Aquatic Exercises for Seniors

Why Our Aging Population Should Use Aquatic Exercise

aquatic-exercise

Aquatic exercise is effective for anyone wanting to build lean muscle mass, increase strength, or heal from injury. It is also the ideal exercise medium for aging adults by helping them maintain their good health at a comfortable, functional level. Here’s why:

Unloading the Joints

Exercise and therapy are far less painful in warm water than on land. Water provides low-impact, low-weight bearing exercise that allows the synovial fluid to bring nutrients to the joint surfaces and minimizes the risk of injury or undue stress on the joints. It reduces the foot-striking forces that so often “jar” muscles, ligaments, tendons and bones, lessening the burden on the body.

Learn How Aquatic Therapy Can Help Your Facility >>

Travis Baughman, Clinic Director and Physical Therapist at Drayer Physical Therapy in Mechanicsburg, PA, states, “Less stress on the joints is one of the main reasons we use water therapy for our senior patients. With water, you’re able to unload those joints yet continually strengthen because the water is always causing some type of resistance. As the joints move, more [synovial] fluid flushes the joints and it feels better for the patient. We see a lot of patients who have pain and discomfort and it’s difficult for them to progress on land.”

“. . . we use the HydroWorx underwater treadmill as a means to get them exercising. With the buoyancy of the water it’s extremely comfortable. Our older patients can do exercises in the water that they cannot come close to doing on the land.


Drayer Physical Therapy, Mechanicsburg, PA
Travis Baughman, Clinic Director and Physical Therapist

During exercise on the underwater treadmill, the weight of a human body is reduced up to 90 percent, depending upon the depth of the water. As the body is gradually immersed, water is displaced, creating the force of buoyancy. This takes the weight off the immersed joints progressively, and with neck immersion, only about 15 lbs. of compressive force (the approximate weight of the head) is exerted on the spine, hips, and knees. This means a 150-pound person carries as little as 15 lbs. when submerged. A body suspended or floating in water essentially counterbalances the downward effects of gravity with the upward force of buoyancy. This effect is of great therapeutic utility as reducing one’s body weight in turn reduces the pressure on one’s joints, allowing aching joints to move more freely, with less pain. A warm aquatic environment also reduces joint inflammation and improves circulation.

Aquatic Exercise Reduces the Risk of Falls

Statistically, during a person’s mid-sixties, falling becomes a major concern. Studies show that one in three 65 year olds will fall annually. And the chance of falling rises proportionally with age, reaching 50% by age 80. Falls are the leading cause of fatal injury in people over age 75 and are a serious concern, especially among retirement communities.

At Lakeview Village, a senior neighborhood in Lenexa, Kansas &mdash clinicians use a HydroWorx 1200 pool for clientele who find it difficult to safely move on land. Jackie Halbin, Living Well manager, CPT, and Certified FallProof instructor, utilizes a unique program to help seniors with balance and mobility, including center of gravity control training, gait pattern enhancement, strength and endurance building, and flexibility training.

Thanks to the underwater treadmill, video camera/monitor, and resistance jets, we’re able to offer our FallProof H2O program with the plan of stopping major incidents from happening. The versatility of the programs keeps clients coming back; in fact, we’ve had zero ‘no shows.’


Lakeview Village Assisted Living and Community Wellness Center
Jackie Halbin, Living Well Manager

There seems to be a pervasive myth that senior adults aren’t ready for intensive exercise programs. Nothing could be further from the truth. Many people over 62 are very fit; however, they may have had an incident, which caused an imbalance, or weakness over time which has lead to balance/fall issues. But with the proper programs and assessment tools in place, facilities &mdash together with clinicians &mdash can provide participants with the best plan of action.

Comprehensive aquatic treatment programs get patients back to their normal lives quicker. Single leg activities can be extremely important to overall balance and are most effectively performed in water. Targeting specific muscle groups becomes easier using water’s natural buoyancy to support a patient walking forward, backwards, or sideways.

Resistance jets can be introduced to increase turbulence for people working to build balance. During such training, participants stand on both legs facing forward, sideways and backwards, then on a single leg, while the jets are on. The turbulence can be increased or decreased depending on the patient’s needs. Progress can be documented based on the jet intensity. Hand rails can be used for protection and comfort, if needed.

