Aquatic exercise, also known as hydrotherapy, involves exercising in water and can provide benefits for rehabilitation. It allows for range of motion exercises, strengthening, balance training, and cardiovascular exercise while minimizing stress on joints. Several studies have shown aquatic exercise to be as effective as land-based exercise for improving aerobic fitness and body composition in overweight individuals. It may also help reduce pain for those with knee osteoarthritis. Muscle activity is generally lower in the legs during aquatic exercise compared to land-based exercise due to buoyancy effects. Water-based exercise has also shown benefits for people with COPD and asthma, improving exercise capacity more than land-based exercise for those with comorbidities. However, more research is still

1. S
Aquatic exercise
(Hydrotherapy)
Nora alwohayeb
Mashael alrayes
Salma almkainzi
Aziza alamri
Fay albuainin

2. Outlines:
S Defining aquatic exercise.
S Facilities and Equipment.
S Goal and indications for aquatic exercisescontraindications.
S AdvantagesDisadvantages.
S Articles

3. Definition:
It refers to the use of multi-depth
immersion pools or tanks that
facilitate the application of various
established therapeutic
interventions.

4. It includes:
S Stretching.
S Strengthening.
S Joint mobilization.
S Balance and gait/endurance training.

6. Notes:
Therefore, any jogging, walking or other impact exercises will likely not
cause any injuries when done underwater.

8. Goal and indications for
aquatic exercise
S Initiate resistance training.
S Facilitate weight-bearing
activities.
S Useful in early stages of
rehabilitation.
S Provide three-dimensional
access to the patient.
S Facilitate cardiovascular
exercise.
S Minimize risk of injury or
reinjury during rehabilitation.
S Extremely useful with lower-
extremity injuries

9. Contraindications for aquatic
exercises.
S Fear of water.
S Neurological disorders.
S Seizures.
S Cardiac dysfunction.
S Small open wound and lines.

10. Facilities and Equipment
S Facility must have certain characteristics
S Should be at least 10 x 12
S Adequate access
S Shallow and deep areas
S Flat pool floor with marked gradients
S Adequate temperature (79-82 degrees)
S Ancillaries
S Prefabricated pools with treadmill or current producing
device
S Pool toys – limited by imagination

13. Aquatic Rehabilitation: Advantages
S AROM exercises supported through buoyancy
S Minimizes discomfort
S Sense of security
S Useful in early stages of rehabilitation
S Supportive environment
S Extremely useful with lower-extremity injuries
S Provides gradual transition from non to full weight-bearing
S May allow earlier locomotion due to decreased compressive
forces

14. S Psychological impact
S Increased confidence due to increased function
allowed by water
S Strengthening and muscle re-education
S Energy expenditure
S Aerobic workout possible to maintain CV fitness
Aquatic Rehabilitation: Advantages

16. Aquatic Rehabilitation:
Disadvantages
S Building and maintaining a rehabilitation pool
S Space and personnel
S Aquatic training may be too challenging if athlete
unable to stabilize body
S Thermoregulation
S May impact tolerance for participation in heat

17. S
VO^sub 2^ Prediction
and Cardiorespiratory
Responses During
Underwater Treadmill
Exercise
Greene, Nicholas P;Greene, Elizabeth
S;Carbuhn, Aaron F;Green, John S;Crouse,
Stephen F Research Quarterly for Exercise and
Sport; Jun 2011; 82, 2; ProQuest Central
pg. 264

18. S They compared the cardiorespiratory responses to exercise on
an underwater treadmill (UTM) and land treadmill (LTM) and
derived an equation to estimate oxygen consumption (VO2)
during UTM exercise
S 55 men and women completed on LTM and five UTM session
on separate days .
S The UTM session consisted of chest-deep immersion with
0,25,50,75, and 100% water-jet resistance . All session
treadmill velocities increase every 3 min from 53.6 to 187.8
m.min-1

19. Method
S First part : designed to compare and contrast submaximal and
maximal cardiorespiratory responses to UTM and LTM
exercise
S Second part : designed to develop and equation to estimate
VO2 .
 Recruited additional 11 participants to exercise in a second
UTM system ( different model ) to strengthen their ability to
accurately estimate vo2 across other UTM systems

21. S Participant were then fitted on a HR monitor and a mask
connected to an automated metabolic gas analyzer .
S The gas analyzer was calibrated after each exercise session
S During the exercise session expired metabolic gases were
measured continuously and HR and RPE were during last 30
s of each exercise stage

