Aquatic Exercises; goals and indication


The specific purpose of aquatic exercise is to facilitate functional recovery by providing an environment that augments a patient’s and/or practitioner’s ability to perform various therapeutic interventions. The specific goals include:

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

Aquatic Exercises


Although most patients easily tolerate aquatic exercise, the practitioner must consider several physiological and psychological aspects of immersion that affect selection of an aquatic environment.


Fear of Water

Fear of water can limit the effectiveness of any immersed activity. Fearful patients often experience increased symptoms during and after immersion because of muscle guarding, stress response, and improper form with exercise. Often patients require an orientation period designed to provide instruction regarding the effects of immersion on balance, control of the immersed body, and proper use of flotation devices.

Neurological Disorders

Ataxic patients may experience increased difficulty controlling purposeful movements. Patients with heatintolerant multiple sclerosis may fatigue with immersion in temperatures greater than 33_C.

Patients with controlled epilepsy require close monitoring during immersed treatment and must be compliant with medication prior to treatment.

Cardiac Dysfunction

Patients with angina and abnormal blood pressure also require close monitoring. For patients with cardiac disease, low-intensity aquatic exercise may result in lower cardiac demand than similar land exercise.

Small Open Wounds and Lines

Small, open wounds and tracheotomies may be covered by waterproof dressings. Patients with intravenous lines, Hickman lines, and other open lines require proper clamping and fixation.


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.

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.


The unique properties of water and immersion have profound physiological implications in the delivery of therapeutic exercise. To utilize aquatics efficiently, practitioners must have a basic understanding of the clinical significance of the static and dynamic properties of water as they affect human immersion and exercise.

Physical Properties of Water

The properties provided by buoyancy, hydrostatic pressure, viscosity, and surface tension  have a direct effect on the body in the aquatic environment.


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

 Clinical Significance

Buoyancy provides the patient with relative weightlessness and joint unloading, allowing performance of active motion with increased ease.

Buoyancy allows the practitioner three-dimensional access to the patient.

Hydrostatic Pressure

Definition. Hydrostatic pressure is the pressure exerted on immersed objects.


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.



Definition. Viscosity is friction occurring between molecules 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. A shorter lever arm results in increased resistance. During manual resistance exercises stabilizing an extremity proximally require the patient to perform more work Stabilizing an extremity distally requires the patient to perform less work.

Increasing the surface area moving through water increases resistance.

Surface Tension

Definition. The surface of a fluid acts as a membrane under tension. Surface tension is measured as force perunit length.


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.

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.

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