1. Dekker Smith, Jenna Aeschbacher, Julianne Fairbanks
Brigham Young University
Technical Writing 316
Enclosed is a text compiled by our team, in which we have extensively researched the
benefits for aquatic exercise and swimming. This text discusses the benefits of
swimming and hydrotherapy on all ages, and serves as an aid to those wishing to
learn or improve skills in aquatic swimming. It teaches how such skills can be used to
the advantage of achieving overall health and well-being.
Regards,
Dekker Smith, Jenna Aeschbacher, and Julianne Fairbanks

2. 1
L
Total Health for All Ages
through Aquatic Exercise and Rehab
Dekker Smith, Julianne Fairbanks,and Jena Aeschbacher

3. 2
Contents
Why Swim? ................................................................................................................................ 3
Swimming as Therapeutic Exercise ....................................................................................... 5
Early Childhood Swimming....................................................................................................... 6
Safety Benefits of Early Childhood Swimming ..................................................................... 6
Social Benefits........................................................................................................................ 9
Teaching Children Water-Safety Basics .............................................................................. 10
Prevention Strategies ............................................................................................................ 12
Adolescents............................................................................................................................... 15
Swimming Competitively..................................................................................................... 16
Elderly ...................................................................................................................................... 32
Strength Training.................................................................................................................. 32
Aerobic Training .................................................................................................................. 37
Rehabilitation of Injury ........................................................................................................ 43
References ................................................................................................................................ 49

4. 3
Why Swim?
Whether enjoying a day at the lake, relaxing on a cruise, fishing, or spending time at
the local community pool, most people have had or will have some sort of
opportunity to be in or around the water. While swimming is an ordinary recreational
activity provided to most, if not all individuals, most peopledo not realize that
swimming also provides a wide array of benefits that extend well beyond the typical
lounging at the pool. Swimming is a widely popular activity that proves to be
beneficial in a variety of ways. Whether swimming be a form of physical exercise, a
way to rehabilitate injured or weak muscles, or just as a form of recreational activity, it
is clear that every one of every age can benefit from the many advantages that come
from being in the water. This book will explain in detail the various benefits that all
individuals can gain through aquatic activity. Whether you be a non-swimmer, parent
of young children learning to swim, medical practitioner, competitive swimmer,
aspiring triathlete, or current sufferer of the inevitable aging process, this book will
help you better understand how you specifically can use swimming to your advantage
for optimal health, wellness, and a happy, comfortable lifestyle.
Listed below is a summary of just some of the various benefits one can gain through
swimming. These benefits are further explained according to each age group
throughout this book.

5. 4
Physical Benefits
-Improves endurance
-Builds muscle and increases strength
-Enhances lung capacity
-Increases blood circulation
-Strengthens heart muscle
-Rehabilitates injured muscles
-Improves overall physique
Social Benefits
-Easy mode to associate with others and have fun
-Additional revenue to make new friends
-When properly educated on water safety, it can be not only fun, but a safe
setting also
-Causes individuals to be more comfortable in other social situations
Psychological Benefits
-Increases endorphins and improves overall well-being
-Relieves stress and tension
-Provides a feeling of energy and renewal
-Improves self confidence
-Enhances the brain’s ability to think

6. 5
In addition to the previously listed physical, social, and psychological benefits of
swimming, simply knowing how to swim can also provide the benefit of personal
safety. Knowing how to swim allows the obvious of being able to survive in the water.
At one time or another, you are going to find yourself in or near water. If you ever
happen to find yourself in or near water that is deeper than your height, knowing how
to swim could not only save your life, but the lives of those around you. It is therefore
essential to learn to swim not only to survive in life-threatening situations in water,
but also to be able to experience all the other benefits that come from swimming as
listed above. One main purpose of this book is motivate and teach those who have
not yet learned how to swim, or who have children who have not learned to swim,
how to get started. Therefore swimming may become not just another recreational
activity to be enjoyed, but will help improve one’s health in every stage of life with
hydrotherapy.
Swimming as Therapeutic Exercise
It is evident that swimming is a great form of exercise and recreation, but what many
do not realize is that one of the main benefits of swimming is also to help people
recover from a variety of accidents and illnesses, including but not limited to: sports-
related injuries, arthritis and fibromyalgia, heart disease, back and spinal cord
problems, and depression. Additionally, it can be a huge aid in combating the aging
process that inevitably affects us all.
According to an online swimming journal by Bonnie Singleton on Livestrong.com,
swimming, or water therapy, has many health benefits, including both physical and
mental, on all ages (Singleton, B). Further details on how hydrotherapy can benefit
each age group can be found under each respective age group.

7. 6
Early ChildhoodSwimming
Learning to swim while in the younger years is not only the best way to ensure water
safety during the growing years in adolescence, but it also permits easy engagement
in other uses in hydrotherapy once they become necessary in the later years of life.
Kids who learn to swim while they are young are more likely to engage in water
activities without any safety problems later on in life. It is better for them to learn
while they are young, to eliminate the need and worry for learning safety precautions
and overcoming water phobias later on in life, when it will likely be more difficult and
embarrassing. A child who learns to swim at a younger age is a lot more likely to have
the fear of water reduced as they become older. Research shows that children who
wait until after around age 8 are a lot less likely to ever learn how to swim, therefore it
is vital that they are taught while they are young.
Safety Benefits of Early Childhood Swimming
Not everyone knows how to swim. Those who have never learned are likely to have a
fear of the water. Learning to swim at a young age will help overcome this fear and
will benefit those who learn throughout their lives.

8. 7
As previously stated
there are many safety
benefits when it comes
to being educated
about and adapted to
the water, especially at
a young age. It is likely
that most individuals
will become exposedto
interaction with some
sort of water landmark
at least once, if not multiple times in life. It is better for individuals to learn these skills
as young as possible, so as to ensure optimal safety when the time for interaction in
the water comes.
Whether a child is attending summer camp near a lake, swimming in a local
community pool, or attending a pool party, there are many instances where they may
come in contact with water. According to the Centers for Disease Control and
Prevention (CDC) “drowning is the leading cause of unintentional death for children
ages 1-4” (poolsafely.gov). It is therefore vital that children learn water safety and are
taught skills they can use in the water to keep their lives from being at risk.
Following are additional statistics providedby USA Swimming:
-Approximately 10 people drown every day in the U.S. (Source: Centers for Disease
Control and Prevention (CDC)).
-More than one in five fatal drowning victims are children younger than 14 (Source:
CDC).
-Drowning is also a silent killer—most young children who drowned in pools were last
seen in the home, had been out of sight less than five minutes, and were in the care of
one or both parents at the time (Source: Present P. Child Drowning study).

