trends in aquatic exercise options broaden the opportunities for seniors to make lifestyle changes using exercise as medicine.
Explore the benefits of water by expanding your instructor training to include the pool. Data was analyzed for 10,518 women and 35,185 men, 20-88 years of age who participated in activities at the Cooper Institute Clinic, Dallas, Texas. Investigators learned that long time runners and swimmers have similar health benefits over time. These health benefits were found to be greater even when compared to people who chose walking as their primary lifetime activity. Discover with your participants how to add variety to their training by broadening their exercise choices. Learn how to use the technical water environment, and then share the skills for a lifetime of purposeful activity, health, and fun!