Aquatic Therapy

August 18, 2009 Written by JP    [Font too small?]

When we think of a serious work out our minds often conjure up images of lifting heavy weights, running long distances or employing advanced technologies such as elliptical trainers. Frequently, swimming and aquatic therapies are not regarded as highly as the previously mentioned exercises. But fortunately, science doesn’t care much about popular perception. In the past few years, a good deal of study has investigated the merits of water based exercises. The results may have far reaching implications for the modern management of a number of health conditions.

First, a look at some of the general benefits exhibited by aquatic exercise training (AE). A new study published in the European Journal of Applied Physiology examined the effects of a 24 week AE program. 46 postmenopausal women were split into three groups: 1) those engaging in aquatic exercises; 2) a set that utilized land-based “elastic bands” (resistance training) and; 3) a “control” group that did not engage in additional exercise. Measures of physical performance and blood chemistry panels were taken pre and post trial. (1)

  • The women participating in aquatic exercises lost more body fat (14.56% vs. 11.97%).
  • Fat-free mass (muscle) was preferentially gained in the AE group (2.88% vs. 1.22%)
  • Various measures of physical fitness were superior in the AE women – abdominal crunch, push up and squat performance
  • Diastolic blood pressure values also dropped to a greater extent in those performing the pool training (8.03% vs. 5.88%)

Another recently released trial found excellent results in a population that is often restricted in their exercise capability. A two year study in “frail elderly” patients found that a twice weekly water exercise program could improve strength and enhance physical function in this at-risk group. Each exercise session consisted of a 10 minute warm up and a 50 minute aquatic therapy session. (2)

There are several key areas in the healing arts where aquatic physiotherapy may be most useful. Here’s a brief review of some of the most encouraging scientific findings:

  1. Cardiovascular Disease – An interesting discovery was recently noted in a trial conducted on 48 patients with coronary artery disease (CAD). Researchers found that water based exercises increased nitrate levels, in the CAD patients’ blood, to a much greater extent than gymnastic exercises. Both types of exercise improved “cardiorespiratory capacity”, but the added rise in nitrate levels may be helpful in improving artery function in those with CAD. Other research has demonstrated comparable effects of water vs. land exercise on physical measures (body composition, endurance and strength) and lipid levels (cholesterol and triglycerides). Finally, aquatic therapy appears to be well suited for those recovering from strokes. Some of the benefits include greater balance, coordination, muscle strength and walking ability. (3,4,5,6)
  2. Fibromyalgia and Other Pain Disorders – A recent 16 week study on 60 middle-aged women with fibromyalgia (FM) determined that three times weekly aquatic therapy could dramatically improve “most of the symptoms of FM”. Other trials have found similar results during the last several years. Osteoarthritis and low back pain sufferers may be good candidates for this variety of exercise as well. Not only can aquatic therapy bring about quick improvements in symptoms, but it also doesn’t seem to worsen degenerative joint conditions. This is a concern that is often leveled against many higher impact forms of physical activity. (7,8,9,10,11,12,13)
  3. Respiratory Impairment – A new study presented in the June issue of the Primary Care Respiratory Journal presents a somewhat controversial conclusion. Swimming pool based exercises may actually benefit those with COPD (chronic obstructive pulmonary disease). 18 participants with “mild to moderate COPD” took part in a 6 week aquatic exercise program. The average age of the COPD patients was 69 years old. At the end of the trial notable improvements were detected in breathing ability (dyspnea) and walking distance. Overall, most of the volunteers subjectively viewed the exercise routine in a favorable light. Self reported emotional ratings and fatigue scores demonstrated a positive trend. (14)
Reduction in Pain Scores in Fibromyalgia Patients
Source: Arthritis Rheum Vol.55, 1 Pages: 57-65  Feb 2006 (link)

Research on water exercise and COPD is controversial because of the chemicals typically used to disinfect public swimming pools. In particular, chlorine exposure has been associated with irritation and potential damage to lung tissue. This is most often pointed out in medical reviews and studies relating to the effects of swimming pool activity and allergy/asthma incidence. This concern has led certain holistically inclined physicians, such as Dr. Andrew Weil, to recommend limiting exposure to chlorinated pools. (15,16,17,18)

In addition to the chlorine issue, there is yet another alarm set off by such pools. A by-product of chlorine, known as trihalomethane, is commonly found in chemically treated water. It’s formed when chlorine and other chemicals come into contact with organic matter such as dirt, leaves, pollen and skin tissue. The danger here is mostly related to a proposed increase in risk of cancer as a result of repeated, long-term exposure. (19,20,21)

Dr. Weil makes several practical suggestions that I’d like to pass along: 1) if you have your own pool, use natural alternatives to chlorine based disinfectants such as silver/copper ion generators; 2) if you frequent a private or public pool, request that they switch to a less toxic pool disinfectant; 3) try swimming only in outdoor pools as the chlorine gas may be less concentrated; 4) wear goggles to protect your eyes from damage/irritation; 5) shower as soon as possible afterward and; 6) try to expose yourself to fresh air soon after swimming. (22,23,24)

