8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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PARKINSON’S DISEASE AQUATIC THERAPY HELPS PATIENTS

PARKINSON’S DISEASE AQUATIC THERAPY HELPS PATIENTSHome > Blog > Aquatic Therapy > Parkinson’s Disease Aquatic Therapy Helps Patients

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

https://www.hydroworx.com/blog/aquatic­exercise­benefits­people­with­parkinsons­disease­free­webinar/ 2/17

 

Parkinson’s disease is a chronic and progressive disorder that impactsmovement and coordination. Symptoms happen because of the loss ofneurons and decrease in dopamine production in the brain. Patients withParkinson’s can have many di삒ⴏerent symptoms, including:

TremorsRigidity or sti삒ⴏness, especially a삒ⴏecting the limbs and torsoSmall movementsImpaired balanceSlow movement or movements that are too quickDecrease in facial expressionsProblems with coordination or mobilityA weak or quiet voice

The brain has important brain cells called neurons, which are responsible forsending information to gland cells, nerve cells and muscle cells. Parkinson’scauses some neurons to function incorrectly and die.

The condition especially a삒ⴏects the neurons in the substantia nigra, animportant part of the brain. The neurons a삒ⴏected by Parkinson’s producedopamine. This chemical sends information related to coordination andmovement, which is one reason why patients with this condition have trouble controlling the movement of their bodies.

HELPING PEOPLE WITH PARKINSON’S DISEASE

According to the Parkinson’s Disease Foundation, nearly one million Americans live with the condition. Worldwide, 7-10 million people area삒ⴏected and about 60,000 new cases are diagnosed in the United States each year. In addition to diagnosed cases, thousands of Americans live

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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with Parkinson’s without knowing it.

According to the foundation, aging is an important risk factor for Parkinson’s disease.  There is a two to four percent risk for Parkinson’s amongpeople over age 60, compared with one to two percent in the general population. The average age at which the condition is diagnosed is 62,and as the baby boomer generation ages it is expected that diagnoses of Parkinson’s may double.

Scientists do not know exactly what causes the condition, and there is no known cure. In many cases, people who are diagnosed with the conditionare given medication or are treated with surgery. While these options do not treat the condition, they can improve quality of life and can helpmanage symptoms.

Some patients are choosing to improve the quality of their life and their overall health to manage symptoms. To do this, patients are turning to:

Natural supplements such as:1. Vitamin E2. Creatine3. Vitamin C

Therapies such as:1. yoga2. meditation3. aquatic therapy

In many cases, these types of Parkinson’s disease therapy solution can be combined with medication and surgery or can be used alone to helpmanage symptoms.

WHAT IS WATER THERAPY?

Aquatic therapy refers to any exercise or therapy that is conducted in a controlled and monitored water environment — usually a pool. Forexample, aquatic exercise inside a pool, usually a heated pool, can involve exercise to improve 䀃ቯtness levels or overall conditions. Aquatic physicaltherapy involves physical therapists using physical therapy protocols in a pool or water setting.

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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Aquatic therapy can be used to help patients with cardiovascular conditions, minor injuries and serious illnesses such as Parkinson’s. Evengenerally healthy patients and high-endurance athletes turn to this form of therapy to improve endurance and to rehabilitate various injuries.

HISTORY OF WATER THERAPY

Water therapy has been used since ancient times, dating back to 400 BC and potentially earlier. By the 17 and 18 centuries, scientists wereconsidering the chemical components that could make this type of therapy more e삒ⴏective, and by the 19 century there was interest in varyingthe temperature of the water to improve e䀨犱ciency. For centuries, natural heated springs and spas were a solution for those su삒ⴏering a variety ofailments, and doctors prescribed “taking the waters” to deal with pain and discomfort.

Today, water therapy continues to be a widely recognized form of therapy for many conditions, including Parkinson’s disease. In 2005, $46 millionwas spent on aquatic therapy in the United States and accounted for about 3% of the codes billed to Medicare.

PARKINSON’S DISEASE AQUATIC EXERCISE: WHAT YOU NEED TO KNOW

People with Parkinson’s disease who exercise regularly move and maintain balance better than those who do not. Water boasts unique propertiesthat enable it to be used for both therapy and 䀃ቯtness, especially for persons who cannot comfortably move on land, as is o쁱ꧼen the case for peoplewith Parkinson’s.

REDUCING A FEAR OF FALLING

In water, the fear of falling evaporates. The biggest danger to people with gait and balance issues, gravity, is simply not an issue in the pool. Thebuoyance of the water can make fear of falling much less. Even if a patient does stumble, the risk of injury is minimal.

