Christine Alexander is the author of 2 books on water exercise each published by Human Kinetics.
Water Fitness Progressions (2019) was written for water fitness instructors and aquatic personal trainers. It describes how to use periodization to help class participants and clients progress in their level of fitness. It contains lesson plans that illustrate how to progressively increase intensity for both cardiorespiratory endurance and strength training.
Water Fitness Lesson Plans and Choreography (2011) was written for water fitness instructors. It has 36 class ideas for shallow water exercise and 36 class ideas for deep water exercise. Individuals may find the exercise descriptions and photos useful for building a personal exercise routine.
Ai Chi (“energy of love”) is a water exercise and relaxation program that combines deep breathing and slow, large movements, performed in continuous, flowing patterns. It was created by Mr. Jun Konno of Japan and further developed by Ms. Ruth Sova in the United States. In spite of the similarities in names, Ai Chi is not a variation of Tai Chi. It has 20 movements: Contemplating, Floating, Uplifting, Enclosing, Folding, Soothing, Gathering, Freeing, Shifting, Accepting, Accepting with Grace, Rounding, Balancing, Encircling with a Shift, Encircling, Surrounding, Nurturing, Flowing, Reflecting and Suspending. For a demonstration and a description of Ai Chi, download Ms. Sova’s video, Ai Chi Quick and Easy from her DSL LTD store. Scroll down to the Techniques: Ai Chi – Video section, to the fifth row, and place your order. It’s free.
There is a focus on breath during Ai Chi. Take slow deep diaphragmatic breaths that expand the ribcage. Inhale with arm movements toward the surface of the water or away from the midline of the body, with the palms facing up. Exhale with arm movements toward the pool floor or toward the midline of the body, with the palms facing down. Do not worry about inhaling or exhaling at the wrong time. With practice, matching the breaths to the movements becomes natural. However it turns out is how it was meant to be for that session.
Ai Chi is used by aquatic therapists and rehab specialists for a variety of outcomes. For example, Ai Chi improves balance and reduces the risk of falling. Shifting, Accepting, Rounding, Balancing, Encircling with a Shift, and Nurturing are all movements that involve shifting the torso away from and back toward neutral, which is a skill necessary for recovering balance. Gathering, Freeing, Accepting, Encircling, Surrounding, and Nurturing are performed with a narrow base of support, which challenges balance. Lateral stepping becomes more difficult with age; Flowing involves steps to the side. Being able to reach over a certain distance is a predictor for fall risk; Gathering, Freeing, Accepting, Rounding, Balancing, Encircling, and Nurturing all involve reaching in various directions. Gait variability decreases with age because of decreased rotation in the spinal joints; Gathering, Freeing, Reflecting and Suspending all involve turning. In addition, having the eyes follow the hands during upper body movements increases cervical spine rotation. (Ruth Sova MS ATRIC, “Ai Chi and Fall Prevention” 3-11-2022)
Spiraling Ai Chi, in which the upper body movements are lead with the back of the hand, is used to enhance and create movement in areas where the neuromuscular movement has been compromised. Spiraling Ai Chi is designed to be multi-planar and multi positional. Diagonal patterns are used to increase coordination and promote joint stability. (Spiraling Ai Chi Course description)
Psychotherapists have used Ai Chi to treat patients with heightened anxiety or depression. People with heightened anxiety are “over the top” and people with depression are “under the bottom.” Ai Chi helps calm the nervous system so that the patient becomes more in touch with his/her body, reducing physical and emotional pain. Ai Chi movements are mindful, which is defined as present-centered awareness with the mindset of nonjudgment, openness and acceptance. Patients have been able to experience a sense of inner calm. (Patricia Henry-Schneider MS, LPC, “Ai Chi as a Model of Calm” 5-6-2022)
Ai Chi’s slow movements in water have been used to help wounded warriors who have lost a limb, learn to balance without being able to feel their prosthetic limb on the pool floor. (Ai Chi Day, 7-25-2021)
Women with multiple sclerosis who practiced Ai Chi showed notable improvements in muscle strength, functional mobility and fatigue. (Rena Goldman “Health Spotlight: Ai Chi” 5-2-2018))
Ai Chi was found to be effective for improving function, mobility and balance in patients with mild to moderate Parkinson’s. (Goldman)
After 10 Ai Chi sessions, women with fibromyalgia experienced improvements in pain levels, mental health and quality of life. (Goldman)
I am a water fitness instructor, not an aquatic therapist. I use periodization with my classes, which means that I progress my classes by increasing intensity over a period of time until participants reach peak fitness. I love using Ai Chi as the cool down at the end of a high intensity interval class. And a long session of Ai Chi works great for the active recovery season that follows peak fitness to allow the muscles to rest, heal any microtears that may have occurred, and replenish their energy reserves. (For more about periodization see my book Water Fitness Progressions.) I created a modification of Ai Chi for my deep-water classes that Ms. Sova is going to include in a book on Ai Chi variations. Watch for it to show up in her DSL LTD store.