9. 8
-If a parent does not know how to swim, there is only a 13 percent chance that a child
in that household will learn how to swim. (Source: National research study by the USA
Swimming Foundation and the University of Memphis)
-Participation in formal swimming lessons can reduce the risk of drowning by 88
percent among children aged one to four years. (Source: Pediatrics & Adolescent
Medicine 2009)
Since drowning appears to be one of the greatest causes of death, especially among
young children, it is extremely important to teach them while they are young. One of
the best ways to ensure water safety for children is to have them participate in group
or private swim lessons with a qualified instructor who has been taught and certified
in Water Safety Instruction.
During formal lessons, kids will also learn water safety skills and pool safety rules. It is
natural that parents are constantly worried about their children’s safety.
Knowing how to swim and be safe around water will not only ease a parent’s fears,
but it can save your child’s life. Participation in swim lessons not only provides safety

10. 9
for children, but it also provides an opportunity to have fun and meet other children
their age.
Children learn a variety of skills in swim lessons, and will be placed in a level that
meets their needs and experience. If they start out really young and haven’t had any
previous water experience, they will be placed in a level where they will learn to
become comfortable in the water. Once they’ve reached a stage where they aren’t
afraid of the water and they’re comfortable getting in and getting their face wet, they
will begin to learn the basic survival skills that will help them support themselves in
the water safely. Generally they will be taught kicking motions with their feet, floating
assisted and then unassisted on the front and back, and gliding across the water’s
surface on the front and back. Knowing these few basic skills alone, can make all the
difference for children when they enter the water, and can even make the difference
between life and death.
More information on how you can teach your children basic safety skills yourself will
be provided later on in this chapter.
Social Benefits
Swimming is a great activity for children to be social and make friends. It allows them
to have fun and be themselves in an environment where they are safe and
comfortable if they have had the proper water training. According to the German
Sports College Cologne, young swimmers are
less shy, more independent, and more
comfortable in social situations than non-
swimmers. Every child is going to be invited to a
pool party at some point or another, so it is
better for them to learn to swim as young as
possible, to eliminate any danger or fear of being
around the water that can creep up on them
later on in life.

11. 10
Teaching Children Water-Safety Basics
When formal swim lessons are not possible for your child, teaching them to swim
yourself can be both easy and fun. Provided is a step-by-step guide for teaching
young children the basics to help them become comfortable and safe in the water.
-Water Immersion: If your child has never been exposed to being immerged in the
water before, start by showing them the water is a fun, safe place to be. Ensure they
are supported in your arms at all times, smile, sing songs, and help them feel
comfortable.
-Blowing Bubbles: This teaches the child to become comfortable getting their faces
wet, and also helps them learn to breathe while swimming. Demonstrate taking in
big, exaggerated breaths of air, and then
blow big bubbles in the water with your
mouth, and prompt them to do the
same. Make sure they understand to
always breathe in while they are still out
of the water, and to blow out when they
are underwater.
-Underwater Bobs: This skill helps them
to become fully immergedin the water, and uses their breathing technique in the
water as well. Either hold onto your child with both hands, with one hand underneath
each of their armpits, or if they are older have them hold onto the wall or stand where
they can touch the bottom comfortably. Demonstrate taking in a big breath of air
and then bending your knees to submerge your body underwater, blow out bubbles,
and then pop back up. If your child cannot yet perform this skill independently, the
best thing to do is to submerge them underwater yourself. As soon as they are
completely submerged bring them back up right away, otherwise fear may set in.
They may cry the first couple times, but be assured this will help them to overcome
their fear in the water, as they will soon see that going under is safe, as long as you
are with them. Letting go when they are not ready, or holding them underwater
however will not help and will lose their trust in you and in the water.

12. 11
-Front and Back Floats: Floating is a skill that is essential before learning how to
swim. Even a child who has not yet learned how to swim, but can float on the front or
back, will be able to support themselves on top of the water and survive in a life-
threatening situation in the water. Start
by teaching the back float; it is easier to
learn and is more efficient in survival.
Face your child away from you and
support a hand under each of their
armpits, with only their head above the
water, the rest of the body relaxed
underneath the surface. Gently lay your
child back onto the water so that their head is resting right on top. Encourage them
to lie still and to lay just as if they were on their bed, with their head resting on a
pillow. It is normal for children to be apprehensive about letting their head relax onto
the top of the water, and they will tense up their neck and shoulders, however,
relaxing every muscle is key to having the body float. It may take some time for them
to become comfortablewith this position, but be patient and encouraging and with
time, they will grasp the skill. When teaching the front float, the same relaxation
techniques apply, only now you want to encourage them to put their entire face in the
water and blow out bubbles for as long as they can. As long as their chin is down
with their face in and they are relaxed, they should float with ease.
-Front and Back Glides: Once your child is comfortablewith putting their face in the
water and can float unassisted, they should be able to perform glides without much
hassle. Have them start at the wall, holding on with one or both hands, and place
both feet on the wall, a few inches underneath the surface. Right before they kick off,
have them take in a big breath of air, put their face in the water, and start blowing out
bubbles, then push off the wall in a streamline position with their arms extended in
front of them.

13. 12
-Kicking: After floats and glides, having a nice, strong kick is key to being able to
swim safely in the water. Practice many kicks sitting on the steps, holding onto the
wall, and with a kickboard. Encourage them to kick with straight legs and pointed
toes. Simply kicking from the knee, extending and flexing the lower leg, will not give
the kick much power and staying on the surface of the water will be a struggle. Show
them how to kick using their entire leg, from the hip down, kicking in an up and down
motion.
-Arm Crawl: Finally, your child is ready to learn the arm crawl. Show them how to
make big scooping motions with their arms, bringing their arms all the way out of the
water above their heads, stretching and reaching as far as they can, and then pulling
the water with their hand all the way through once it enters the surface.
Once your child has mastered these skills and is comfortablein the water, you can
have them move up to higher-level swim classes where they can continue enhancing
their technique, and learn additional swim strokes. When they are ready and if they
desire, joining the local swim team would be a great option.
Prevention Strategies
In addition to learning how to teach basic water-safety skills to your child, you can
also us certain prevention strategies that will ensure the utmost safety for your child.
The Centers for Disease Control and Prevention suggest guardians take the following
safety precautions for their children to prevent accidents around the water:

14. 13
-Stay within arm’s reach at all times in and around the pool : You can never know
when a situation can arise that will present danger.
Make sure you are always ready and able to extend an
arm and pull your child to safety in a manner of
seconds.
-Assign an adult water watcher: If you are a busy
parent and your child wants to swim while you are
unable to give your full attention, ensure that an adult
is present with your child so that they are not left in danger. If you attend a gym with
a pool that offers swimming to children while parents work out, make sure a lifeguard
is present before leaving your child, even if there are other adults present or if your
child already knows how to swim.
-Fence your pool: Many parents do not consider putting fencing around large
inflatable pools, the AAP says, and because these pools are considered to be portable,
they fall outside of many state regulations. The AAP recommends parents install a
four-sided fence that is at least 4 feet high if you have any kind of pool in your back
yard. The American Red Cross also offers a home pool maintenance class online to
help you ensure your pool is set up properly. The two-hour class costs $19.95 and
you receive a manual to keep at your home (Singleton, 33).
-Install pool and gate alarms: Even with a fence around
your pool, there may be the occasional incidence of the
mischievous two-year-old, who has mastered how to
unlock the gate, yet hasn’t yet mastered how to swim.
This is where it would be good to install alarms on the
gate, so that no accidents happen.
-Learn how to swim: This is an obvious prevention
strategy, but a most helpful one nonetheless. Not only
should you yourself learn to swim if you are the guardian of a child, but your child
should also learn to swim at the earliest age possible to ensure optimal safety around
any body of water.