Participants find is easier to work on balance in the water because the fear of falling is eliminated. Because of this, participants can work out “harder,” thus more rapidly improving needed skills. This gives them psychological benefits, as they feel more “in control” of their daily lives. Additionally, research shows that older adults that consistently exercise on an underwater treadmill gain additional benefits such as; improve flexibility, sleep patterns and joint pains.

Aquatic Exercise Can Help Osteoporosis Patients

An estimated 10 million individuals currently suffer from osteoporosis, with another 34 million at risk. Even bone density can be improved significantly with the use of aquatic exercise. Many osteoporosis patients avoid exercise because they fear injuring themselves. Aquatic exercise provides a way to achieve the benefits of exercise without the risk of breaking a bone.

In one clinical trial conducted in Canada, researchers reported “significant improvements in balance and global change suggest that [aquatic exercise] is a viable alternative for older women with [osteoporosis] who have difficulty exercising on land.”

Findings from patient results documented by the Greater Philadelphia Physical Therapy Practice validate previous research studies for patients with osteoporosis. Water-based exercise improves or maintains the bone health of post-menopausal women.

Anytime there is someone with limited mobility on land, getting them in the water to take the weight off their joints and increase their mobility is going to be really important. Exercise improving cardiovascular health with low-impact on the joints is especially beneficial for the patients with decreased bone density who find it difficult to exercise.


Penn State Hershey Medical Center
Darin Jurgensmeier, Orthopedic Resident

The removal of the fear of falling is extremely advantageous for osteoporosis patients and the water does just that. Some aquatic exercises to help boost the confidence of osteoporosis patients include:

  • Mastering walking with good posture in an aquatic environment
  • Walking mechanically correctly on an underwater treadmill at higher speeds
  • Stopping and starting in a water environment
  • Changing the gait pattern with speed and resistance

When an underwater video camera is hooked up to a TV monitor, both client and physical therapist can capture changes of gait pattern or posture and correct them immediately.

Aquatic Exercise is Enjoyable

aquatic-exercise_v2

Not many of us will stick with an exercise program that is painful and awkward. Exercise sessions — even for diligent seniors — must be enjoyable as well as beneficial.

Robert N. Butler, former director of the National Institute on Aging, once stated, “If exercise could be packed into a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” Unfortunately for some older adults, an “exercise pill” may seem to be the only solution to their fitness needs. Although enthusiastic in their quests to lead longer, healthier lives, exercise can be difficult, if not impossible, for senior adults, especially those with health problems.

Seniors, who otherwise experience stiffness and joint aches can, in an aquatic environment, enjoy a nearly pain-free workout.

There are 35 million senior adults in the United States, half of whom are older than 75. Some of this population are active and in good health. Others are plagued with chronic conditions such as arthritis, hypertension, hearing and vision impairments, heart and lung disease, and orthopedic conditions. Whatever the categories or classifications, physical therapists are challenged to provide suitable fun and fitness opportunities for seniors at all ability levels. The opportunities provided for aquatic exercise will not necessarily prolong life, but they will aid in increasing the years of feeling good.

The fact that aquatic exercise and therapy is enjoyable has the additional benefit of increasing compliance with rehabilitation programs. When aquatic therapy is used for rehabilitation purposes the compliance with the program is much higher than with land-based therapy. According to Robert P. Cusick, MD of Kansas Joint & Spine Institute, “. . . the patients enjoy going to therapy. They don’t dread that, they don’t cancel, they don’t skip appointments. In fact, the opposite is true, they want to go more than they are allowed to. In fact, they dislike it when they have graduated from therapy. So they become functional faster and they enjoy [rehab] so much more with aquatic therapy.”

Instead of canceling appointments due to pain, patients are eager to attend [pool] sessions — even scheduling extra — because they experience pain relief during sessions. Our clinic receives virtually no cancelations due to pain.


