Aquatic exercises can be performed in water between 26-33°C for flexibility, strengthening, gait training, and relaxation. Therapeutic exercises in 33°C water may benefit patients with painful musculoskeletal injuries due to relaxation, elevated pain threshold, and decreased muscle spasm. Cardiovascular training should occur between 26-28°C for increased exercise efficiency, stroke volume, and decreased heart rate, while intense aerobic training over 80% maximum heart rate requires cooler 22-26°C water to minimize heat illness risk. Aquatic equipment provides buoyancy, challenges balance, and generates resistance to movement intensity.

1. Equipment and ExerciseEquipment and Exercise

2. Aquatic exercises, including flexibility,Aquatic exercises, including flexibility,
strengthening, gait training, and relaxation,strengthening, gait training, and relaxation,
may be performed in temperaturesmay be performed in temperatures
between 26 C and 33 Cbetween 26 C and 33 C

3. Therapeutic exercise performed in warmTherapeutic exercise performed in warm
water (33 C) may be beneficial for patientswater (33 C) may be beneficial for patients
with acute painful musculoskeletalwith acute painful musculoskeletal
injuries because of the effects of relaxation,injuries because of the effects of relaxation,
elevated pain threshold, and decreasedelevated pain threshold, and decreased
muscle spasmmuscle spasm

4. Cardiovascular training and aerobic exerciseCardiovascular training and aerobic exercise
should be performed in water temperaturesshould be performed in water temperatures
between 26 C and 28 C. This rangebetween 26 C and 28 C. This range
maximizes exercise efficiency, increasesmaximizes exercise efficiency, increases
stroke volume, and decreases heart ratestroke volume, and decreases heart rate

5. Intense aerobic training performed aboveIntense aerobic training performed above
80% of a patient’s maximum heart rate80% of a patient’s maximum heart rate
should take place in temperaturesshould take place in temperatures
between 22 C and 26 C to minimize the riskbetween 22 C and 26 C to minimize the risk
of heat illnessof heat illness

6. Aquatic equipment is used to provideAquatic equipment is used to provide
buoyant support to the body or an extremity,buoyant support to the body or an extremity,
challenge or assist balance, and generatechallenge or assist balance, and generate
resistance to movement. By addingresistance to movement. By adding
or removing equipment, the therapist canor removing equipment, the therapist can
progress exercise intensityprogress exercise intensity

7. Equipment designed to assist with patientEquipment designed to assist with patient
positioning by providing buoyancy assistancepositioning by providing buoyancy assistance
can be applied to the neck, extremities, orcan be applied to the neck, extremities, or
trunk. Inflatable cervical collars are used fortrunk. Inflatable cervical collars are used for
the supine patient to support the neck andthe supine patient to support the neck and
maintain the head out of the watermaintain the head out of the water

8. Often the rings are used at the wrists andOften the rings are used at the wrists and
ankles during manual techniques to assistankles during manual techniques to assist
with patient positioning and relaxation.with patient positioning and relaxation.
Several types of belt exist that may be used toSeveral types of belt exist that may be used to
assist with buoyancy of an extremity or theassist with buoyancy of an extremity or the
entire bodyentire body

9. Often the rings are used at the wrists andOften the rings are used at the wrists and
ankles during manual techniques to assistankles during manual techniques to assist
with patient positioning and relaxation.with patient positioning and relaxation.

10. Several types of belt exist that may be used toSeveral types of belt exist that may be used to
assist with buoyancy of an extremity or theassist with buoyancy of an extremity or the
entire bodyentire body

11. Belts and vests are used to position patientsBelts and vests are used to position patients
supine, prone, or vertically for shallow andsupine, prone, or vertically for shallow and
deep water activities.deep water activities.

12. Buoyant dumbbells (swim bars) are availableBuoyant dumbbells (swim bars) are available
in short and long lengths. They are useful forin short and long lengths. They are useful for
supporting the upper body or trunk insupporting the upper body or trunk in
upright positions and the lower extremities inupright positions and the lower extremities in
the supine or prone positionsthe supine or prone positions

13. Patients can balance (seated or standing) onPatients can balance (seated or standing) on
long swim bars in deep water to challengelong swim bars in deep water to challenge
balance, proprioception, and trunk strength.balance, proprioception, and trunk strength.

14. Resistance to upper extremity movements isResistance to upper extremity movements is
achieved by applying webbed gloves orachieved by applying webbed gloves or
progressively larger paddles to the handsprogressively larger paddles to the hands

15. Hydro-tone® bells are large, slotted plasticHydro-tone® bells are large, slotted plastic
devices that increase drag during upperdevices that increase drag during upper
extremity motions. The bells generateextremity motions. The bells generate
substantially more resistance than gloves orsubstantially more resistance than gloves or
hand paddles.hand paddles.

16. The application of fins or boots to the feetThe application of fins or boots to the feet
during lower extremity motions generatesduring lower extremity motions generates
resistance by increasing the surface arearesistance by increasing the surface area
moving through the water. Fins aremoving through the water. Fins are
especiallyespecially
useful for challenging hip, knee, and ankleuseful for challenging hip, knee, and ankle
strength.strength.

17. Hydro-tone® boots are most effective duringHydro-tone® boots are most effective during
deep water walking and runningdeep water walking and running

18. Kickboards are a versatile and effective aquatic toolKickboards are a versatile and effective aquatic tool
for augmenting any exercise program. Kickboardsfor augmenting any exercise program. Kickboards
may be used to provide buoyancy in the prone ormay be used to provide buoyancy in the prone or
supine positions, create resistance to walkingsupine positions, create resistance to walking
patterns in shallow water when held vertically, orpatterns in shallow water when held vertically, or
used to challenge seated, kneeling, or standingused to challenge seated, kneeling, or standing
balance in the deep waterbalance in the deep water