15. 14
-Learn CPR: According to the NIH, “all parents and those who take care of children
should learn infant and child CPR if they haven't
already.” But note that CPR recommendations vary
by age group. You can find a CPR training class
near you through the American Heart Association,
and the National Institutes of Health has
guidelines for performing CPR on children
between the ages of 1 and 8. Who knows, it may
even be beneficial to teach your child CPR as well.

16. 15
Adolescents
Once a child has passed the basic learning stage, there is still lots of room for
improvement and broadening of skills. Whether they continue swimming just as
recreation, or begin swimming on a team, swimming has the likelihood of providing
continued health, confidence, and well-being throughout their lives. All the previous
benefits of swimming mentioned for children (safety, social, etc) also exist for
adolescents. Adolescents who are instructed in water safety and have acquired water
skills, are likely to enjoy all the additional benefits that come from swimming. Though
health is not as great a problem for adolescents as it may be for adults, various health
benefits are still available to youth who regularly swim, including but not limited to:
improved bone density, heart and lung health, improved flexibility and strength, and
prevention of childhood obesity.
Swimming can also benefit adolescents emotionally. Like most sports, it is a mental
exercise, and can therefore improve emotional health and well-being. Those who
swim regularly are more likely to have better skills in time-management, self-
accountability, and motivation to work hard to achieve personal goals.

17. 16
Swimming Competitively
Competitive swimming provides a
fun, yet challenging way for
children and teens to stay fit. It
gives an added sense of confidence
in adolescents. It is something that
if they start young, they can
continue to do for the rest of their
lives, thereby leading to increased
health and fitness in the long run. An additional benefit of swimming is that it can be
done either individually or as a team. Throughout the adolescent years, as well as
later on in life, swimming provides an opportunity to enjoy exercise on an individual
basis (in the circumstance where joining with others is not possible or wanted). Other
sports, such as soccer, football, and baseball, are difficult to perform individually, and
almost always require the presence of multiple individuals. Thus swimming is a great
skill to acquire for those instances of individual workouts. Not only can an individual
gain all the fitness benefits from a solo workout as they can from a team or group
workout, but the ability to set and achieve personal records, and work at one’s own
desired pace is also an advantage. In addition, although swimming provides an array
of benefits on the individual level, it is also a great opportunity to learn to work with a
team, and provides many benefits in this sense as well, especially for adolescents.

18. 17
Young swimmers who compete can also experience the satisfaction of achieving
personal goals and receiving personal rewards. The skills that they learn from
competitive swimming can benefit them throughout their lives, as they constantly
strive to become better and achieve what they haven’t yet achieved. During the
adolescent years, there are many great lessons to be learned. Swimming, especially
competitively on a team, provides adolescents with this opportunity, and they are able
to learn important life skills and lessons that perhaps they would not learn elsewhere.
Many beneifts exist for individuals of all ages who participatein competitve
swimming, especially for those in the adolescent years of life. Whether you have a
child reaching the adolescent years, or you are one yourself, consider competitve
swimming as an option for achieveing optimal health, fitness, and overall well-being.

19. 18
Adults
As an adult much of life has conviently been spent on the land. Some walk, run, bike,
or jump, but the water offers a completely other world to discover as an adult.
Swimming provides a source of escape from life on land and the pressure of gravity.
Within this Chapter the benefits of swimming on atheletes, orthopedic injuries, and
pregnancy are explained. To kick start your underrstanding of swimming key points
and workouts are also provided. Enjoy discovering a world down under.
Cross-Training
While swimming is a great sport in its self, it is a resource that could benefit all
athletes no matter what sport or activity they hope to succeed in. As one swims they
will find the resistance of the water to build and tone their bodies in a way different
than that of other activities, specifically compare to activites done on land (What).
Other than over-working ligaments such as the shoulders, swimming is a low impact
sport that provides great aerobic exercise with little injury. Swimmingspecifically
improves lung capacity and engages many muscles in the body leading to an increase
muscle strength and endurance (Swimming).
Respiration Improvement
Swimming improves the cardiovascular system including lung capacity (Evans). As an
aerobic exercise swimming increases respiration rate. Air is easily available while
swimming backstroke or doggy paddle with the face out of the water. Swimming with
ones face in the water takes more control to ensure the body receives with the oxygen
it need without water getting in the way. Inhalation and exhalation takes control and
coordination.

20. 19
As the diagram illustrates above, carbon dioxide is exhaled under the water. To ensure
water does not enter the nose, exhale air through the nose or the mouth. Inhalation of
air occurs as the head turns with the rotation of the body to the side till the mouth
clears the surface of the water. Maintain a vertical position while breathing. A
horizontal position relieves stress often placed on the neck when the head is lifted
rather than rotated to breath. As the body and head are horizontal, the body and
head can rotate to the side so the mouth can easily access air (Feel).
The technique of exhaling while the face is under the water and turning the head to
breath can be challenging but with practice will becomenatural. Below are several
drills to assist in breathing comfortably while swimming, increasing the ease of
respiration.
Bubble Jump
In order to become comfortable in performing a task one can practice by performing
“bubble jumps.” While staying in one spot one goes under the water at a comfortable
depth, mouth just under the surface of
the water, entire head under the
surface, or going all the way down to
the bottom of the pool. While under
the water blow air out either through
your mouth or nose, creating bubbles
till there is little air left in the lungs.
Return to the surface. Once the mouth
is clear of water take a quick, big inhale. Return back under the water exhaling air
from the lungs once again. Repeat this process several times until it is comfortable to
spend more time under the water blowing air out and as little time above the surface
of the water inhaling.

21. 20
Underwater Work
Plan to do a set of four to ten 25 yard lengths of the pool. The goal is to make it as far
as you can while staying under the water, limiting your intake of air to only when you
absolutely need it. Before pushing off the wall take a deep breath, filling the lungs to
max capacity. Push off the wall with hands either above your head as if you were a
torpedo (image illustrated to the
right) or beside your body. Maintain
your momentum from the wall by
kicking “butterfly kick” pushing the
water up and down with your legs
and feet together or “freestyle kick”
pushing the water up and down
with your legs moving in opposite
directions. Continue either motion while holding your breath. Though initially the
holding of ones breath underwater the entire 25 yards may be challenging,
improvement will come through setting goals to make it farther down the pool than
the lap before or the day before.
Increasing Number of Strokes between Each Breath (3 Strokes 1 Breath; 5 Strokes,
1 Breath; 7 Strokes, 1 Breath)
Once one is able to swim freestyle with their face in the water and becoming
comfortable turning their head to the side to breathe while maintaining strokes, lung
capacity will improvethrough setting goals to take several strokes between each
breath. First start by taking 3 strokes and then breathing continuing the cycle for as
long as desired. Then practice a certain length with only taking a breath every 5
strokes. This cycle can be continued in several varieties. One variety would be to swim
100 yards starting with taking 3 strokes and breathing, 5 strokes and breathing and
proceeding to increase strokes between breaths as they swim 100 yards. By the end
the entire length of the pool is swam without breathing.