Four State Physical Therapy & Aquatic Rehabilitation & Premier Surgical Institute, Galena, Kansas
Kurt Stork, Director of Rehabilitation

Exercises for Improved Outcomes

Below are some easy-to-implement aquatic exercises for Osteoporosis which may be used with an underwater treadmill:

Warm Up: This stage is integral to the overall success of any training session. Participants should start from the bottom of the body, working upward and include:

  • Heel-to-toe raises — This movement is important for forward propulsion when walking and helps prevent shuffling.
  • Side-to-side rocking — This helps engage the hips and legs and is essential for a positive outcome on an underwater treadmill as it helps to prepare for weight shifting and side stepping patterns.
  • Trunk rotation and posture press ups — Handrails work extremely well to assist with exercises that encourage upright posture and trunk movement. By lightly pressing down on the rails to extend the spine, participants can perform exercises to engage the core muscles.

Walking Workout: The intrinsic nature of water forces hydro-therapy participants to consider more fully their posture, gait and speed. The following methods will insure a solid calorie burn:

  • Arm swing progressions — Participants who ambulate with a walker typically do not swing their arms when walking. With the help of the buoyancy of water, participants can gradually connect arm swing with walking again.
  • Level 2 arm swings — This is done by extending the arms through a greater range of motion against the natural resistance of the water.
  • Cross-shoulder swing — This provides a boost to the caloric “burn” of the underwater treadmill walking routine. The motion of the cross-shoulder swing increases flexibility and strength.

Range of Motion, Strength and Balance: At the core of concern for aging seniors is this trio &mdash all of which can be improved during the underwater treadmill workout:

  • Sit Back Hip Stretch — Holding onto the support bars for balance, an individual can “sit back” in the water, bending downward to stretch the upper legs and hip area.
  • Hip abduction — Important for balance and walking, this is a great exercise for preparing to side step on the treadmill.

Losing weight isn’t as easy for seniors as it is for their younger counterparts. And that fact is often coupled with the reality of comorbid medical conditions that preclude many land-based forms of exercise and training.

Walking in water burns up to 3.5 times a similar activity on land. Water-based activities also provide increased metabolism and increased strength, slows down age-related loss of muscle mass, improves cardiovascular health, and increases reaction time that typically decreases with age. Weight loss is just one of the scores of health benefits aquatic exercise provides.

85-year old Margaret needed to lose weight as a means to improve her hip osteoarthritis. She began with water walking on the underwater treadmill for 30 minutes, one to two times per week. In one year, not only was she able to lose 35 pounds, but she was also able to increase her strength in her legs and her hips. This increased strength helped her knee replacements work better and has allowed her to avoid the hip replacement she once thought she needed.

Benefits of Community Programs

Socializing among seniors in a group setting is vital. Seniors &mdash particularly those widowed or serving as caregiver to spouse &mdash can easily become isolated. Socializing in an aquatic exercise medium can provide a much-needed social outlet. Group aquatic exercise programs allow people with similar conditions or fitness desires to encourage and help each other. Group sessions also provide an additional medium for social interaction.

Many facilities have created additional revenue streams by offering the pool to the public, creating new programs and charging a monthly membership fee. By offering a diverse array of services, facilities broaden their scope of revenue, create a clinic “community” of users who network and refer others to the facility, and increase visibility within the community, can become the “Community of Choice” in their local area, resulting in increase productivity, increased RUG scores, and better patient mix.

Aging Exercisers are Less likely to Enter Long-term Care or Get Sick

In the United States, approximately 10,000 people per day turn 65. This statistic will be true for the next 18 years. Yet today’s arriving seniors don’t want to be slowed down by Mother Nature. They wish to keep working out despite any physical impediments they might face. The overall goal for seniors is to remain independent and enjoy their quality of life. Therefore, continued exercise is essential.

There are clearly many benefits that can be derived from participation in an aquatic exercise program for [seniors]. It is well-recognized that many physical and psychological conditions that commonly occur during aging can be prevented or delayed with regular physical activity.

Physical activity in [seniors] has been linked to playing a role in the prevention of some cancers as well as reduced risk to heart disease, hypertension, osteoporosis, obesity, type II diabetes, osteoarthritis and abnormal cholesterol. Mature adults who maintain high levels of cardiovascular endurance, strength, and flexibility are also less likely to be dependent for long-term care.

Len Kravitz, in The Age Antidote, states, “A sedentary lifestyle is a predisposition to disability, early death, and a depreciated quality of life. Educating the elderly to the positive aspects of including cardiovascular activity, muscle strength and flexibility in their life is a challenge for the health fitness professional. Awareness must be directed to the fact that chronological age does not really represent quality of health. As fitness professionals, we need to focus our attention on creating wonderful opportunities of lifetime fitness, for our students of all ages, and provide a broad overview of health to a population with diverse interests and backgrounds.”