Aquatic therapy equipment, such as HydroWorx therapy pools, comes with support bars and other tools to o삒ⴏer added assistance for those whorequire it. The pool becomes a safe and supportive place for therapy and exercise. Patients can work with physical therapists with the added

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8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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con䀃ቯdence of knowing falling is less likely and there are bars and other safety protocols in place to help them even if they do lose balancetemporarily.

Water’s buoyancy immediately renders anyone submerged to feel lighter than he or she would on land. Depending upon the level of submersion,up to 80-90 percent of a client’s body weight could be counteracted. Thus, a 200-pound man would move as if he only weighed 20-40 pounds. As aresult, his movements would take less e삒ⴏort than if he were doing the same movements in a land-based environment.

EASIER MOVEMENTS

The assistance of buoyancy allows for bigger movements. Clients can practice walking with a more normal or exaggerated gait and carry outprogressively larger ranges of motion. At the same time, forces of resistance and turbulence challenge balance and coordination. In addition, thesoothing, warm temperature relaxes muscles and helps lessen rigidity and pain. When someone with Parkinson’s is able to 삃ቯoat and move in apool, they feel so much freer than on land. Participants can stand up tall, with increased truck extension and move more freely.

Parkinson’s patients most notably su삒ⴏer from tremors, and water can assist with this as well. A warmer pool can soothe muscles while the naturalresistance of the water relaxes movements. Tremors are lessened and patients have more time to respond and focus on movement.

Since the water is o쁱ꧼen kept warmer in these sessions, it is important to keep the air warmer as well for comfort and to prevent shivering. O삒ⴏeringclothing or a covering when patients get in and out of the pool can also help keep patients comfortable.Aquatic therapy o삒ⴏers the added bene䀃ቯt of hydrostatic pressure, or the force exerted by the water on the body. Even patients who have moreadvanced Parkinson’s can enjoy some of the bene䀃ቯts of being submerged in an aquatic therapy pool. Hydrostatic pressure can:

Reduce swellingReduce painHelp the heart and boost circulationReduce sensory input to the brainReduce the pooling of blood in the extremities

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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For all these reasons, even someone who is new to aquatic therapy and exercise may 䀃ቯnd some bene䀃ቯt and relief simply by getting into the pool.Physical therapists can use this initial improvement to motivate a patient to try exercises and movements the patient thought were not possiblefor them.

In the water, low-impact exercise is possible and is easier to achieve. On land, each step may cause stress on joints, muscles, and tissues, but in thewater the buoyancy naturally creates less stress on the muscles and the body. Patients who cannot easily move on land sometimes 䀃ቯnd theirmobility much easier in the water. At the same time, the water provides some resistance to improve the e삒ⴏectiveness of exercises.

Since Parkinson’s patients may worry about falling and about movement, this can prevent them from exercising. The reluctance can meanmuscles weaken further without exercise, leading to even smaller ranges of movement.

Patients who don’t bear weight and attempt to exercise may 䀃ቯnd themselves moving less, eventually losing con䀃ቯdence and independence. WithParkinson’s disease exercise programs in an aquatic therapy setting, patients feel more comfortable, which can encourage them to exercise sothey can gradually build up strength.

A RANGE OF EXERCISES

A range of Parkinson’s disease therapy exercises are possible with aquatic therapy. Let’s run through the most important ones.

STA N D I N G E X E R C I S E S

Patients can try standing and stretching in place or marching to improve core strength. Focus on posture can also help build strength and posturalstability, which can be an issue for those living with Parkinson’s disease.

ST R E N G T H E N I N G E X E R C I S E S

Leg li쁱ꧼs are made easier with the buoyancy of the water and can help strengthen muscles to improve walking and mobility. Hip extensionexercises and walking on the treadmill can improve posture and mobility. Physical therapists can lower or raise the water levels in therapy pools

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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so that patients who are working on postural and leg exercises in the water can be half-submerged.

WA L K I N G E X E R C I S E S

To help with walking, patients can be submerged further. At 䀃ቯrst, patients may want to hold onto the support bars for balance, but with timepatients 䀃ቯnd they may be able to walk without the assistance of the bars, especially when submerged up to the neck. As patients work on simplemovements and walking, they can slowly regain agility, balance and coordination. Patients can walk:

BackwardForwardWith side steps

These exercises encourage a range of movements to improve posture and 삃ቯexibility. With each repetition, endurance and strength improve.

As patients improve their walking and movement, they can enjoy the bene䀃ቯts of a low-impact aerobic exercise in the pool. This is especiallyimportant for Parkinson’s patients, who may get less aerobic exercise if they worry about falling or experience mobility problems.