22. Each participant completed
six experimental exercise
session on different days
 LTM at 0% grade
 UTM at 25% jet resistance
 UTM at 50% jet resistance
 UTM at 75% jet resistance
 UTM at 100% jet resistance
S VO2 max for UTM exercise was
taken the highest VO2 achieved at
volatile exhaustion during UTM
exercise session
S treadmill velocities increase every
3 min from 53.6 to 187.8 m.min-1
for every season

23. equations
0-25% jet
S Weight-relative VO2(mlo2 x kg-1
xmin-1 )= 0.26144 x height (cm2 ) +
0.13482 x velocity (m.min-1 )-
0.11966 x weight (kg)-33.72236
25-100% jet
S Weight-relative VO2(mlo2 x kg-1
xmin-1 )= 0.19248 x height (cm2 ) +
0.17422 x jet resistance (%) +
0.14092 x velocity (m.min-1 )-
0.12794 x weight (kg)-26.82489

25. Conclusion
S Considering that no weight-bearing exercise is
recommended for therapy and training in some
populations , the buoyant unloading provided by the
UTM may offer a good alternative to tradional LTM
exercise

26. S
Comparative Efficacy of
Water and Land Treadmill
Training for Overweight or
Obese Adult
GREENE, NICHOLAS P.; LAMBERT, BRAD S.; GREENE, ELIZABETH S.;
CARBUHN, AARON F.; GREEN, JOHN S.; CROUSE, STEPHEN F.
©2009The American College of Sports Medicine

27. Purpose
S No known previous research has been published to explore the
efficacy of underwater treadmill (UTM) exercise training for the
obese. Thus, the purpose of this study was to compare
changes in physical fitness, body weight, and body composition
in physically inactive, overweight, and obese adults after 12
wks of land treadmill (LTM) or (UTM )training.

28. UPON ENTRY
S 57 physically inactive, overweight,
and obese men (n = 25) and
women (n = 32) participated.
S Later Subjects were randomly
assigned to exercise three times
per week for 12 wk on either LTM
(n = 29) or UTM (n = 28)
S Diet: stay the same as before
AGE 44± 2 yr
WEIGHT 90.5 ± 2.4
kg,
BMI 30.5 ± 0.7
kg·m-2,
VO2 MAX 27.1 ± 0.7
mL O2·kg-
1·min-1

30. Physiological assessments.
S Body composition, including regional and whole-body percent
fat and lean body mass, Waist girths and waist-to-hip ratios
S An incremental maximal graded exercise test (GXT)
S Oxygen consumption during exercise was assessed using an
automated metabolic gas analysis. Each subject was tested
using the same metabolic equipment at pretraining and
posttraining assessment periods.
S V·O2max was taken as the highest 15-s average oxygen uptake
achieved during the exercise test.
S HR and rhythm ,RPE , blood pressures.

31. Exercise training
S Subjects exercised three times
per week during the 12-wk
period
S The UTM water depth was
standardized to the level of
each subject's fourth intercostal
space
S LTM exercise training was
conducted on a standard motor-
driven treadmill.

32. Results

34. Conclusion
S UTM and LTM training are equally capable of improving
aerobic fitness and body composition in physically inactive
overweight individuals, but UTM training may induce increases
in LBM.

35. S
The Effects of Underwater
Arm-Cranking Exercise on
Cardiac Autonomic
Nervous Activity.
Kumiko Ono, Kuniyoshi, and Y. Tanigaki.2013
Presented by: Fay
AlBuainain

36. Purpose
S To determine the beneficial effects of
exercise underwater on cardiac autonomic
nervous activity during arm cranking.

37. Subjects
S Age 21 ± 1.5 yrs
S Height = 171.0 ± 5.7 cm
S Body mass= 60.7 ± 3.8 kg
S BMI = 20.4 ± 1.7n= 10 men

38. The experiment was done on 2 sessions each session was done on
separate days.
Method
Control conditionWater condition
Resting in setting position for
5 minutes. 10 min exercise
50 revolution/min
Resting in setting position for 10 minutes
Then they started arm cranking exercise
for 10 minutes
arm ergometer monark
portable ergometer 881E

39. Cont.
Parameters that was measured:
S VO2
S Heart rate (HR).
S Rating of perceived exertion ( RPE )
S Rating of perceived fatigue sense ( RPFS ) by using borg
scale
S Cardiac parasympathetic nervous activity (HF)

40. Result

41. Conclusion
Arm cranking exercise in the sitting
position in water could lead to faster
recovery of heart rate than on the
ground.