Jackie Halbin adds, “By utilizing aquatic exercise, seniors become more active, healthy and independent, thus increasing their lengths of stay within assisted and independent types of living.”

The utilization of the Senior Fitness Test and the Criterion Standards to help residents maintain or increase functional levels can lead to increased average length of stay in independent and assisted living settings. Offering a way to exercise with less pain &mdash like warm water programming or group aquatic classes — increases the number of residents which may be impacted and increases the facilities R.O.I.

Enlightened Mental Outlook

aquatic-exercise_v3

“You can’t believe how happy I am that I was able to find some means of helping get my strength back,” says Virginia, who suffers from MS and Parkinson’s disease. “Being in the HydroWorx pool allowed me to be able to get up from a sitting position. I never dreamed of how much improvement I could make in such a short time.”

In a study conducted at the University of Wisconsin, Department of Kinesiology, fourteen adults with previous histories of physical ailments participated in a five week study. Each participant exercised on a HydroWorx underwater treadmill two days a week for forty minutes performing both aerobic exercise and aquatic resistance training. Participants also took a quality of life survey that measured changes in flexibility, the ability to perform daily activities, energy levels, and sleep patterns. Upon completion of the study, subjects expressed feeling better both physically and psychologically during the exercise period. Eleven reported decreased joint pain and seven reported better quality of sleep.

“We see a lot of people do extremely well with their general progression and their strengthening in the water,” acknowledged Bellido. “As they progress, it becomes easier for them to do their basic activities &mdash walking, cooking, standing — without having to take a break every five minutes. They love what the water does for them.”

Furthermore, physically active people recover from mild depression more quickly, and physical activity is strongly correlated with good mental heath as people age. Depression is related to low levels of neurotransmitters which are naturally produced through exercise.

The increase in strength and balance in older adults through the use of aquatic exercise allows individuals to keep up with their normal activities of daily living (ADLs) longer. By maintaining these important life skills, individuals tend to have an improved mental outlook as they remain independent and active.

By using aquatic therapy to increase strength and balance, older adults are able to keep up with their normal activities of daily living (ADLs) longer. By maintaining ADLs, they may have an improved mental outlook as they keep their independence and stay active.

But I find that when I’m in the water there’s something about the buoyancy of the water that permits me to stand up straight and to walk standing straight and it feels so damn good to be straight . . . All I can say is that at 86 I just couldn’t believe that I could jog, and I have. It’s been great!


Life Enriching Communities, Cincinnati, OH
Jim Stallings, Resident

Benefits of Warm Water

Many aging Americans are precluded from a land-based exercise program due to pain or obesity. Aquatic therapy offers this group relief and better outcomes through several of water’s intrinsic properties.

Buoyancy assists in de-weighting patients’ body mass, decreasing joint stress and making it easier and less painful for patients suffering from arthritis or joint replacement surgery to exercise. Water levels may be adjusted to create the ideal environment for patients ranging from 90% to 10% de-weighting.

Aside from buoyancy, water offers hydrostatic pressure, which reduces joint inflammation, enhances circulation and improves joint position awareness. Postural corrections can be accomplished with less effort and discomfort. Warm water also stimulates body awareness, balance, and trunk stability. Patients experience muscle relaxation and vessel vasodilatation, resulting in an increase of blood flow and earlier healing.

The viscosity of an aquatic environment is an excellent source of resistance for strengthening. Patients can improve mobility, strength, and function rapidly during the healing process. The aquatic environment also provides sensory feedback, opens the vessels and increases blood flow.

The healing powers of warm water environments can enhance one’s multiple dimensions of well-being. HydroWorx pools can help older adults maintain and/or regain independence. They provide individuals with increased environments and individuals can be proactive and take responsibility for their health and wellness.


Whole-Person Well International
Jan Montague, President

America’s population will continue to age in record number. With 77 million “Baby Boomers” currently, and many more to come, hydrotherapy will continue to be the sought-after medium for which to effectively and safely — among other things — unload the joints, reduce the risk of falls, and enlighten mental outlook.