Without aerobic exercise, patients may 䀃ቯnd they experience overall weakness or loss of conditioning. Lack of aerobic exercise can also lead tohigher blood pressure or heart health issues over time. Aquatic therapy puts aerobic exercise within reach for many Parkinson’s patients, allowingthem to reap the reward of this type of exercise.

ST R E TC H I N G E X E R C I S E S

Yoga, Pilates and other exercise modalities are also very possible in an aquatic therapy setting and potentially o삒ⴏer plenty of bene䀃ቯt to Parkinson’spatients. Both yoga and Pilates encourage a range of movements and deep breathing exercises that can build con䀃ቯdence, 삃ቯexibility and strength.

On land, these exercises can be very intimidating for Parkinson’s patients but they become more possible when adapted for therapy pools becausethe buoyancy of the water supports patients as they try new movements. Pilates, yoga and other exercises can also be very e삒ⴏective in the waterbecause the water o삒ⴏers natural resistance, making the muscles and the heart work harder to get through the resistance.

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

https://www.hydroworx.com/blog/aquatic­exercise­benefits­people­with­parkinsons­disease­free­webinar/ 8/17

WHOLE-BODY HEALING

Since movement in the water is easier than it is on land, patients immediately get a con䀃ቯdence boost once they see movement is easier than theyexpected. Con䀃ቯdence in the pool can lead patients to try more exercises and movements.

One of the big challenges with patients who have Parkinson’s and other chronic conditions is patients may su삒ⴏer a range of disappointments.Patients may have tried exercises or movements and not been successful, making them reluctant to try again because they believe they “can’t” doa speci䀃ቯc move. Water therapy and exercise can show patients they can, which can make them more cooperative to try di삒ⴏerent Parkinson’sdisease exercise protocols.

Aquatic environments are also a great place to move facial muscles, practice breath control and vocal volume.  O쁱ꧼen, clients enjoy creating anecho, blowing bubbles or ping pong balls across the pool.  Counting repetitions forward or backward by twos and threes, quickly changingdirections on command, and discussing historical or current events speci䀃ቯcally stimulate the brain while exercising.The combination of social, mental and physical activity in aquatic therapy can help Parkinson’s patients. Patients who try this type of therapyreport:

A wider range of movementBetter stabilityGreater independenceIncreased con䀃ቯdenceBetter quality of life

One of the things that can be frustrating about a Parkinson’s diagnosis is patients are told the condition is chronic and progressive. Patients worrythere is no cure and they will slowly lose independence. With aquatic therapy and exercise, patients can see they are managing symptoms and insome cases improving mobility and function, improving their outlook as they improve their physical condition.

Water-based therapy can also encourage patients to keep moving. According to neurologist Dr. Lynn Struck of Iowa Parkinson DiseaseInformation and Referral Center, among patients who exercise and stay 䀃ቯt early on, motor skills and mobility can be preserved for longer and at ahigher level. In addition to intangible bene䀃ቯts, Parkinson’s disease exercise therapy and aquatic therapy o삒ⴏer real, tangible bene䀃ቯts.There may be other, less tangible bene䀃ቯts for patients who try aquatic therapy:

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

https://www.hydroworx.com/blog/aquatic­exercise­benefits­people­with­parkinsons­disease­free­webinar/ 9/17

Group classes can encourage socializing, which can reduce the risk of anxiety, depression and isolation that chronic disease can sometimescause.Exercise has been shown to reduce stress and to improve con䀨犱dence, which is also useful for patients su삒ⴏering from a serious diseasesuch as Parkinson’s Disease.Aquatic therapy can be relaxing and soothing, which is important in reducing the stress and possible emotional upset of living with aserious condition.

Just as healthy patients will feel soothed by climbing into a warm bath and anyone can feel more relaxed by 삃ቯoating in a pool on a warm day,patients with Parkinson’s can experience the tranquility that comes with being safely submerged in warm water.

For physical therapists, aquatic therapy pools o삒ⴏer a range of tools that can help them assist patients. HydroWorx pools, for example, o삒ⴏer:

Underwater video monitoringAdjustable depthMoveable 삃ቯoors that double as an underwater treadmillTherapy and resistance jetsHydro massage

Many physical therapists and doctors recommend a water-based Parkinson’s disease exercise program for patients. In fact, the AmericanParkinson Disease Association has recommended aquatic therapy as a good option for Parkinson’s patients.

THINGS TO CONSIDER WITH PARKINSON’S DISEASE AQUATIC EXERCISE

Although aquatic therapy o삒ⴏers a range of bene䀃ቯts for Parkinson’s patients, there are a few things physical therapists, athletic trainers and group䀃ቯtness instructors will want to consider when leasing or buying Parkinson’s disease exercise equipment and o삒ⴏering aquatic therapy.