42. S
Effects Of Underwater
Treadmill Exercise On
Mobility Of
People With Knee
Osteoarthritis
Jaimie Roper. Utah State University
Logan, Utah.2010
Presented by: Fay AlBuainain

43. Purpose
S To determine the effectiveness of aquatic
therapy on in OA patients.

44. Subjects
S Inclosion criteria :
S Previously
diagnosed with
knee OA.
S Able to walk a city
block
n= 14 men
S Exclosion criteria :
S Currently exercised on
an aquatic treadmill.
S CVD, NMD
S Stroke
S Surgeries to the lower
limb.
S Intra-articular
corticosteroid injections
in the past month.
WHY?

45. Method
3 sessions/week 3 sessions/week
20 min Intensity to
X 0.26 m/s
Xiphoid
process

46. Cont.
S The parameters were measured before and after the
experiment:
S Gait kinematics: To measure step length, step rate, joint
angles, and velocities.
S Pain scale
S Self-efficacy scale: were asked to how many times they
could walk around the gymnasium without stopping. And
their level of certainty.
very
severe
pain
no pain
1 2 3 4 5 6 7 8 9 10 11
12

47. Result
S Self-selected speeds during exercise indicated they were not
different between aquatic (0.76 ± 0.24 m/s) and land (0.80 ±
0.26 m/s) treadmill exercise (p = 0.13).
S Velocity gain scores that were significantly different at the p =
0.05
S Left knee extension significantly higher for aquatic treadmill
exercise by 38.1% (p = 0.004) during both of stance and
swing.
S During stance, the joint angle gain score for left hip flexion
was greater for land exercise by 7% (p = 0.007)
S During swing, the angular velocity gain score for right hip
extension was significantly greater for aquatic exercise by
28% (p = 0.01).
S During stance, joint angle gain score for left ankle abduction

48. Result
S Pain was 100% greater for land than aquatic treadmill
exercise (p =0.02)
S Self-efficacy gain scores were not different between
conditions (p= 0.37).
S Step rate and step length gain scores were not different
between conditions (p =0.31-0.92).

49. Conclusion
Acute training period on an aquatic treadmill tended to
increase select joint angular velocities and decrease
arthritis related joint pain. But un clear until now if
the aquatic exercise is a better than land over long
time.

50. S
Lower Extremity Muscle Activity during
Different Types and Speeds of Underwater
Movement
Koichi Kaneda, Hitoshi Wakabayashi, Daisuke Sato and Takeo Nomura

51. Purpose
S To compare lower extremity muscle activity during land
walking (LW), water walking (WW), and deep-water running
(DWR) at self-determined intensity.
“ The water temperature was set at 27°C and the water depth was set at
1.1 m throughout the experiment”.

52. Methods
S Nine healthy young males participated in this experiment as
subjects.

53. Methods
S The subjects performed LW, WW, and DWR at self-
determined low, moderate, and high intensities for 8 sec with
two repetitions.
S Aqua jogger .
S Surface electromyography (EMG).

54. Six muscles

55. Results
S SOL and GAS showed significantly lower activity (p<0.05) during
DWR than LW and WW at all intensities
S During WW, SOL showed significantly lower activity (p<0.05) than
LW at all intensities.
S GAS showed significantly lower activity (p<0.05) than LW at low
intensity.
S BF showed significantly higher activity (p<0.05) during DWR than
LW and WW at low and moderate intensities, and than LW at high
intensity (p<0.05).

56. Conclusion
S The lower activity of SOL and GAS depended on water depth.
S Higher activity of BF occurred by greater flexion of the knee
joint or extension of the hip joint during exercise.

57. S
Water-based exercise is more effective than
land-based exercise for people with COPD
and physical comorbidities
Karin Wadell
Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå
University, Umeå, Sweden

58. Purpose
To compare the improvement of exercise capacity and health-
related quality of life in water based exercise and land based
exercise in COPD patients with comorbidities.

59. Methods
S Inclusion criteria :
S Adults with stable COPD were included if they had at
least one physical comorbid condition (eg,
musculoskeletal conditions, peripheral vascular disease).
S Exclusion criteria :
S unstable cardiac disease or a contraindication to water-
based exercise, such as open wounds.

60. Participants

61. Methods
S Both WBE and LBE required participants to attend three 60-
minute sessions each week, for 8 weeks.
S The WBE group and LBE group were matched as closely as
possible in terms of intensity and the muscle groups exercised.

62. Results
S A total of 45 participants completed the study.
S Greater gains were seen in the distance walked in the WBE
group but not in the LBE group.

63. Conclusion
In people with COPD and physical comorbidities, WBE appears
to confer greater gains in exercise capacity when compared with
LBE.