22. 21
Muscle Tone and Strength
Swimming engages many muscles in the body providing a “full-body muscle
endurance work-out” (Stevens). Through the use of glutes, legs and feet to kick; backs,
shoulders, arms and hands to pull; as well as the core to rotate; one propels
themselves through the water by nearly using every muscle. Increasing distance and
speed leads to an increase in strength and endurance. Water creates a greater
resistance than the air resulting in a different level of muscle use than when on land.
Over time muscles continue to grow in endurance but strength, including muscle
mass continues through more weight baring exercise, such as weight lifting (Steven).
As further explained, specific equipment and strokes lead to an increase in muscle
mass to a certain limit and ultimately increase muscle endurance.
Equipment
The equipment listed below will work certain muscles causing an increase in muscle
use throughout a workout:
o Limiting the use of muscles such as the arms or legs with the use of a pull
buoy or kick board
o Increase the surface area by using paddles or fins causing the muscles to use
greater strength to pull or kick more water
o Create greater resistance in the water by the use of a parachute

23. 22
Pull Buoy
To better engage the back, shoulders, arms,
hands and other upper body muscles, one
can eliminate the use of their legs by not
kicking. A pull buoy placed between the legs
limit movement of the legs and causes them
to add weight to pull.
A pull buoy also acts as a flotation device to
keep the legs at the surface of the water.
After consecutive laps the arms, shoulders
and back muscles grow in lean body mass.
The legs, hips and core of the body are also engaged as the body rotates from side to
side while swimming either backstroke or freestyle.
Paddles
Paddles are another resource that
assists in increasing lean body mass.
Paddles create more surface area to
the hands leading the muscles to be
even more engaged to pull a greater
amount of water.

24. 23
Kick Board
To engage the glute, hip flexor, legs, feet
and other lower body muscles, one can
limit the use of the arms by kicking with the
arms above the head in a tight streamline,
looking similar to a torpedo, or with the
arms by their side. One could also use a
kick board by holding on to the rounded
convex edge of the kick board, extending
the arms along the top/side of the board.
The kick board allows the body, including
the legs to stay on top of the surface while
kicking.

25. 24
Fins
The use of fins are another way to engage the muscles used
to kick. Just as the paddles, the fins increase the surface
area of the feet, causing more muscle strength to push the
water.
Parachute
Over all strength will improve by increasing the
resistance. Certain equipment such as
stretchbands, parapchute or the wearing or a t
shift or tennis shoes will create resistance causing
there to be greater muscle engagement in order
for an individual work it’s way through the water.
The image to the right shows a parapshute that
would be attached to a rope or band. The band
would then be tied around the waist of the
swimmer. As one swims they are able to increase
their strength as more water is pulled.
Specific Muscle Strengthening
Swimming has the ability to work many different muscles no matter the stroke. Some
of the muscles involved in each of the stokes are listed below (What).
o Core, abdominal and lower back muscles help the body maintain a streamlined
positions while moving across the water.
o Deltoid and shoulder muscles to help the hands have proper entry in the water
and to reach out far.
o Forearm muscles that are worked when pulling in the water.
o Upper back muscles that stabilize the shoulders throughout the swimming
strokes.
o Glutes and hamstring muscles to keep the body in a balanced position and to
aid in propulsion.

26. 25
o Neck muscles to stabilize the head and to aid in rotation or lifting during
breathing.
o Though many of same muscle groups are worked during all the strokes
specific strokes work different muscles as shown in the diagram below. Further
explanation can be seen below.
Diagram above illustrates the specific muscles that are used during each of the strokes
(What).
Freestyle (front crawl)
o The Core (abdominal and obliques) aidin rotating through the water from one
side to the other.
o Hip flexors as well as the glutes power the movement of the legs up and
down.
o The triceps to assist in pulling the water behind the body, propeling the body
forward.

27. 26
Backstroke
o The Core (abdominal and obliques), hip flexors and glutes are used just as with
freestyle. See explanation above.
o Deltoids are engaged through the pull of backstroke.
Butterfly
o Sholders to power arms and hands to pull the water and propel the body
forward
o Lower back to lift the body out of the water to breath and to rotate the arms
back forward
o Glutes to power the body forward with an up and down simultaneous kick.
Breaststroke
o Pectoral and latissimus dorsi to pull/ sweep the water in the opposite direction
of the movement forward.
o Glutes and quadriceps to power kick
Flexibility
While swimming joints are mobilized in a way that maintains mobility and flexibility.
With each stroke the arms and shoulders rotate in a complete circle. While kicking, the
hip joint allows the legs to move up and down in a scissor motion. As the body
rotates from side to side the spine and neck are engaged. Along with the movement
of the joints, the body stretches with each stroke as the body lengthens to grab water
(Michael).
Pregnancy
As swimming provides a beneficial aerobicexercise, studies prove that swimming has
little to no effect on the fetus of a pregnant woman (Lynch). This evidence leads to
encourage pregnant women to participate in swimming as an aerobic exercise,
resulting in better heath for themselves while pregnant. Listed below are some
benefits of swimming while pregnant.

28. 27
o Relieve the stress and weight of the fetus on the mother the buoyancy of the
water.
o Strengthens core muscles, preventing rounding of the spine and shoulders
due to extra weight in the stomach
o Limit overheating that can often occur in other activities
o Decrease the duration of the second stage of labor causing a smoother
delivery as other sources of aerobic exercise would
o Better utilize oxygen
o Supports the joint while in motion
Safety
As with any aerobic exercise, pregnant women should be cautious overexerting
themselves. During most of the pregnancy any stroke will be beneficial. Turing the last
trimester backstroke should be done with caution as it may increase pressure on the
blood vessels in the stomach. Breaststroke will specifically benefit a pregnant woman’s
body as it will strengthen back and chest muscles (Great). It would be important to
make sure to stay hydrated as well.
Orthopedic Injuries
Swimming allows continued endurance exercise even while injured as it is low impact
and provides an active form of stretching, including providing a full range of motion
(Caldas). The use of training equipment can assist in disabling injured joints disabling
the injured joint and putting greater focus on the uninjured parts of the body. The
benefits of swimming on back injuries, sprained ankles, elbow and wrist tendinopathy
are found in this section.
Back Injury
Depending on the severity of a back injury, swimming can
offer relief during an injury. Ultimately while in the water
gravity is lessened, limiting pressure on the back.

