Aquatic therapy in lifestyle diseases
Aquatic therapy (AT) plays a crucial role in managing and preventing lifestyle diseases, offering a unique and effective approach to improving health and well-being. Lifestyle diseases, such as cardiovascular diseases, immuno-metabolic diseases, and musculoskeletal disorders, are often linked to sedentary lifestyles, poor dietary habits, stress, chronic (nociplastic) pain, sleeplessness. AT provides a variable-impact, versatile, and enjoyable means of addressing these health issues.
One of the primary benefits of aquatic exercise is its ability to promote cardiovascular fitness. Water resistance provides a natural form of resistance, requiring the body to work harder during movements. This enhances cardiovascular endurance, lowers blood pressure, and improves circulation, reducing the risk of heart-related conditions. Additionally, aquatic exercise is suitable for individuals with joint problems or arthritis, as the buoyancy of water reduces impact on joints, facilitating pain-free movement and promoting joint flexibility. For individuals with diabetes, aquatic exercise contributes to better blood sugar control. Regular sessions in the water help enhance insulin sensitivity, making it an effective component of a comprehensive diabetes management plan. The buoyancy of water also reduces the impact on the feet and lowers the risk of injuries, particularly important for those with diabetes-related neuropathy; with mechanical low impact one can achieve a physiological high impact. One could say: the more co-morbidities, the better AT.
Variable-impact means that exercise intensity can be chosen from passive to high intensity impact training, depending on the goal: Aqua-T-Relax, Clinical Ai Chi, Aqua-T-Fit, motor-cognitive exergaming and BRRM are interventions that will be used in this variable-impact approach.
Underlying mechanisms to be addressed are low grade systemic inflammation, the heart-brain axis, the gut-brain axis, cerebral health (blood flow and large scale neuronal networks) and the proprioceptive system to decrease central sensitization
Water Specific Therapy
Water Specific Therapy (WST) – previously known as Halliwick-therapy - is THE aquatic therapy concept worldwide, included in more than 60 published research articles, see at https://www.halliwick.net/en/literature/articles . WST covers virtually all neuromusculoskeletal ICF-goals including one of the most important topics in rehabilitation: postural control. WST ranges from muscle strengthening, increasing range of motion, decreasing pain to core stability, agility and fall prevention. WST can be used to evoke subtle muscle contractions that are unable to be generated on land. WST is applied from pediatrics to geriatrics and has been taught in over 50 countries.
It is an aquatic therapy with elements of the Halliwick 10 point-programme swimming method that are used as pretraining for exercises that use the fluidmechanical properties of water: flow conditions (turbulence), waves of transmission and metacentric effects (using the change of gravity and buoyancy induced torques). A clinical question in WST could be: “can metacentric effects be used to train central stability in an ataxic patient”?
WST was developed by a team of physiotherapists in Switzerland in the early seventies, supporting James McMillan in his efforts to develop Halliwick towards a “Halliwick-Therapy”. The development still continues, following contemporary issues in health care. Examples are executive functions, muscle power training or modifying neuroinflammation.
WST = motor learning in water to be used on land, whereas Halliwick = motor learning in water to be used in water
Bad Ragaz Ring Method (BRRM)
Around 1955, physiotherapists in the German city of Wildbad started resistance exercise in the pool with patients in a supine position. Supported by a neck collar and car tubes around the pelvis and the ankles (when necessary). This method was quickly used in Bad Ragaz, where three-dimensional patterns of proprioceptive neuromuscular facilitation (PNF) were included in the early sixties. This was the start of a long history of adaptations to the state of the art in aquatic PNF. The key element is the activation of muscles in myofascial chains as a preparation for functional activities in water and on land. Recently, principles of muscular fine tuning, PNF techniques (like a combination of isotonics), and training physiology have been included. Also, concepts like functional kinetics and core stabilization are part of contemporary BRRM and are applied to working with neurologic, orthopedic, and rheumatic populations. See www.badragazringmethod.org
Examples of contemporary topics that are included in the course are:
Reversals of antagonists: Reversals increase strength much more than contractions in one direction.
Combination of isotonics: the eccentric component is very important to balance inflammation reactions in, e.g., the muscle envelope.
proprioceptive discrimination training in an environment in which pain is "under the radar", in order to influence neuro-inflammation, e.g., in low back pain
Three-dimensional movements are essential to proper mechanotransduction, using fascia properties.
The tensegrity of the intramuscular fascia can be trained by smooth, variable contractions, which add to fascia resilience.