NOTE: The photo above is from a recording of Ai Chi Day 2020 which can be purchased in the DSL LTD store.
Water fitness instructors may spend a lot of time preparing for their class, coming up with a lesson plan, selecting music, showing up early, getting out the appropriate equipment, and being ready to greet their participants with a smile. It is rewarding when everything goes smoothly and you end the class with a feeling of accomplishment. Alas! Things don’t always go smoothly. Here are some common problems that might crop up and some possible solutions:
Some participants don’t seem to be able to follow your cues. Allow your participants to perform each exercise at least eight times before moving on to the next exercise, at least the first time around. Some people will not be able to keep up if you pace the exercises too quickly. If that doesn’t solve the problem, try using a variety of cueing techniques. Cues can be visual or audible. Visual cues include physical demonstrations and hand signals. Audible cues include spoken instructions, hand claps, and whistles. Consider using a deck microphone if possible. Cues can also be physical, such as pointing to the muscle you want your participant to focus on, but never assist anyone to perform an exercise by touching them without permission.
A participant does not follow your directions. It is not uncommon to have a participant who does not put much effort into the workout, or who always seems to be doing an exercise different from the one you are cueing. She may have some kind of physical issue that she has not told you about, such as arthritis or an injury. Give her the benefit of the doubt and assume she is doing the best she can.
A participant asks you a medical question. Always know your limitations. Do not give medical advice. Refer your participant back to his own doctor.
Some participants spend more time talking with each other than exercising. This might be a good time to teach in the pool. Circulate among your participants and give them some individual encouragement, especially the talkers. This may be all that is needed to get them involved in the class. Sometimes, however, participants come to a class for the social aspects. If this is their objective, then you need to have patience with them. You might try encouraging them to socialize during the warm up and the cool down, but ask them to focus on the workout during the main set.
A participant shows up to class who is afraid of water. Suggest that the participant work close to the pool wall in the shallowest part of the pool. You can give her a pool noodle to hold onto for stability. Tell her that she does not need to travel until she feels comfortable doing so. Do not allow her to turn her back to the wall and hang by her arms with her elbows on the deck, because this has the potential of injuring the shoulder joint. After a few classes the participant may become more comfortable in the water.
Some participants are afraid to lift their feet off the floor during suspended moves. In that case, let them perform the exercises standing upright or offer them options in the neutral position, with their hips and knees flexed. When they are comfortable in the neutral position, encourage them to lower their shoulders below the surface of the water, which allows them to experience their center of buoyancy in the lungs, as opposed to their center of gravity in the hips. Teach them to scull, which helps provide lift during suspended moves. Later you can ask them to pick their feet off the floor for only a brief moment, perhaps with a jacks tuck or a tuck ski. Finally, cue them to hold the tuck for a longer period of time. They have become suspended!
Your participants fill up the space in the pool and their is not enough room for traveling. This problem has more solutions than you might imagine:
Quarter turns: Perform an exercise 4 times and turn to the left side of the pool, perform the exercise 4 times and turn to the back of the pool, perform the exercise 4 times and turn to the right side of the pool, then perform the exercise 4 times and turn back to the front.
Half turns and full turns. Perform an exercise 4-8 times then turn toward the back of the pool, perform it 4-8 times again and turn back to the front. Full turns require a quick spin that can be both challenging and fun.
Perform an exercise 4 times while traveling backward and 4 times while traveling forward, continuing to travel back and forth. The quick change of direction challenges core strength and balance.
Divide the participants into two groups facing each other on opposite sides of the pool. Have them travel forward to the opposite side of the pool to change places, and backward to return to their original location.
Have the participants stand in a big circle. They can travel a few steps toward the center of the circle and a few steps back, or a few steps sideways to the right or to the left. They can also travel around the circle clockwise or counterclockwise, but avoid traveling this way too far because a current quickly forms that can sweep some participants off their feet.
Avoid creating a current by dividing the participants into two concentric circles. The inner circle might travel clockwise, and the outer circle counterclockwise. This creates a lot of turbulence that increases the intensity.
If you have something similar to four lap lanes, divide the class into two groups. One group travels down the first lap lane and up the second lap lane, and the other group travels down the third lap lane and up the fourth lap lane. The effect will be travel in two oval patterns side by side.