29. 28
Unlike being on land, while swimming the body is positioned horizontally. Caution
should be used as the back is still engaged. If injury is severe, simply getting in the
water walking along the bottom of the pool allows movement while limiting pressure
on the back. (Caldas)
Sprained Ankle
Any movement of a sprained ankle should be taken with caution. Specific
investigation by a physician should be done performing an activity. Generally, if
movement of the ankle is not painful and the swelling is gone, swimming can be
performed at low intensity (Is). One option of swimming would be to put a pull buoy
between the legs disabling the use of the legs and ankles to kick. Further drills will be
explained below. The use of a pull buoy is optional.
Sculling: While either on the stomach sweep in and out through the movement of the
wrist and hands, maintaining pressure on the hands and arms. Refer to image below
for further understanding (Gary).
While on the back, extend hands towards your feet with fingers extended. Sweep
hands in and out maintaining pressure on your hands the whole time. Legs can be
drug behind allowing relaxation of the ankle and engagement of other muscles;
including, arms and shoulders. To engage abdominals, position yourself in a V shape
while sculling by your sides.

30. 29
Heads up: Swim with head out of the water on your stomach. Dragging your legs
behind. Swimming with a pull buoy will assist in staying ontop of the water.
Wrist and Elbow Pain
Swimming with a kick board allows the wrist and elbow to relax which the legs power
the stroke. While on the stomach or back hold on to the top of the kick board and
extend arms along the top or edge of the kickboard. Arms can also relax at the side
while on the stomach or back allowing for disengagement of joint.
Work-outs
While it may be easy to jump in a pool, to truly get the most out of being in the water
a proper workout should be performed.
In order to fully enjoy swimming and understand swimming terms, general
information about swimming are listed below:

31. 30
o One length of normal training pool equals 25 yards. Two lengths (swimming
down and back) equals 50 yards.
o The black lines on the bottom of the pool guide swimmer while on their
stomach
o When the black line comes to a T, the wall will be within 2 feet of the top of
the T
o The flags hanging over the pool indicate 5 yards from the wall (assist mainly
while on the back)
o General equipment includes: kickboard, pull buoy, paddles, fins
o Drills include using equipment as well as swimming in a way that emphisizes a
certain technique
As with other aerobic activities, a work out consists of warming up, improving
technique with drills, training to improve endurance/speed/strength and finally cool-
down. Below you will find examples of each of these (adapted from Ruane).

32. 31
Warm-up
o 400-500 swim
o 200 swim, 200 pull, 200 kick, 200 drill, 200 swim
o 3-4 × (150 freestyle, 50 non-freestyle)
o 400 swim, 300 pull, 200 kick, 100 drill
o 10-15 minutes of whatever you would like
Drills
o 4-10 × 75 with 15 sec rest (kick, drill, swim by 25; pull, kick, swim; drill, swim,
drill)
o 3 × (100 pull, 50m swim)
o 2-4 × 150 (25 drill, 50 swim)
Endurance
o Speed
o 3 × (100 swim hard, 50 easy)
o 10 × 100
o 2 (5 × 100 fast decending effort, 100 easy)
o Distance
o 4 × 300 moderate with 20 sec rest
o 6 × 200 (Odds: good technique, even: moderate)
o Technique/ Strength
o 4 × (100 pull, 50 one-arm drill, 250 pull)
o 3 × (4 × 50 pull with :10 sec rest, 200 pull with :15 sec rest)
o 2 (4 × 100 with : 15 sec rest, breathing every 3/4/5/6 by 25)
Cool Down
o 4 × 50 easy
o 100-300 easy
o 10 minutes easy swimming of choice

33. 32
Elderly
Strength Training
Building and Retaining Muscle
Muscle weakness in old age is associated with physical function decline. One of the
challenges elderly individuals face is loss of strength in muscles associated with life
changes and aging. At the age of 30 the body begins the struggle to maintain muscle
mass and density like prior to age 30. Elderly individuals are often faced with basic
situations that become increasingly difficult. Most therapist work with these
individuals to gain the strength needed to complete basic tasks such as: sitting to
standing, getting into and out of bed, navigating around the house, use of stairs and
lifting moderate objects.
“Evidence from 121 randomized controlledtrials (6,700
participants) shows that older people who exercise their
muscles against a force or resistance become stronger.
They also improve their performance of simple activities
such as walking, climbing steps, or standing up from a
chair more quickly. The improvement in activities such as
getting out of a chair or stair climbing is generally greater
than walking speed. Moreover, these strength training
exercises also improved older people's physical abilities,
including more complex daily activities such as bathing or
preparing a meal. Progressive Resistance Training also
reduced pain in people with osteoarthritis.” (Liu)

34. 33
Research has shown positive benefits of strength training among the elderly and has
led to more interest in the field of strength training, specifically with aquatic exercise.
Diverse information exists that attributes strength growth in certain groups to aquatic
exercise however; there is also much evidence to conclude that aquatic exercise alone
will not affect strength of elderly. After considering several sources, land based and
water based exercise may be the best complimenting combination for the elderly.
“In summary, both warm-water and land-basedactivities…
were beneficial in maintaining strength and in improving
lower-body flexibility. Between protocols, the aquatic
exercise appeared a better activity to increase dynamic
balance and promote weight loss”. (Bergamin)
Aquatic Strength Building Program Example
Warm up- 5/10 minutes of walking in chest deep water for resistance. Add to this by
walking backwards or shuffling side to side for 5-10 minutes for a proper warm up to
activity.
 Squatting- Hamstrings, quadriceps, gluteus, range of motion,
core strength
Repetitions of a squatting motion
while holding the edge of the
pool or hand railing. Feet
shoulder width apart, knees over
toes, butt out, back strait, knees
bent to angle depending upon
ability of the person.

35. 34
 Heel Raises-Gastroc, Soleus (muscles of the calf)
Standing chest deep in the pool,
keeping the knees strait, lift up
onto the toes and then slowly
return to the floor of the pool.
Repetitions of this motion while
holding the edge or railing of the
pool. To add more resistance
move to a more shallow end of
the pool.
 Lunges- Hamstrings, quadriceps,
gluteus, balance and core strength
Need to be done in a
shallow pool. Bringing
one foot forward at a time
into a kneeling position
then pushing off with the
forward foot to return to
the original position.
Weight of the body
should be over center
mass.

36. 35
 Abduction/Adduction- IT Band, Hip abductors
Standing next to the edge of the
pool for stability shift weight onto
one foot and bring the opposite
foot out creating space between
the feet. (similar to a scissor
motion) Then return to foot to
normal position and repeat for
repetitions.
 Bicycle Kicks- Knee ROM (range of motion) quadriceps,
hamstrings
In a corner of the pool hold onto
the edges leaning into the corner.
Bring legs close to the surface
and make a peddling motion as if
on a bicycle. Continue for a length
of time to increase endurance and
to promote fluid motion of the
knee joint.
 Standing Pushup- Pectorals, biceps, triceps
Difficulty depends on the depth
of the pool. Stand about arm’s
length away from the pool edge
or safety railing. Grasp the railing
firmly and lower yourself into a
pushup position against the wall
then push back to original
standing position.

