People of all ages, both healthy and injured are coming to the water for its refreshing properties and the low-impact exercise benefits. These people have heard of the many healing and rehabilitative properties of water. Working and playing too hard may have taken its toll on their bodies and training on land may not be a feasible option for some of these individuals.
Everyone knows that exercise is the key to good health and wellbeing yet water exercise is largely misunderstood when compared to land exercise. Understanding the properties of water for effective program design is paramount for achieving benefits with water exercise.
Water exercise may offer a modality that is safe yet effectivefor improving quality of life on land. These health gains are made in a buoyant yet resistive environment where gravity-based impact may be controlled, range of motion is enhanced and the danger of falling and injury is minimized.
The properties of water facilitate a protective environment thusproviding optimum healing and decreasing potential strain on the body. Water exercise is especially beneficial because overall body training and stabilization is aided by the natural resistance of the water.
Water training is an excellent exercise modality especially for those with injuries and movement disorders. If the body is injured and the person is new to water training, shallow water training will be the easiest modality for achieving balance and control. However, if the lower body is injured, deep water training may be the best choice; the vertical stress and impact on the lower body can be assuaged by exercise in deep water. The properties of water that help to heal and facilitate exercise among injured or frail individuals are as follows:
Buoyancy: is defined as the upward thrust exerted by water on a body that is completely or partially immersed. Water acts as a cushion for your weight-bearing joints, thus preventing injury, strain, and re-injury that may be common to land exercise programs. In water, loading or weight bearing of joints may range from zero to 50% depending on a person’s water depth or working and body position.
Hydrostatic pressure: water provides a compression of 14 lbs. per square inch on emerged objects (ref. Robert Foster, Director of Robert Foster Physical Therapy and Water Rehab. Center). This hydrostatic pressure acts like an A.C.E. bandage compressing capillaries and assisting venous flow return, thus decreasing swelling and water retention. This compression provides natural relief to sites of injury by decreasing pain and providing added support.
Analgesia: water provides pain relief; it acts like ice to provide a counter-irritant, i.e., a surface stimulus to override pain on a site of injury. This in turn acts as a painkiller raising the threshold of the nerves that signal pain resulting in a decrease in pain sensation. Simply stated: water helps de-sensitize us from pain. Having said this, exercise programming should be conservative until an individual has recuperated from injury/pain. When water alleviates pain, individuals may be tempted to push themselves and expand their exercise routine but informed trainers know to progress routines gradually and safely and to re-assess the condition of their clients frequently after each program or session.
Resistance: in the water is, in effect, a natural 3-dimensional weight training machine that is instantly adjustable, i.e. the harder an athlete pushes and pulls, the more resistance will be achieved. Water- specific equipment may exponentially increase the surface area and drag to add intensity and load to any movement. Buoyancy equipment may add complexity to the exercise because a joint may easily go beyond normal range of motion with speed or lack of control.
Loading the Joints: in shallow water exercises, i.e. when an individual’s feet are touching the pool floor, results in loading the joint or weight bearing so that there may be up to 50% gravity or vertical stress on the 
joints. Rebounding and lower body squats for strengthening are important exercises to be programmed in this water depth. Often, in deep water, the quadriceps muscles may be difficult to effectively work or load without advanced drag equipment such as fins, cuffs or resistive kickers (or even shoes). Everyone needs to strengthen the lower body to move the body for functional independent life on land. An athlete may gradually load the joints by starting in deep water, then going to neck depth (10% of body weight), then to chest (25% of body weight) and finally working at waist depth (50% of body weight) prior to returning to their land activity or sport.
Unloading the Joints: or working in a suspended body position will result in unloading the joint or non-weight bearing of the joint so there is minimal gravity or vertical stress on the joints. There is 
still an opportunity for muscular function, strength and balance; and an individual will require core strength for balance and to optimally support their movements. Therefore, without bottom contact, the client will require more skills and individual attention to maintain correct body alignment and quality technique. Using the appropriate buoyancy equipment to balance their body posture may make or break their results. Buoyancy belts, noodles, cuffs or dumbbells must balance the person’s body compositions so that the head may stay above the water with the shoulders as much submerged and protected as possible. The body should be able to hang vertically without falling forward, backwards or sideways due to an imbalance of their body composition. Generally men have more chest buoyancy whereas women have more hip body fat and therefore tend to tilt forward. A buoyancy belt that has too much lumbar support may easily tilt a very buoyant lady forward and negate any postural benefits that the water may offer. It is important for trainers to be aware of not only the most effective programming for water fitness, but also the most effective equipment to maximize their clients’ benefits from water exercise.
Water programs, whether they are one-on-one or group exercise may provide simple, personal, health-enhancing movement that produces positive results in a very time-efficient manner. Always get in the water and try your exercise design prior to programming any new exercise or piece of equipment. Just mimicking the movement on land may yield a very different result and benefit from performing the proper techniques in the water. Let’s expand our programs so that more individuals can experience the health and movement benefits of quality water fitness programming!