1) Patients May Be Challenged by BuoyancyWhile buoyancy in the pool can make movement easier and can strengthen the core, it can also o삒ⴏer a challenge for patients just starting out and

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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patients who have weakened or spastic muscles and extremities. This can cause balance problems in the pool. Using grab supports or 삃ቯoatsupports can help, especially as patients slowly gain strength and con䀃ቯdence.

2) Patients May Feel Stress and Trepidation at FirstPatients who have already tried a number of therapies without success may not have high expectations. Some may worry whether they can staysafe in the pool with a limited range of movement. For many people with physical challenges caused by Parkinson’s and other conditions, simplybeing seen in a bathing suit by others can be stressful.

There are many things that can help patients with these concerns. Testimonials from other patients and more information about aquatic therapycan help. Explaining the therapy pool, Parkinson’s disease therapy protocol, and exactly what will happen in and out of the pool can also be useful.Open communication, sensitivity and humor can help patients overcome trepidation, shyness and worry in many cases.

3) Environment is ImportantIn addition to developing a Parkinson’s disease physical therapy protocol and leasing or buying the needed equipment, creating the rightenvironment is important. Creating a pleasant therapy area and o삒ⴏering plenty of time for questions and treatment can be helpful. Colors andmusic can create a pleasant and relaxing environment. A good balance of privacy and support can also help patients feel more comfortable.

 

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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HOW EFFECTIVE IS PARKINSON’S DISEASE AQUATIC THERAPY?

A number of exercise research studies have shown Parkinson’s disease aquatic therapy can be very e삒ⴏective, even when compared with othertypes of Parkinson’s disease exercises and therapies.

For example, a 2011 research study published in the Archives of Physical Medicine and Rehabilitation compared Parkinson’s disease aquatictherapy and land-based Parkinson’s disease therapy. The study’s authors concluded postural stability improved “signi䀃ቯcantly” more for patientsusing aquatic therapy.In 2013, Brazilian researchers published a study in the journal Advances in Parkinson’s Disease. The researchers examined Parkinson’s patientsbefore and a쁱ꧼer aquatic therapy and concluded that motor skills of the patients improved a쁱ꧼer Parkinson’s disease aquatic exercises in a heated

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pool.A 2012 study published in Gait & Posture found patients who worked with aquatic exercise programs showed better hip angle, gait, speed andstride length. Many other studies have supported these 䀃ቯndings, concluding aquatic therapy and exercise are an e삒ⴏective way to assist Parkinson’spatients. Some studies have also concluded aquatic therapy is e삒ⴏective for Alzheimer’s and other serious conditions as well.

WATCH AND LEARN HOW AQUATIC THERAPY HAS HELPED THIS PARKINSON’S PATIENT:

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8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

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FINDING OUT MORE ABOUT PARKINSON’S DISEASE EXERCISE RECOMMENDATIONS

If you’d like to see the power of Parkinson’s disease physical therapy and aquatic therapy for yourself, request a free informational kit fromHydroWorx to learn more about owning or leasing a therapy pool. You can also browse the HydroWorx website to 䀨犱nd out more about aquatictherapy research and 䀃ቯnd other resources that can help clinicians maximize the properties of water and creatively challenge clients withParkinson’s disease.

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8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

https://www.hydroworx.com/blog/aquatic­exercise­benefits­people­with­parkinsons­disease­free­webinar/ 14/17

Bigger is Better: Aquatic Exercise Bene䀃ቯts People with Parkinson’s Disease, a free webinar, presented by Cathy Maloney Hills and Christine Shidlaon March 21, 2013 from 2 to 3pm EST.

This webinar will provide tools for therapists, personal trainers and group 䀃ቯtness instructors to maximize the properties of water and creativelychallenge clients with Parkinson’s disease. ICAA Members can watch the webinar on demand here>>

SPEAKER BIOS:

Cathy Maloney-Hills, RPT, is an aquatic physical therapist working for Courage Center at Summit Place Senior Campus, Eden Prairie, MN andHeritage Park Senior Services Center in Minneapolis, MN. She is co-investigator/author for the study and program: Golden Waves® FunctionalWater Program for Older Adults, University of Nevada, Reno and a co-author of the YMCA Water Fitness for Health.

8/26/2016 Parkinson's Disease Aquatic Therapy Helps Patients ­ HydroWorx

https://www.hydroworx.com/blog/aquatic­exercise­benefits­people­with­parkinsons­disease­free­webinar/ 15/17

Christine Shidla is the Director of Wellness at Summit Place Senior Campus, Eden Prairie, MN.  She is also a trainer and speaker for exercise for theArthritis Foundation. Christine received her Bachelor of Science Degree in Kinesiology, with emphasis in Sports Medicine, from the University ofMinnesota.

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