37. 36
 Sitting/Standing Fly- Pectorals, biceps, triceps, deltoid
Preferably while sitting on a pool
bench or steps, but can also be
done standing. Bring arms
perpendicular with the body
outstretched in a “T” shape. Bring
hands together as if you were
clapping them together
underwater while not bending the
elbows. This can be performed as
fast or as slow as needed for the
individual.
 Rotational Wake- Core, Trunk stability
While sitting or standing like
previously. Bring arms into the
clapping position in front without
bending the elbows. Keep hands
together by interlocking the
fingers. As the hands are
stretched in front then perform a
trunk twisting motion moving all
the way to the left and then
coming around to the right. Keep
this at good pace so as to use the
wake left by the rotations as
strength building.
*Plans used or know of from Physical and Sports Therapy Services.
Brad Mangum PT, Darren Averett PT.

38. 37
Aerobic Training
Increased popularity in water related activities has spawned research and application
in many medical fields. What has been found is still being studied, however the results
apply to a wide range of health conditions. People who struggle with arthritis, joint
pain with movement, osteoarthritis, soft tissue injures, obesity, and even self-esteem
during exercise.
The Texas A&M Research Laboratory specifically has stated that obese and
overweight individuals will benefit from aerobicwater training while losing weight.
400-500 calories per hour can be lost according to the Aquatic Exercise Association.
Reports that Aerobic water training increases vasodilation in warm water to target
injured tissues with oxygen, nutrients and remove cell waste through the increased
blood flow. Increased bloodflow has also been in part to the equalized pressure
places on all the chambers of the heart while in the water. In short, lowering blood
pressure and lowering heart rate, especially in elderly and the obese are outcomes of
the application of aerobic water training. (Benefits of Exercising in Water)

39. 38
“The method is used for purposes of preventing injury and
promoting recovery from strenuous exercise and as a form of
supplementary training for cardiovascular fitness. Both stroke
volume and cardiac output increase during water immersion: an
increase in blood volume largely offsets the cardiac decelerating
reflex at rest. At submaximal exercise intensities, bloodlactate
responses to exercise during deep-water running are elevated in
comparison to treadmill running at a given oxygen uptake (VO2).”
“While VO2, minute ventilation and heart rate are decreased under
maximal exercise conditions in the water, deep-waterrunning
nevertheless can be justified as providing an adequate stimulus for
cardiovascular training.” (Reilly)
In specific groups aerobic water exercise is showing very effective with vast benefits.
Therefore, as individuals look to integrate aerobic water exercise into a fitness plan
they should understand if research has shown benefits of application in their specific
circumstance. Generally, after searching research, aerobic water exercise will highly
benefit elderly, women, obese, and those in chronic joint pain. Even some men have
found success in application of water aerobics.

40. 39
“After the intervention the heart rate at rest was 8% lower. Their
heart rate at submaximal exercise was 3%, their maximal oxygen
uptake was raised by 10%, and their maximal ventilation was
increased 14%. In conclusion, high intensity deep water running
with vest improves submaximal work capacity, maximal aerobic
power, and maximal ventilation with the effects transferable to
land-based activities in elderly women.” (Broman)
“Exercise lowered systolic blood pressure and
mean arterial pressure by 11.71 and 5.90 mm Hg
respectively. A 10-week course
of water aerobic exercise markedly reduced the
systolic and mean arterial blood pressure of
patients with essential hypertension and is
especially recommended for the obese and the
elderly who have orthopedic problems or
bronchospasm.” (Farahani)
These numbers show just a small portion of the findings when water aerobic exercise
were added to a specific group with specific health conditions. These results will not
be universal, however, findings show that an individual may be confident that
application of such exercise may benefit hear rate, blood pressure, hypertension,
ventilation and other key health measurements.
Aquatic water therapy/exerciseis cutting edge in many areas including hypertension.
As you apply what you read here keep in mind that the research is showing wide
positive effects, even in mental health as well as physical health. Very few adverse
effects of water aerobic exercise have been reported. Some groups will find minimal
help from this activity and other will find great success, therefore trial of this is
encouraged by many researchers and health care providers especially in specific,
proven use situations.

41. 40
”32 were randomized; none were lost to follow-up. Office BPs
decreased significantly after heated water exercise (36/12
mmHg). Decreased 24-hour systolic (from 137±23 to 120±12
mmHg) and diastolic BPs (from 81±13 to 72±10 mmHg);
daytime systolic (from 141±24 to 120±13 mmHg) and diastolic
BPs (from 84±14 to 73±11 mmHg); and nighttime systolic (from
129±22 to 114±12 mmHg) and diastolicBPs (from 74±11 to
66±10 mmHg). The control group after 12 weeks significantly
increased in 24-hour systolic and diastolic BPs, and daytime and
nighttime diastolic BPs. HEx reduced officeBPs and 24-hour
ABPM levels in resistant hypertensive patients. These effects
suggest that HEx may be a potential new therapeutic approach
in these patients.” (Guimaraes)

42. 41
Water Aerobic Exercise Examples-
Aerobic exercise is done to raise the heart rate and keep it there for a certain amount
of time. Similar to what running or circuit training would do on land. Therefore, you
can be creative with what you do in the water and as long as you are moving at a
consistent pace with few rest intervals you will mimic these land based activities.
1. Zumba-
Aerobic fitness program normally land based showing movements inspired by styles
of Latin American dace and usually uses culturally similar dance music. This is a high
tempo, high energy activity done
in the water for aerobic exercise.
Time of exercise depends upon
those participating.
https://www.zumba.com/ will be
a key resource as you personalize
a plan for those participating.
2. Kickboxing-
A martial art that combines boxing and karate. Series or kicks, punches and moves as
if training for combat. Coupled with water resistance and continual movement,
Kickboxing can serve as aerobic fitness

43. 42
3. Tai Chi-
Adapted from the Chinese martial
art, this is a stylized, meditative
exercise. Emphasized, slow
methodical movements and
positions of body and balance to
strengthen and test movements.
Done continuously results in aerobic
fitness
4. Yoga-
Originally of Hindu Philosophy and hugely popular in American culture, this new age
fitness technique combines stretching, strength building, balance and movements
that will stimulate aerobic fitness.
5. Circuit Training-
Highly effective allowing
individuals to personalize the
aerobic activity with whatever
fitness actions they want. Series of
activities done quickly without rest,
one after another for a certain
amount of time. Any strength-
building plan can be turned into a
circuit by eliminating rest intervals.
As you are choosing which will apply best to the people you work with remember that
you will need to research and become familiar with these activities in order to teach
them or instruct them. The local YMCA, various Gyms (Vasa, Gold’s, Planet Fitness)
provide daily instruction for these activities as well as private instructors who can be
hired.