64. S
Water-based exercise for adults with
asthma
Grande AJ, Silva V, Andriolo BNG, Riera R, Parra SA, Peccin MS. Water-based exercise
for adults with asthma.
Cochrane Database of Systematic Reviews 2014,

65. Purpose
S To evaluate the effectiveness and safety of water-based
exercise for adults with asthma.

66. Methods
S They included randomized controlled trials (RCTs),
regardless of language, age of publication or publication
status.
S A cross-over RCTs were also included; however they
analyzed separately the data obtained from them.

67. S They considered participants who met the following
criteria:
S Adults of either gender.
S Adults with asthma diagnosed according to clinical criteria
S Studies that compared any type of water-based exercise
versus another type of water-based exercise, land-based
exercise or usual care were included .

68. S They documented the duration and frequency of sessions
and the overall length of the programme.
S At least one group in each comparison used water-
based exercise.
S The following possible comparisons were made.
S Water-based exercise versus land-based exercise.
S Water-based exercise versus usual care

69. Result
S The primary outcomes of quality of life and
exacerbations leading to use of steroids were not
reported by these studies.
S For exacerbations leading to health center/hospital visits,
uncertainty was wide because a very small number of
events was reported (in a single study).

70. S Secondary outcomes :symptoms, lung function,
changes in medication and adverse effects.
S No clear differences were noted between water-based
exercise and comparator treatments.

71. S There was an uncertainty about the effects of water-
based exercise for adults with asthma

72. Conclusion
S The small number of participants in the three included
studies, the clinical and methodological heterogeneity
observed and the high risk of bias .
S Randomized controlled trials are needed to assess the
efficacy and safety of water-based exercise for adults
with asthma.

73. S
Effectiveness of low-intensity aquatic
exercise on COPD:
A randomized clinical trial
Zenia Trindade de Souto Araujoa, Patricia Angelica de Miranda Silva
Nogueirab, Elis Emmanuelle Alves Cabralb, Lourena de Paula dos Santos
Ivanizia Soares da Silvab, Gardenia Maria Holanda Ferreirab, 2012

74. Purpose
S To evaluates the impact of low-intensity
water and floor exercises on COPD

75. Method
S 42 individuals with moderate to very severe COPD,
divided into 3 groups:
S Control Group (CG)
S Floor Group (FG)
S Aquatic Group (AG).

76. S Subjects were over 40 years of age
S From both sexes
S Gave informed written consent
S Clinically stable without periods of exacerbation for at
least 8 weeks.
S Nonsmokers or ex-smokers for at least 3 months.
S Free of lung infection and had medical supervision.

77. S Spirometry.
S Respiratory muscle strength (MIP and MEP).
S The 6-Minute Walk Test (6MWT).
S Medical Research Council (MRC).
S BODE index
S The St. George’s Respiratory Questionnaire (SGRQ).
All participants were assessed
using:

78. Result
S Pulmonary function :
S both (FG, AG) significantly improved FEV1 post-intervention, while
the CG exhibited a significant decrease in the FEV1/FVC
S However, no significant difference was observed among the three
groups after training

79. S Respiratory muscle strength:
S A statistical difference was observed in MIP,MEP in
the training groups after the physical exercise program
(FG, AG).
S No significant difference was recorded in the CG
post-intervention.

80. S 6MWT:
S There was no difference between groups for 6MWT or for
mean for dyspnea at rest and after the 6MWT. Only the
FG showed a significant reduction in Rate of Perceived
Exertion.
S After training, the dyspnea index was significantly lower
in the AG and higher in the CG.

81. S In regard to risk of death from COPD:
S A significant reduction in the BODE index for the
physical training groups: (FG,AG).
S Increased in the CG

82. S SGRQ scores :
S There was no significant difference between groups
at the beginning of the study
S The FG showed improved quality of life evidenced
by the total score on the SGRQ

83. Conclusion
S Results show that both forms of low-intensity physical
exercise benefit patients with moderate and very severe
COPD.
S The AG exhibited additional benefits in physical ability,
indicating a new therapeutic modality targeting patients
with COPD.

85. UTM and LTM training are equally capable of improving
aerobic fitness and body composition in physically
inactive overweight individuals, but UTM training may
induce increases in LBM.
Acute training period on an aquatic treadmill tended to
increase select joint angular velocities and decrease
arthritis related joint pain.
UTM may offer a good alternative to tradional LTM
exercise in some cases only
Effect of Underwater exercises on asthma
and COPD

86. Arm cranking exercise in the sitting position in water
could lead to faster recovery of heart rate than on the
ground.