Have participants travel in a scatter pattern, over all parts of the pool area.
September is Fall Prevention Awareness month. It is estimated that one in four Americans over the age of 65 will fall every year. Falls not only can be life threatening, but they are associated with poor health outcomes and a sense of fear that can hinder independence, activity and strength in older adults. Therefore preventing falls in the first place is important. The Mayo Clinic offers the following tips for preventing falls:
Review your medications with your doctor. Some drug interactions may increase your risk of falling.
Exercise to improve strength, balance, coordination and flexibility.
Wear sensible shoes. Shoes like high heels and floppy slippers can contribute to a fall.
Remove tripping hazards from walkways in your home.
Secure loose rugs with double-sided tape or remove loose rugs entirely..
Clean up spills immediately.
Make sure there is adequate light in your living spaces so you can see where you are going.
Turn on the lights before going downstairs.
In addition to these tips for the home, aquatic fitness instructors can help with fall prevention by including some of the following exercises in their classes:
Gait training. People who are afraid of falling, perhaps because of a previous fall, tend to shorten their stride and look down at the floor. The hydrostatic pressure of the water supports the body and reduces the fear of falling, so a water exercise class is the perfect place for gait training. Walking is a good warm up at the beginning of class, or cool down at the end of class. Walk forward, backward and sideways. Include starts and stops. Try slow motion walking, or walk without moving the head or torso. Try walking with hands on hips to remove stabilizing arm movements. Change the tempo by walking slow for a few steps, then fast for a few steps, and slow again. Walk with quick changes of direction.
Webbed gloves
Drag bells
Paddles
Resistance tubing
Foam dumbbells
Kickboards
Strength training. Include exercises to strengthen the muscles of the back to improve posture. Examples include shoulder blade squeeze; standing rows with webbed gloves, drag bells, paddles or kickboards; bowstring pull with drag bells or resistance tubing; lat pull-down with webbed gloves, drag bells, paddles, resistance tubing or dumbbells; and chin tucks. Leg exercises against the resistance of the water will strengthen the quadriceps, hamstrings, gluteus maximus, gluteus medius and adductors.
Flexibility. Movements through their full range of motion promote flexibility. A form of exercise that uses full range of motion is Ai Chi created by Jun Kono of Japan and brought to the United States by Ruth Sova. Follow the link for a YouTube video of June Kono performing Ai Chi. It is also important to stretch at the end of class, while the muscles are still warm. Stretches can be static or dynamic. Examples of static stretches are clasping hands behind the back to stretch the chest, and lifting the heel in back with a pelvic tilt to stretch the quadriceps and hip flexors. Examples of dynamic stretches are swinging one leg forward and back through a full range of motion, and lifting one leg to the side, crossing the midline in front of the body, lifting it to the side again, and crossing the midline behind the body.
Ankle flexibility. Weak ankles or reduced range of motion in the ankles contribute to reduced stability. Some exercises to improve ankle flexibility are walking on toes or on heels – both forward and backward, rolling from heels to toes and back to heels, ankle circles, sitting on a noodle and writing your name with your foot, and squats keeping the heels on the floor. Squat with the feet in various positions, such as a narrow stance, a wide stance, toes pointing in, toes pointing out, or a tandem stance with one foot directly in front of the other.
Balance challenges. Asymmetrical movements require more core stabilization. Try walking, jogging, cross-country ski or jumping jacks with one hand on the hips or behind the back, or with each arm performing a different movement. Another challenge is to jog, ski or do jumping jacks with just one leg, keeping the other foot grounded. Stand and reach one arm as far forward as possible until you start to lose your balance. Reach your arm to the side and to the back until you start to lose your balance as well. Walk with one foot directly in front of the other or do a crossover step. Stand on one foot with and perform asymmetrical arm movements, or turn your head from side to side, or keep your head still and look from side to side, or close your eyes.
Unpredictable command. Improve your participants’ reaction time with the unpredictable command technique. Direct the class to perform unexpected movements. For example, walk diagonal, forward, backward, or sideways. Walk faster, knees higher, on toes or heels, with toes curled up or down or one of each. Look over your shoulder, tuck your chin, lower your shoulder blades, or touch your shoulder. Lift one arm to the side, front or back, lift both arms and let your fingers walk on the water. For more on the unpredictable command technique, see a previous blog post “Improve Reaction Time.”
Deep water exercise requires a lot of core stabilization, often leading to improved posture. My book, Water Fitness Progressions, includes 3 lesson plans, one for functional core strength, one for balance training, and one a Pilates fusion class for deep water. There are also variations of the same 3 lesson plans for shallow water. Now is a good time to start working on fall prevention.
