# Exercise as it relates to Disease/The Benefits of Aquatic Training in the Older adult.
### Difficulties Confronting the Older Adult

The older adult is at more risk of falling and injuring themselves from a lack of muscle strength and stability in comparison to the young adult. More at risk of cardiovascular disease. May suffer from chronic joint or back pain. May be unable to perform certain actions or tasks.

### Aquatic Training

Aquatic training is a form of non-weight bearing exercise that can be performed while the body is immersed in a pool, lake, the ocean or body of water. It used by elite athletes as a form rehabilitation, as the athletes buoyancy allows them to move without putting unwanted stress on injuries. This is commonly used for torn ligaments in the knee (ACL, MCL) and skeletal muscle tears of the leg (Rectus femoris, vastus medialis).

## Common forms of Aquatic Exercise

Common forms of aquatic exercise include:
* Resistance exercises: Hip flexion/extension/adduction/abduction, leg scissors, walking lunges, leaping, and calisthenics. Intensity of these exercises can be modified by including specific resistance material that increase resistance from the water (noodles, cuffed weights), or by varying the velocity of the movements using the water as resistance.
* Aerobic exercises: Jogging or bounding up down through pool lanes, swimming, water polo, long lever pendulum-like movements of extremities and calisthenics.
* Underwater/submerged treadmill: This is commonly used form of rehab, This involves the subject to be immersed in water while they walk on a submerged treadmill. The subjects buoyancy in turn decreases the force on their knees and legs.
* Aquatic Plyometrics: An anaerobic exercise involving the athlete jumping with maximal force onto submerged box/step or out of a body of water. This uses the weight of and drag of the water as resistance.

## Barriers for aquatic exercise

Reasons why older adults may not participate in aquatic exercise:
* inability to swim
* embarrassment/self-esteem
* costs
* motivation
* lack of time

## Benefits

Benefits from Aquatic exercise include:
* Cardiovascular benefits: When the human body is immersed in water, it falls under the influence of hydrostatic pressure. This is beneficial as hydrostatic pressure enhances venous return to the heart. This increased venous return results in a reduced resting heart rate, mean stroke volume, cardiac output and VO2 max.
* Reduced risk of fall injury: The resulted muscular strength as a product of aquatic exercise allows for improved balance. This reduces the risk of falling, thus reducing the risk of injury.
* Increased flexibility
* Increased muscular endurance
* Increased muscular strength
* Increased gait stability through an increase in muscular strength
* Decreased perceived pain
* Overall increase in quality of life from improved muscular strength, endurance and flexibility allowing the subject to perform certain physical tasks easier and reduced joint and back pain.
* Provides a healthy form of exercise whilst putting less stress on the body

## Exercise Recommendations

Aquatic training sessions should be performed 3 times per week with each session lasting 55–60 minutes. This should include 10 minutes of warm-up, 15–20 minutes of resistance exercises, 20–25 minutes of aerobic exercises and 10 minutes of cool-down.

## Further reading

Further information on how the older adult can benefit from aquatic training can be found at:
* http://www.webmd.com/healthy-aging/features/water-exercise-seniors
* http://www.livestrong.com/article/104715-water-aerobics-exercises-seniors/
* http://www.rehabpub.com/2014/01/aquatic-management-for-patients-with-arthritis-and-joint-replacement-conditions/
* http://aquatictherapytoday.com/usa/

## References

* 1 2 3 4 5 6 Pedro Angel Baena-Beato (2013). Effects of Different Frequencies (2-3 Days/Week) of Aquatic Therapy Program in Adults with Chronic Low Back Pain. A Non-Randomised Comparison Trial. Pain Medicine. P145-158
* ↑ W. Matt Denning (2012). A Review of Biophysical Differences Between Aquatic and Land-Based Exercise. International Journal of Aquatic Research and Education. Vol. 6. P46-67
* 1 2 3 4 Vlatka Wertheimer (2013) Aquatic Training – An Alternative or a Compliment to the Land-Based Training. Hrvat.Sportskomed. Vjesn. P3-66
* ↑ A. Sherlock (2013). The Physiological Effects of Aquatic Exercise on Cognitive Function in the Aging Population. International Journal of Aquatic Research and Education. Vol. 7. P266-278
* 1 2 3 4 Marco Bergamin (2012) Is Water-Bases Exercise Training Sufficient to Improve Physical Fitness in the Elderly?. Eur Rev Aing Phys Act. Vol. 9. P129-141
* ↑ Talin Louder (2014). Effect of Aquatic Immersion on Static Balance. International Journal of Aquatic Research and Education. Vol. 8. P53-65
* 1 2 3 Stan Elena Amelia (2012) Aquatic Fitness and Rehabilitation at Individuals with Disabilities. Medicina Sportiva. Vol. 8. P1951-1956
* ↑ Alison Fisken (2014) Perception and Responses to Different Forms of Aqua-Based Exercise Among Older Adults with Osteoarthritis. International Journal of Aquatic Researsch and Education. Vol. 8. P32-52
* ↑ Jaime A. Roper (2013) Acute Aquatic Treadmill Exercise Improves Gait and Pain in People with Knee Osteoarthritis. Archives of Physical Medicine and Rehabilitation. Vol. 94. P419-425