Water Exercise in Patients With and Without Cardiovascular Disease: Benefits, Rationale, Safety, and Prescriptive Guidelines

Research regarding the benefits of exercise-based cardiac rehabilitation is extensive and well documented. Water exercise, in the form of stretching, walking, jogging, aerobics, strength and balance training, and swimming, provides an attractive alternative from traditional land-based exercise for achieving improved health and fitness. Patients with orthopedic or musculoskeletal limitations, pulmonary disease, excess adiposity, and other medical conditions may significantly benefit from a water-based exercise program. Although water exercise is beneficial for varied patient populations, the safety and appropriateness of higher intensity activities such as swimming should be considered. Because coronary patients have a reduced ability to identify ischemic symptoms in water, water exercise should be prescribed with caution in high-risk patients, individuals with limited swimming skills, and those with significant left ventricular dysfunction. Furthermore, the acute physiological responses during water submersion and exercise may vary considerably from land-based activity and require attention when prescribing a water-based exercise program for patients with and without coronary artery disease.