Of all the things I might lose as I age, the scariest one is losing my brain health. Worldwide, more than 54 million people had Alzheimer’s disease and other dementias in 2020, according to the American Heart Association, and that number is expected to grow. The Aquatic Exercise Association listed 10 early signs and symptoms of Alzheimer’s in their 2nd Quarter 2022 issue of Leader Tools:
Memory loss that disrupts daily life.
Challenges in planning or problem solving.
Difficulty completing familiar tasks.
Confusion with time or place.
Trouble understanding visual images and spatial relationships.
New problems with words in speaking or writing.
Misplacing things and losing the ability to retrace steps.
Decreased or poor judgement.
Withdrawal from work or social activities.
Changes in mood or personality.
If there is anything that can be done to prevent or delay the onset of dementia, I definitely want to do it! Scientists long believed that the brain was not capable of producing new neurons, but modern research has revealed that the hippocampus, the part of the brain that allows learning, is capable of generating new cells throughout adult life. The ability of the brain to change and grow is called neuroplasticity. John J. Ratey, MD and Eric Hagerman published a book in 2008 called SPARK: The Revolutionary New Science of Exercise and the Brain. They discussed the research that had been done which shows that aerobic exercise helps the brain as much as it helps the heart. Aerobic exercise stimulates the release of the substance known as brain-derived neurotropic factor (BDNF) which sets in motion the growth of new synaptic connections and bolsters the strength of signals transmitted from neuron to neuron. A study by Dr. Aron Buchman done at the Rush University Medical Center in Chicago was published in the Journal of Neurology. He followed 535 individuals, with an average age of 81, for an average of six years, testing their cognitive functions (thought processes and memory) each year. After their deaths, the researchers took note of the BDNF levels in the brain. The subjects who had exercised had the highest levels of BDNF, and they experienced a 50 percent slower loss of cognitive functions compared with those who had the lowest BDNF levels.
Studies have shown that immersion in water relaxes the blood vessels, which facilitates an increase in the cardiac output of blood throughout the body, including the muscles working during exercise, and the brain. In a 2015 booklet entitled Water Immersion Works, Dr. Bruce Becker, the director of the National Aquatics & Sports Medicine Institute in Spokane, Washington, noted that anecdotal evidence suggests that time spent in the swimming pool has a beneficial effect on people with dementia. Individuals in a study showed improved speech and language function, improved balance and agility, and improved cognitive and memory function, an improvement that persisted after their sessions in the pool.
What about those computer games and puzzles that claim “doctors beg their patients to play these games” in order to keep their brains young? Research has found that these computer games and activities such as Sudoku and crossword puzzles are not as beneficial as originally thought. However, there is neuroplasticity training that can be combined with physical movement to strengthen, improve and even change some brain regions. Putting those neuroplasticity drills into a water fitness class is like using all the tools in your toolbox for reducing the risk of dementia. So how does this work?
Lawrence Biscontini, MA, has been involved in brain training since 1972. As an Advisory Board Member for the International Council on Active Aging, and as an active ager himself, Biscontini dedicates a great deal of time to making practical the most recent research on keeping our brains as young and sharp as possible. Check his website for information on his workshops and to read some of his articles. Below are some examples of neuroplasticity drills to perform out loud (to get more senses involved) while doing exercises in the pool such as jogging, jumping jacks, cross-country ski or any other combination of exercises.
Spell your first name forwards and backwards
Say the names of the months backwards starting with December and skipping every other month (December, October, August…)
Count down from 100 by 3s
Teach participants a word in any other language; repeat it and spell it 7 times
Say out loud (the whole class together) your first memory, first birthday party, how you met your first friend or some other long term memory
Recite the digits of your phone number forward and backward
Add the digits of your phone number together, two at a time
Give the class math problems to solve (addition, subtraction, multiplication, division)
Give each of 5 exercises a number, and call out the number instead of the name of the exercise
Spell the name of your state, adding the next letter after each letter, e.g. T (U) E (F) X (Y) A (B) S (T) for Texas
When performing an exercise, such as a lunge, with the right leg name a fruit, and with the left leg name a vegetable
Name as many green vegetables, cold drinks, names beginning with the letter R, birds, car makes or any other list you can think of
You can have a lot of fun coming up with neuroplasticity drills for your class and your class will have a lot of fun trying to imagine what you will come up with next. You will also be helping them to keep their brain health and reduce their risk of Alzheimer’s. That’s a win for everyone!
