As you design your Splash class, consider the population you are working with and the conditions they may be experiencing. The following conditions may need specific accommodations and additional cues for hydration and perceived exertion.
Heart Disease refers to several types of heart conditions, including coronary artery disease (CAD) which affects blood flow to the heart, irregular heartbeats (arrhythmias), disease of the heart muscle and heart valve disease.
Aquatic exercise recommendations for heart disease:
- Encourage even and continuous breathing. Cue participants to avoid breath-holding and straining while performing exercises.
- Avoid exposure to extreme heat or cold, including pool and air temperatures that are out of the safe range.
- Avoid exercises that might produce an increase in blood pressure, such as isometric muscle conditioning and sustained overhead arm work.
Diabetes is a chronic health condition that affects how your body turns food into energy. Individuals with diabetes do not make enough insulin or they are unable to use insulin effectively to break down the food they eat into glucose for energy. When there isn’t enough insulin or when cells stop utilizing or responding to insulin, too much blood sugar remains in the bloodstream. Over time, this can lead to conditions such as vision loss, neuropathy, heart disease and kidney disease.
Type I Diabetes is most often diagnosed in children and young adults. This condition causes the body to stop making insulin and requires daily insulin injections.
Type II Diabetes is common in adults and becoming more prevalent in children, teens and young adults. With type II diabetes, the body is unable to use insulin efficiently so it cannot stabilize blood sugar levels. This type of diabetes is usually less severe and can often be controlled with healthy lifestyle changes including eating a healthy diet, being active and maintaining a healthy weight.
Aquatic exercise recommendations for diabetes:
- Encourage participants to exercise at the same time each day for consistency in maintaining blood glucose levels.
- Remind participants to exercise one or two hours after eating and carry carbohydrate snacks.
- Be sure the participants drink water before, during and after exercise.
- Diabetes can harm blood vessels and nerves in feet. Aquatic footwear is necessary to avoid foot lacerations, cuts and bruises.
Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue, according to the Mayo Clinic. Cancer often has the ability to metastasize or spread throughout the body.
Aquatic exercise recommendations for persons recovering from cancer:
- During cancer treatment, bouts of fatigue may compromise safety during a workout routine, so encourage class members to pace themselves and pay attention to perceived exertion levels.
- Create a safe environment by providing variations designed for multi-level participation.
- All participants with skin cancer are recommended to cover exposed skin while in an outdoor pool environment.
- Encourage participants to follow their physician’s directives regarding all amputations and/or surgical procedures.
- Because chemotherapy can lower the body’s ability to fight infection, cancer patients going through chemo may be advised to avoid public pools.
Asthma, Exercise Induced Asthma (EIA), Chronic Obstructive Pulmonary Disease (COPD), and Emphysema are diseases of the lungs and respiratory system.
Aquatic exercise recommendations for pulmonary diseases:
- Encourage participants to arrive early and begin a longer, slower and more progressive warm up.
- Inform participants that a shallow position in the water may be more comfortable.
- Teach participants to exhale with a “steady blow” rather than forcefully breathing out.
- Pools, especially indoor pool environments, can trigger asthma because of the high humidity and chemical odors. Encourage participants to bring their inhalers or oxygen to the pool area.
- Create a safe environment – clean air and comfortable temperature.
Arthritis is a chronic, degenerative disease characterized by joint inflammation. There are more than 100 different arthritic diseases, and it is estimated that most adults over 65 years of age suffer from at least one form of arthritis. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.
Aquatic exercise recommendations for arthritis:
- Those with arthritis may require more time to completely warm up and prepare for the work segments of class.
- Provide low to moderate intensity exercise to decrease pain and stiffness in arthritic joints.
- To avoid increased pain after exercise, use progressive overload training techniques, providing a full range of variation for movement designed for your Splash class.
- Participants with rheumatoid arthritis should NOT exercise during a “flare up.”
- Those with pain in hands and wrists are recommended to use the therapeutic grip for the splashboard described and pictured in Lesson 4.1 under Basic Movement Cues. Cue participants to avoid gripping or squeezing the splashboard too tightly.
- Participants should avoid forcing a stretch.
- Participants should avoid exercising in cold temperatures.
Osteoporosis is a disease that weakens bones, putting those who have it at greater risk for unexpected and sudden bone fractures. Individuals with osteoporosis have less bone mass and decreased bone strength and are at elevated risk of fractures, especially of the hip, wrist and spine.
Aquatic exercise recommendations for osteoporosis:
- The pool is a perfect place for participants to increase bone density and practice posture and balance. Previously it was believed that only specific land-based, weight-bearing activities could counteract bone loss, but research indicates that water’s resistance and safely training with impact options in a shallow water exercise class can provide adequate bone-loading activity.
- Increase weight-bearing activities and consider aquatic strength equipment. Water can produce 12 – 14 times greater resistance than air and has been proven to increase bone density.
Joint replacements offer participants an opportunity for pain-free mobility. The most common joint replacements are of the hip and knee, but replacement surgery can be performed on other joints as well, including the ankle, wrist, shoulder and elbow.
Aquatic exercise recommendations for joint replacements:
- Water exercise can be soothing and therapeutic for these participants. Communicate regularly to gradually increase intensity.
- After hip replacement surgery, participants may be directed that:
- The affected leg should not cross the midline of the body. (e.g., crossing at the ankle or crossing legs)
- The hip should not flex past 90°.
- Hip rotation should not be performed.
- Avoid exercises that require excessive hyperflexion of knee beyond physician-recommended directives.
- Participants should follow all physician directives.
- Remind participants to gradually increase intensity. Be prepared to individualize and demonstrate modifications for progressive strength and range of movement exercise.
Obesity and overweight are defined as abnormal or excessive fat accumulation that presents a risk to health. However, fat distribution and structural instabilities caused by an excess of body weight may create additional challenges for individuals. A body mass index (BMI) over 25 is considered overweight and over 30 is considered to be obese.
Aquatic exercise recommendations for obese individuals:
- Encourage low to moderate exercise intensity that begins with more frequent workouts (five times per week) performed for short time periods (15 – 20 minutes).
- Be prepared to demonstrate modified choreography and body positions appropriate for a larger body.
- Include movements for coordination, balance, ROM and body alignment.
- Cue proper knee and foot position to avoid joint injury.