44. 43
Rehabilitation of Injury
A constant battle of the elderly is rehabilitation of injury due to a fall, surgery or some
other form of accident. This can be an unbearable task to those who are suffering
from chronic pain or various conditions. Just as discussed in the strength building
section, aquatic exercise can be highly beneficial
when used with normal weight bearing, land based
exercises. Along with injury comes problems with
balance.
Aquatic exercise will provide a safe environment for
those who are struggling with balance who are
rehabilitating injuries. In water, there is no fear of
falling. Therefore, the individual will be more
confident doing activities that will help them with balance. In addition, heated pools
also provide a less stressful environment on joints. The warm water also has a
warming effect upon synovial fluid in the joints easing joint pain. The water buoyancy
eases the weight on joints and will cause positive effects on those already suffering
from joint pain. Opinions differ greatly on this subject with studies finding both
significant differences and no differences at all on different areas of the body.
Specifically in total knee replacement,
(TKA), a wide range of results can be
seen. Land based rehabilitation has
solely been the standard of
rehabilitation for many years. As
researches have worked with aquatic
therapy, they have found that in
long-term success aquatic therapy
matches and even in some studies
exceeds the results found in land-based rehabilitation. One of the advantages of
water is that water eases weight-bearing surfaces, reducing pain or susceptibility to
injury.

45. 44
“Eleven patients reported adverse events (i.e. discomfort) in land-
based exercise, while only 3 reported adverse events in the aquatic
exercise. Only land-based exercise showed some improvement in
pain and muscle strength compared with the control group, while
no clinical benefits were detectableafter aquatic exercise
compared with the control group. However, aquatic exercise has
significantly less adverse effects comparedwith a land-based
program.” (Lund)
Even when no statistical benefit or “difference” is shown, fewer adverse effects tend to
happen statistically in aquatic based therapy than with traditional land based therapy.
“Compared with the change in the control group, habitual walking
speed increased by 9% and stair ascending time decreased by 15%
in the aquatic training group. The training increased knee extensor
power by 32% in the operated and 10% in the nonoperated leg,
and knee flexor power by 48% in the operated and 8% in the
nonoperated leg comparedwith controls. The mean increase in
thigh muscle CSA of the operated leg was 3% and that of the
nonoperated leg 2% after training compared with controls.
Progressive aquatic resistance training had favorable effects on
mobility limitation by increasing walking speed and decreasing
stair-ascending time. In addition, training increased lower limb
muscle power and muscle CSA. Resistance training in water is a
feasible mode of rehabilitation that has wide-ranging positive
effects on patients after knee replacement surgery” (Valtonen).

46. 45
Here positive results were found, naming aquatic therapy as a “feasiblemode of
rehabilitation” in total kneed replacements. In many of these trials the authors urge
for more trials and research to be conducted so as to know for certainty the outcomes
of aquatic therapy not only for knee injuries. These differences in research are seen in
tests with knees, ankles, and lower back. Not as much is see with upper extremity due
to the need for water depth above the head (Shoulder).

47. 46
“After the 12-month follow-up, the 12-week
aquatic training-induced benefits in knee
extensor and flexor power were maintained,
whereas the mobility benefits had
disappeared. Aquatic resistance training
should be continued at least on some level
to maintain the training-induced benefits in
mobility. Aquatic resistance training-
induced benefits in knee extensor and
flexor power were maintained at 12-month
follow-up in persons with knee
replacement. However, 12 months seemed
to be too long a period for the gains
achieved in mobility to be maintained by
regular physical activity alone.” (Valtonen)
Initially, AT(aquatic therapy) outperformed
the control group up to the 12 month mark then became too difficult to maintain,
therefore leveling with the CON (control group).

48. 47
“A short-term, clinically pragmaticproblem of ether land-basedor water-based
rehabilitation deliveredin the early phase after TKR(kneed replacement) was
associated with comparable ourcomes at the end of the program and up to 26 weeks
postsurgery. No between-group differences were evident at baseline, except for a
higher frequency of heart disease in the land-based group.” (Harmer)
In the graphs shown here as well as in the original research there is very little
statistical differencebetween land based and water basedtreatment groups. Numbers
were even similar in infection rates, manipulation rates and even death.
An open mind should be kept as contemplation of aquatic therapy is considered.
Along with specific positive results to the general field of aquatic therapy, specialized
conditions also seem to be affected by aquatic therapy. From current research, more
results are being found when applied to a more specific group of individuals. This may
be interpreted as aquatic therapy being more applicable to “less common” patients,
however much more research is needed to verify. This is just the trend.

49. 48
“To decrease the risk of falling by improving physical function in
DLSS patients, aquatic walking and jogging program was executed
in our study. Water supplied safe environment to the patients
having ambulation problem and permitted them upright exercise.
As a result, 12 week aquatic exercise showed positive effects such
as increases of balance, muscle function, ankle ROM and fall
efficacy in elderly DLSS patients. We found significant increases in
balance, muscle function, ankle ROM and fall efficacy after training
intervention. In conclusion, aquatic exercise seems to affect
physical function and fall efficacy positively in elderly DLSS
patients. ” (Lee)
Rehabilitation of injury are to be overseen and conducted by certified individuals. Ask about
aquatic exercise and see if it applies to your circumstance. Always seek professional guidance
when rehabilitating past injuries.
**See (Fisken et al., 2015; Kim and O’Sullivan, 2013; Sato et al., 2011) as excellent sources in
the bibliography for further study.

50. 49
References
ACS Distance Education. (n.d.). acsedu.com. Retrieved October 22, 2015, from
ACS Distance Education website: http://www.acsedu.com/info/fitness-
news/fitness-industry/swimming.aspx
Bergamin, M., Ermolao, A., Tolomio, S., Berton, L., Sergi, G., & Zaccaria, M.
(2013). Water- versus land-based exercise in elderly subjects: effects on
physical performance and body composition. Clinical Interventions in
Aging, 8, 1109-1117. http://doi.or
Benefits of exercising in water. (n.d.). Retrieved November 29, 2015, from
Hydroco.com website: http://hydroco.com/hydroco-benefits-of-
water.html
Broman, G., Quintana, M., Lindberg, T., Jonsson, E., & Kaijser, L. (2006). High
intensity deep water training can improve aerobic power in elderly
women. European Journal of Applied Physiology,98(2), 117-123.
Calds, H. (n.d.). Rehab Your Back Injury with Swimming, Not Surgery. Retrieved
October 22, 2015, from BreakingMuscle.com website:
http://breakingmuscle.com/swimming/ rehab-your-back-injury-with-
swimming-not-surgery
Etzler, L. (2013, October 13). Mental and Physical Benefits of Swimming.
Retrieved October 22, 2015, from livestrong.com website:
http://www.livestrong.com/article/477375-mental-physical-benefits-of-
swimming/#page=1
Evans, J. (n.d.). Why choose swimming? Retrieved December 1, 2015, from
http://www.humankinetics.com/excerpts/excerpts/why-choose-
swimming
Farahani, A. V., Mansournia, M. A., Asheri, H., Fotouhi, A., Yunesian, M., Jamali,
M., & Ziaeev, V. (2010). The effects of a 10-week water aerobic exercise
on the resting blood pressure in patients with essential hypertension.
Asian J Sports Medicine, 1(3), 159-167.

