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Heart Warming: Aquatic Cardiac Therapy

Updated: Jan 16

Turns out a heated pool is great place for cardio therapy and rehab. Is your facility right for this growing population?


Byline: Andrea Salzman, MS, PT For generations, swimming has been the exercise recommendation of choice for some respiratory conditions, like cystic fibrosis.


But strangely, during the same time period, very few investigators examined the benefits of any vertical aquatic exercise for the cardiac or respiratory patient.


In fact, many patients with congestive heart failure, circulatory insufficiencies, or respiratory disease often were warned vehemently against exercising in the pool.


Over the past 20 years, however, it has been shown repeatedly that vertical aquatic exercise does not offer the same risks to the cardiopulmonary compromised patient as swimming does. In effect, the pool just became vogue for this growing population.


Continue reading below.


The concept of vertical exercise in the pool (originally called hydro-gymnastics) gained accelerated exposure in the early 1900s. By the 1950s and 1960s, the age of space exploration did much to stimulate research into the effects of “reduced gravity environments” on breathing and circulation. But it wasn’t until the 1990s that a new organization, the Aquatic Exercise Association, and the Aquatic Section of the American Physical Therapy Association, brought the same popularity to vertical aquatic exercise as horizontal swimming had enjoyed.


To provide efficient cardiopulmonary training in your pool, you will need water temperature no greater than — and preferably less than — 93 degrees Fahrenheit.


Most therapy pools hold their temperatures between 90 and 94 degrees. However, because cardiopulmonary training can elevate the body’s core temperature, cooler waters will allow for more intensive training.


Reading Original Article Here or keep reading below.

Love learning? Attend webinar 50 Novel Aquatic Therapy Ideas and get CEUs while you learn!


Traditional swimming pools, with temperatures near 80 degrees, can be used for very vigorous aerobic training. Otherwise, pools ranging between 85 and 90 degrees make excellent sites for cardiopulmonary workouts. Humidity levels exceeding 50 percent will make it more difficult for patients to disperse heat during workouts.


A pool with a sloping bottom running between 3-feet and 4-feet deep will work just fine, unless deep-water work is desired. Cardiopulmonary training can be performed in almost any position — or depth — in the pool. There is no single exercise that defines this kind of training.


Some of the more popular training methods include:

1 Breath-control while swimming beneath the surface. This should be done only with careful supervision.


2 Forceful exhalation of air through tubing or large straws into progressively deeper water.


3 Propulsion of an object across the pool’s surface using sustained breaths. The object can be as low-tech as a ping pong ball or as elaborate as an Egg-Flip, a toy that flips on its axis when bombarded with air.


4 Circuit training, consisting of brief bursts of strength-training “stations” interspersed with aerobic exercise.


5 Calisthenics performed in waist- or chest-deep water.


6 Water walking in waist- or chest-deep water.


7 “Charging the hill,” in which participants stride from chest-deep water to thigh-deep water and back again.


8 Deep-water running using a noodle or buoyancy belt.


9 Lap swimming, recommended for the skilled swimmer only.


At a minimum, your facility will need to stock water noodles, flotation belts and resistive equipment such as barbells, paddles or gloves. Well-equipped pools also stock tubing, straws, Egg-Flips or ping-pong balls, dive toys and heart rate monitors.


Few commercial seminars are available today to address only cardiopulmonary training; however, many aquatic therapy seminars include cardiac training as part of the package.

Fortunately, there are hundreds of training DVDs that explore aerobic exercise in the pool. Many of these exercises can be extrapolated for use in your pool by a competent therapist.


Love learning? Attend webinar 50 Novel Aquatic Therapy Ideas and get CEUs while you learn!


Some helpful references:

Jug, B., Vasić, D., Novaković, M., Avbelj, V., Rupert, L., & Kšela, J. (2022). The effect of aquatic exercise training on heart rate variability in patients with coronary artery disease. Journal of Cardiovascular Development and Disease, 9(8), 251.


Cugusi, L., Manca, A., Bassareo, P. P., Crisafulli, A., Deriu, F., & Mercuro, G. (2020). Supervised aquatic-based exercise for men with coronary artery disease: a meta-analysis of randomised controlled trials. European Journal of Preventive Cardiology, 27(19), 2387-2392.


Monoli, C., Tuhtan, J. A., Piccinini, L., & Galli, M. (2023). Wearable technologies for monitoring aquatic exercises: A systematic review. Clinical Rehabilitation, 37(6), 791-807.


Benzo-Iglesias, M. J., Rocamora-Pérez, P., Valverde-Martínez, M. Á., García-Luengo, A. V., & López-Liria, R. (2023). Effectiveness of Water-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis. Sensors, 23(20), 8557.

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