Fall Prevention

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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.
  • 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.

See you in the pool!

Author/Instructor Photo
Chris Alexander

Train Your Brain

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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:

  1. Memory loss that disrupts daily life.
  2. Challenges in planning or problem solving.
  3. Difficulty completing familiar tasks.
  4. Confusion with time or place.
  5. Trouble understanding visual images and spatial relationships.
  6. New problems with words in speaking or writing.
  7. Misplacing things and losing the ability to retrace steps.
  8. Decreased or poor judgement.
  9. Withdrawal from work or social activities.
  10. 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!

See you in the pool!

Author/Instructor Photo
Chris Alexander


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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!

Author/Instructor Photo
Chris Alexander

Mindfulness and Water Exercise

Mindfulness is a state of active, open attention to the present. When you are attentive to the present, you are not thinking about events in the past nor stressing about the future. Mindfulness is an ability that we all naturally possess, but it is more readily available to us when we practice it. There are many situations in which mindfulness is beneficial. Dieticians recommend mindfulness during meals. When we pay attention to what we are eating, we are more aware of the taste of our food, we are more likely to chew thoroughly, and we are more alert to our body’s signals when we are full, preventing overeating and weight gain. The Department of Public Safety would like everyone to be mindful when they are driving a vehicle, aware of the other drivers on the road and able to anticipate what they might do in order to avoid collisions. Certainly texting while driving is not driving with mindfulness. Mindfulness while listening to music increases our appreciation of the piece by allowing us to hear the various musical instruments and how the musicians play off of each other and to enjoy the skill of the vocalist.

Certain forms of exercise, known as mind-body exercise, cultivate the practice of mindfulness. These include Yoga, Tai Chi, Ai Chi, and Pilates. Mind-body exercise focuses on breath, precision, control, and concentration. A mind-body exerciser is never oblivious to the exercises they are performing, nor do they read, watch television or videos, or wear headphones. They are mindful. Other forms of exercise, while not qualifying as mind-body exercise, can benefit from practicing mindfulness.

Water exercise classes involve a number of participants, and sometimes friends take the class together, therefore there is the temptation to chat during the class. However the benefits increase when participants perform the exercises with mindfulness. Movement in the water provides a different sensory experience from movement on land. Notice how the water feels against your skin, the resistance against different areas, and how it flows and ripples as you move. The water moves in response to your movement, which requires you to make an effort to maintain good posture, especially in deep water.

In fact, posture is one of the most important things to pay attention to when exercising in deep water. There is no floor under your feet which means you have to be alert to whether your shoulders are over your hips and your hips are over your feet. Once alignment has been achieved, bracing the core and sculling helps maintain neutral posture. Are you performing the exercises correctly? With a knee-high jog, press your heels down toward the floor and avoid bending forward. With a heel jog, keep the knees down and lift the heels in back. With a kick forward do not lean backward to make the kick higher, and conversely with a kick backward, do not lean forward to make the kick higher. Start an inner thigh lift and a hopscotch with the legs wide so that the exercise does not become the same as a knee-high jog or a heel jog. With a cross-country ski make sure your legs extend as far to the back as they do to the front. With a jumping jack making the arms and legs opposite will keep you from bobbing up and down.

Next pay attention to the movement of the water. Slicing hand positions move the least amount of water, fists move a little more water, and cupped hands that face the direction of movement move the most amount of water. Sculling is an important skill in deep water. Scull with the palms down and the hands in front of your chest or out to the sides to stabilize and prevent drifting. A propeller scull in a figure eight with the arms down by your sides makes you travel forward. A propeller scull in a figure eight with the fingers up and the hands in front of the chest makes you travel backward. Movements of the arms that pull the water toward the body make you travel forward, and movements that push the water away from the body make you travel backward. Leg movements can also assist with travel – movements to the back move the body forward and movements to the front move the body backward.