We usually breathe without thinking about it. It may come as a revelation to learn that there is more than one way to breathe and that how we breathe affects our posture and mobility. There are also a variety of breathing techniques that can be utilized. Most people use a chest-oriented breathing pattern. They take a deep breath by expanding their rib cage. They pull their stomach in and breathe only into their rib cage, lifting it up as they inhale. This type of breathing recruits the chest, neck, shoulder and upper back muscles, which leads to poor posture and chronic tension, which in turn reduces mobility.
The most efficient and effective way to breathe is diaphragmatic or lower abdominal breathing. In the clip art image to the left, the top of the diaphragm is represented by the curving red line at the bottom of the lungs. Diaphragmatic breathing is sometimes referred to as belly breathing. Try placing the edge of your hands alongside the lower rib cage where the red line is and take a breath. If you experience a noticeable lateral expansion of the rib cage, you have taken a diaphragmatic breath. Now exhale by squeezing an imaginary sponge upwards in the stomach. Another way to make sure you are breathing diaphragmatically is to put the tip of your tongue on the roof of your mouth just behind your front teeth. This stimulates your vagus nerve ending, which is involved in the regulation of breathing, and causes diaphragmatic breathing.
Diaphragmatic breathing has many benefits. It decreases blood pressure, decreases stress, decreases heart rate, and decreases pain and pain awareness. It also increases circulation, increases blood flow to the muscles, improves digestion, and improves ability to focus. Combining diaphragmatic breathing with extension exercises in the water is one way to decrease pain. Try walking backward and breathing diaphragmatically, lifting the crown of your head each time you inhale. Next press your shoulder blades down on inhalation. Relax completely during exhalation. Point your thumbs out to externally rotate the shoulders on inhalation and again relax completely during exhalation. For more information on diaphragmatic breathing, see the article written by Ruth Sova, the founder of the Aquatic Therapy and Rehab Institute, “Pain and Our Breathing Patterns” in Akwa June/July 2019 and her article “Aquatic Therapy Implementation” in Research to Practice Newsbytes Vol. 1 No. 2 Find the articles by logging onto the members only section of the AEA website.
The use of diaphragmatic breathing during exercise helps you increase your aerobic capacity, since it increases circulation and blood flow to the muscles. This is important for exercisers wishing to improve or maintain their levels of fitness. Elite athletes wishing to improve their performance may take the extra step of having the maximum amount of oxygen their bodies can utilize during exercise, or VO2 Max, measured in the lab. For more information on VO2 Max, see the article written by Dr. Luis Javier Pena-Hernandez, MD, FCCP in Garage Gym Reviews.
There are also breathing techniques to facilitate a variety of outcomes. The USMD Health System encouraged a 4-7-8 breathing exercise that is proven to help people relax. Breathe in for 4 seconds, hold your breath for 7 seconds, and breathe out for 8 seconds with gusto! Dr. Nick Shroff, a urologist and Yoga teacher in Plano, Texas, did a presentation on breathing at a Yoga festival on June 16, 2022. He also described the 4-7-8 breathing technique, adding that it helps to put your hand on your belly and push the hand out as you inhale (diaphragmatic breathing), then relax the shoulders as you hold your breath, and finally push the belly in and relax the jaw as you exhale. He said it not only relaxes you but it also helps you fall asleep. Pursed lip breathing increases lung capacity. Breath in for 2 seconds, the breathe out for 4 seconds with pursed lips, as if you are blowing out a candle. An intentional breath hold improves fitness, calms the nervous system and decongests the nose. Take a small breath in and exhale a small breath, then hold your breath until the first sign of breath hunger. To make breathing more efficient during rest, close the mouth and inhale through the nose, then open the mouth and exhale as if you are trying to fog a mirror, whispering “ahhh!” Humming Bee breathing increases oxygenation to tissues, soothes the nervous system, and ventilates the sinuses. Inhale through the nose, then do a prolonged exhale with a humming sound. Press your ear flaps with your fingers to focus on the humming vibration. .If someone is hyperventilating, they are quickly taking in oxygen but not exhaling enough CO2. Breathing in a paper bag makes them inhale their exhaled CO2 and restores balance. Finally Dr. Stroff said that observing your breath anchors your mind in the present. (See my blog post on Mindfulness.) Laurie Denomme, the founder of WECoach, an organization that trains and supports water fitness instructors, described a breath optimizing strategy developed by Carl Stough, the founder of the Institute of Breathing Coordination. His strategies were used with emphysema patients and later by Olympic athletes to handle greater workloads. He called one breath strategy “whisper counting.” First inhale, then as you exhale, in a low whisper count 1-2-3-4-5-6-7-8-9-10 quickly and as many times as you can until you naturally run out of air. Then take a breath.
I find this fascinating and I’m looking forward to practicing diaphragmatic breathing with my classes. See you in the pool!