I’d like to add one additional recommendation. It’s possible that consuming plenty of antioxidants may help to protect lung tissue from chemically induced inflammation and otherwise support healthy lung function. So far, there’s only preliminary research to support this theory. I’m sharing this information based purely on laboratory research that I hope will afford some protection to frequent swimmers. (25,26,27,28,29)

It’s clear to me that the benefits of aquatic therapy and swimming are considerable. I don’t however discount the risk of chemical exposure, especially for those with conditions that make them particularly vulnerable. A day will likely come when chlorine will no longer be used to disinfect swimming pools. But that time will come more quickly if we passionately express our desire for it. This is yet another example of commercial availability based on consumer demand. Until then, consider the pros and cons of aquatic therapy carefully. Use every precaution you have at your disposal and make the most of your time in the water.

Be well!


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Posted in Alternative Therapies, Exercise, Heart Health

6 Comments & Updates to “Aquatic Therapy”

  1. Anonymous Says:

    It’s a dilemma
    On the one hand, this therapy can treat the disease and the other can cause disease. But it does not mean there is no solution.
    If health is expensive, we may be able to select a pool of free chlorine.

  2. JP Says:

    I think seeking out a chlorine-free pool would be best. But, in many instances, even exercising in a chlorinated pool would offer more benefits than risks – especially if certain precautions are followed.

    Be well!


  3. Jeff Sloan Says:


    You’re right that swimming is a great way to get exercise, and you’ve definitely done your homework to support that fact. Most medical experts agree that swimming is a healthy form of exercise for children and adults.

    You’ve noted that chlorine byproducts are formed when contaminants react with chlorine, but I’d like to add that the level of byproducts can be managed by controlling contaminant levels. On that note, I’d like to add to your list of suggestions: shower before entering the pool. This reduces the level of contaminants that you’ll bring into the pool with you, and thus reduce the level of chloramines and other by-products. If your pool is properly managed, chlorine and chlorination byproducts pose little risk to health. Levels are generally below the World Health Organization (WHO) guideline values for drinking water, which are considered protective over a lifetime of exposure (more information available at WHO has concluded that “the risks from exposure to chlorination byproducts in reasonably well managed swimming pools would be considered small and must be set against benefits of aerobic exercise and risks in the absence of disinfection.”

    In addition, there are no “natural alternatives” to replace chlorine disinfectants in pools. Silver/copper ionizers must be used with residual levels of chlorine, according to ANSI/NSF standards for pool equipment (

    Again, the key to ensuring a safe and healthy pools is ensuring that chemical and contaminant levels are monitored and properly managed. If you think there’s an issue with your pool, don’t hesitate to share your concerns with the pool manager. More information about the signs of a clean, healthy pool is available at

    I hope this is helpful – please feel free to email me if you have any questions.

    Best Regards,

    Jeff Sloan
    American Chemistry Council

  4. JP Says:

    Thanks for your valuable input, Jeff. Much appreciated!

    Be well!


  5. montiner Says:

    I love doing aquatic exercises because for me it’s less tedious as compared to a regular exercise in the gym. You get to cool down right away because you do in pools or facilities of such kind.

  6. JP Says:

    Update: Hydrotherapy also benefits patients living with fibromyalgia …

    Clin Exp Rheumatol. 2015 Mar-Apr;33 Suppl 88(1):73-81. Epub 2015 Mar 18.

    Effects of a hydrotherapy programme on symbolic and complexity dynamics of heart rate variability and aerobic capacity in fibromyalgia patients.

    OBJECTIVES: To evaluate the effects of a hydrotherapy programme on aerobic capacity and linear and non-linear dynamics of heart rate variability (HRV) in women with fibromyalgia syndrome (FMS).

    METHODS: 20 women with FMS and 20 healthy controls (HC) took part in the study. The FMS group was evaluated at baseline and after a 16-week hydrotherapy programme. All participants underwent cardiopulmonary exercise testing on a cycle ergometer and RR intervals recording in supine and standing positions. The HRV was analysed by linear and non-linear methods. The current level of pain, the tender points, the pressure pain threshold and the impact of FMS on quality of life were assessed.

    RESULTS: The FMS patients presented higher cardiac sympathetic modulation, lower vagal modulation and lower complexity of HRV in supine position than the HC. Only the HC decreased the complexity indices of HRV during orthostatic stimulus. After a 16-week hydrotherapy programme, the FMS patients increased aerobic capacity, decreased cardiac sympathetic modulation and increased vagal modulation and complexity dynamics of HRV in supine. The FMS patients also improved their cardiac autonomic adjustments to the orthostatic stimulus. Associations between improvements in non-linear dynamics of HRV and improvements in pain and in the impact of FMS on quality of life were found.

    CONCLUSIONS: A 16-week hydrotherapy programme proved to be effective in ameliorating symptoms, aerobic functional capacity and cardiac autonomic control in FMS patients. Improvements in the non-linear dynamics of HRV were related to improvements in pain and in the impact of FMS on quality of life.

    Be well!


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