51. 50
Fisken AL, Waters DL, Hing WA, Steele M, Keogh JW. (2015). Comparative
effects of 2 aqua exercise programs on physical function, balance, and
perceived quality of life in older adults with osteoarthritis. J Geriatr
Phys Ther, (38),17–27.
Great pregnancy exercise: Swimming | BabyCenter. (n.d.). Retrieved November
16, 2015, from http://www.babycenter.com/0_great-pregnancy-
exercise-swimming_7822.bc
Guimaraes, G. V., Dorea, E. L., Bocchi, E. A., De Barros, C. L.G., & Fernandes-Silva,
M. M. (2014). Heated water-based exercise training reduces 24-hour
ambulatory blood pressure levels in resistant hypertensive patients: a
randomized controlled trial (HEx trial). Int J Cardiol,172(2), 434-441.
Harmer AR, Naylor JM, Crosbie J, Russell T. (2009) Land-based versus water-
based rehabilitation following total knee replacement: a randomized,
single-blind trial. Arthritis Rheum, 61(2):184–91.
How is swimming beneficial for pregnant women? (n.d.). Retrieved November
16, 2015, from https://www.myactivesg.com/sports/swimming/how-to-
play/did-you-know/swimming-beneficial-for-pregnant-women
Is it OK to Go Swimming with a Sprained Ankle? (2013, August 16). Retrieved
November 25, 2015, from http://www.livestrong.com/article/391057-is-
it-ok-to-go-swimming-with-a-sprained-ankle/
Kim SB, O’sullivan DM. (2013). Effects of Aqua Aerobic Therapy Exercise for
Older Adults on Muscular Strength, Agility and Balance to Prevent
Falling during Gait. J Phys Ther Sci, (25), 923–927.
Lee, J. H., & Sung, E. (2015). The effects of aquatic walking and jogging
program on physical function and fall efficacy in patients with
degenerative lumbar spinal stenosis. J Exerc Rehabil, 11(5), 272-275.
Letieri, R. V., Furtado, G. E., Letieri, M., Goes, S. M., Pinheiro, C. J., Veronez, S. Q.
Dantas, E. M. (2013). Pain, quality of life, self-perception of health and
depression in patients with fibromyalgia, submitted to hydro
kinesiotherapy. Revista Brazileria De Reumatologia, 53(6), 494-500.
http://www.ncbi.nlm.nih.gov/pubmed/24477728

52. 51
Liu CJ, Latham NK. (2009) Progressive resistance strength training for
improving physical function in older adults. Cochrane Database of
Systematic Reviews, Issue 3. Art. No.: CD002759. DOI:
10.1002/14651858.CD002759.pub2.
Lund, H., Weile, U., Christensen, R., Rostock, B., Downey, A., Bartels, E. M., . . .
Biddal, H. (2008). A randomized controlled trial of aquatic and land
based exercise in patients with knee osteoarthritis. Journal of
Rehabilitation Medicine, 40(2), 137-144
Lynch, A. M., McDonald, S., Evans, E. F., Choy, P. L., Dawson, B., Blanksby, B. A.,
& Newnham, J. P. (2003). Effectiveness and safety of a structured
swimming program in previously sedentary women during pregnancy.
The Journal of Maternal-Fetal & Neonatal Medicine, 14(3), 163-169.
http://www.tandfonline.com/doi/abs/10.1080/jmf.14.3.163.169#.VihdL_
mrTIU
Michael, F. (2011, May 16). 10 Health Benefits of Swimming. Retrieved
December 1, 2015, from
http://health.howstuffworks.com/wellness/aging/retirement/10-health-
benefits-of-swimming.htm#page=3
Pan, C. Y. (2010). Effects of water exercise swimming program on aquatic skills
and social behaviors in children with autism spectrum disorders.
National Kaohsiung Normal University, 14(1), 9-28.
http://www.ncbi.nlm.nih.gov/pubmed/20124502
Pozzi, F., Snyder-Mackler, L., & Zeni, J. (2013). PHYSICAL EXERCISE AFTER KNEE
ARTHROPLASTY: A SYSTEMATIC REVIEW OF CONTROLLED TRIALS. Eur
J Phys Rehabil Med, 49(6), 877-892.
Reilly, T., Dowzer, C. N., & Cable, N. T. (2003). The physiology of deep-water
running. J Sports Sci, (12), 959-972.
Ruane, A. (n.d.). A Beginner's Guide to Structuring Your Swim Workout.
Retrieved December 2, 2015, from
http://breakingmuscle.com/swimming/a-beginner-s-guide-to-
structuring-your-swim-workout

53. 52
Sato D, Kaneda K, Wakabayashi H, Shimoyama Y, Baba Y, Nomura T. (2011),
Comparison of once and twice weekly water exercise on various bodily
functions in community-dwelling frail elderly requiring nursing
care. Arch Gerontol Geriatr, (52) 331–335.
Singleton, B. (2014, August 14). Swimming as a Therapeutic Exercise. Retrieved
October 22, 2015, from livestrong.com website:
http://www.livestrong.com/article/ 421711-swimming-as-a-
therapeutic-exercise/#page=2
Steven, E. (n.d.). The Case for Swimming. Retrieved November 24, 2015, from
http://breakingmuscle.com/swimming/the-case-for-swimming
Swimming May Be the Best Method of Recovery for All Athletes. (n.d.).
Retrieved December 1, 2015, from
http://breakingmuscle.com/swimming/swimming-may-be-the-best-
method-of-recovery-for-all-athletes
Tovin, B., Wolf, S., Greenfield, B., Crouse, J., & Woodfin, B. (1994). Comparison
of the effects of exercise in water and on land on the rehabilitation of
patients with intra-articular anterior cruciate ligament reconstructions.
Journal American Physical Therapy Association, (74), 710-719.
Retrieved from http://ptjournal .apta.org/content/74/8/710.long
Valtonen A, Pöyhönen T, Sipilä S, Heinonen A.(2011) Maintenance of aquatic
training-induced benefits on mobility and lower-extremity muscles
among persons with unilateral knee replacement. Arch Phys Med
Rehabil, 92(12): 944–50.
Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. (2010) Effects of aquatic
resistance training on mobility limitation and lower-limb impairments
after knee replacement. Arch Phys Med Rehabil, 91(6):833–900.
What muscle groups do swimming develop? (2014). Retrieved November 24,
2015, from https://www.myactivesg.com/sports/swimming/how-to-
play/did-you-know/what-muscle-groups-do-swimming-develop