The ability to manipulate water effectively helps with stability and travel and allows you to use the water’s resistance to increase intensity. The next step is to focus on adding acceleration to your movements. Intensity increases when you push and pull and drag the water with power. Use power to increase turbulence during stationary moves or to increase speed of travel. Power the arms and legs toward center to propel the body upward, lifting the shoulders out of the water, for example with cross-country ski and frog kick. Power movements allow you to push your heart rate into the anaerobic zone for brief periods.

Mindfulness improves your water exercise experience in both deep water and shallow water. If you are an instructor, you can use periodization to help train your participants to exercise with greater mindfulness. Periodization divides the year into four seasons – Preseason, Transition Season, Peak Fitness and Active Recovery. It is also possible to use periodization for shorter time frames, such as six months, three months, or even one month. In the Preseason ask your participants to focus on their posture and cue them to perform the exercises correctly. In the Transition Season encourage your participants to focus on how their arm and leg movements manipulate the water. In the Peak Fitness Season tell them that they are ready for powerful movements that push them to the highest level of fitness they will achieve in this period. In the Active Recovery Season they will give their bodies time to repair any microtrauma caused by the months or weeks of continuous training so that the microtrauma does not lead to a cumulative injury. Options for active recovery include low intensity cardio, core strength training and fun activities such as modified synchronized swimming and games.

My book Water Fitness Progressions has information about periodization for both deep and shallow water, including lesson plans with variations for Preseason, Transition Season and Peak Fitness; strength training lesson plans without equipment and with buoyant, drag and rubberized equipment; and lesson plans and activities to use for Active Recovery.

See you in the pool!

Author/Instructor Photo
Chris Alexander

3 Pool Safety Tips Every Parent Should Know

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Plus Extra Resources So Your Summer Goes Swimmingly. Thanks to guest blogger, Jason Lewis from Strong Well.

Having a backyard swimming pool makes your house the place to be during the warm months. However, pools can be dangerous places if you don’t instill rules and use the right safety equipment. Here is a refresher and some additional guidance on how you can help your kids be safe swimmers and how you can make your pool a less dangerous place.

Raising Confident Swimmers

When your children feel confident in the water, they can become stronger and safer swimmers.

  • Teach your kids the basics of swimming at home. Start with kicking and blowing bubbles.
  • Or, you can sign your children up for swim lessons. The City of Plano offers lessons for ages 6 months-3 years, ages 3-5 years, and ages 6-12 years at Oak Point Recreation Center, Carpenter Park Recreation Center, and Tom Muehlenbeck Recreation Center. The Plano Aquatic Center offers lessons for ages 3-5 and 6-12. Registration opens May 7 at 8:00 AM for Plano residents. Registration begins May 9 at 5:00 AM for non-residents. Go to the Plano Parks & Recreation website and click on the Plano Recreation Catalogue to sign up.
  • When your kids are ready, get them comfortable with deeper water.
  • Make sure your kids know what to do in case another swimmer is in distress.

Prepping Your Pool

No matter how well your kids can swim, pools need a variety of maintenance and equipment in order to be safe environments.

  • Opening your pool for the season is no easy task, so consider hiring a pro.
  • If you don’t have one already, hire a local fence company to install a fence to prevent kids from falling in. 
  • If you live in a cooler area, consider getting a pool heater.
  • Keep in mind that if you make any significant changes to your yard, pool, or house, you could increase the appraisal value of the property.

Laying Down the Rules

Securing your pool and ensuring your kids are strong swimmers is a good start. However, to make your pool as safe as it can be, it’s also necessary to lay out the ground rules.

Swimming pools can be safe places as long as you take precautions and ALWAYS supervise your kids when they’re having fun. It also helps to make sure your kids are confident in the water and know how to stay safe.

If swimming becomes your child’s passion, consider signing him or her up for a swim team, The City of Plano has swim teams for both recreational swimmers and serious swimmers. They also offer lifeguard training and water safety instructor training for those who would like to teach swim lessons. Classes are offered throughout the summer. And while your child is participating in swim activities, you might want to consider taking an adult swimming conditioning class or a water aerobics class yourself. Sign up for sessions in the Plano Recreation Catalogue.

See you in the pool!

Author/Instructor Photo
Chris Alexander