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CancerLynx - we prowl the net
September 28, 2009

Aquatic Exercise
Mary Essert, BA, ATRIC

Water is a healing medium which offers therapeutic and normalization benefits to persons who are in cancer treatment or have completed their regimen. Recently, The American College of Sports Medicine (ACSM) has created guidelines for exercise for cancer patients which advocate moderate exercise several times per week. My theory is that aquatic exercise provides a comfortable introduction to movement which can then be expanded to land work as the individual is ready to progress.

Why? Water is comfortable:
- Buoyancy factor: when submerged to neck one experiences only 10% of body weight
- No Jolt
- Ease of movement
- Reduction of edema (swelling)
- Increased Range of Motion
- Increased Strength
- Promotes normalization
- Socialization
- Decreases stress and promotes relaxation
- Helps to prevent lymphedema
- Deep breathing enhances pumping in thoracic duct
- Muscle contraction in hands and feet helps venous return

Treatment goals include:
pain reduction, increased cardiorespiratory conditioning, education re: nutrition and weight management

There may be a downside:
- Some folks don't like water or are afraid
- Water may appear cooler than one likes. 86-88 deg. F. is good for exercise which may include an aerobic component. 88-92 deg. F. is comfortable for stretching and relaxation.
- Some folks don't want to be seen in a swimsuit for several reasons including a sense of personal disfigurement
- For some it is bothersome or fatiguing to dress and undress
- For some, any excuse will do - water is not for everyone.
- Beginning aquatic therapy depends upon your doc's knowledge, drains out, incisions healed, consider radiation and use good judgement in preventing any infection (some wait until finished) When an individual feels comfortable is a good rule of thumb for beginning any exercise program - the sooner the better.

Precautions to aquatic exercise in warm water:
- Fever over 100 deg.
- Uncontrolled cardiac, lung, seizure issues
- Open wounds
- Limited vital capacity
- Severe urinary tract disorders
- Respiratory tract or blood infections
- Tracheotomy
- Bowel Incontinance
- Menstruation w/o internal protection
- Sensitivity to pool chemicals
- Behavior problems
- At risk pregnancy

Further information includes the following precautions: (Courneya, S. et al., 2002)
- Be aware of blood count levels and ask health care provider re: side effects of treatment in relation to exercise
- Absolute neutrophil count less than or equal to 10: avoid activities that increase risk of infection such as crowded areas, class or with children who are prone to disease
- Hemoglobin less than or equal to 10 Avoid high intensity aerobic exercise
- Platelet count less than 50,000
- IV chemotherapy within 24 hrs avoid strenuous exercise
- Nausea: exercise to tolerance as it seems to dissipate after exercise
- Fatigue: decrease work load, gradually increase exercise tolerance and work out at times when you have the most energy, ie mornings.
- Ataxia, dizziness, peripheral neuropathy: Avoid activities that require balance as treadmill. Avoid uneven surfaces which may increase risk of falls such as outdoors. ("aquatic medium is excellent for strengthening core muscles, increasing balance, and decreasing falls." Essert)
- Bone pain/metastasis: Avoid activities which increase risk of fracture, ie high impact. Aquatic exercise could be particularly helpful in this instance because of reduced loading on musculoskeletal system.
- Lymphedema advisories: individual wears compression sleeve for land exercise, but the hydrostatic pressure of water serves the same purpose in the aquatic setting. This is one of the values of water therapy/fitness. Water temperature is a consideration. Warmer water decreases postural tone, encourages relaxation and decreases fear. (over 88deg. F.) Cooler water stimulates tone and alertness and makes aerobic work safe. Avoid water over 90 deg. F. with lymphedema symptoms.

Other benefits to the body's systems include increased cardiac output, more effective respiration, weight unloaded on musculoskeletal system and increased effectiveness of renal system. Added value for quality of life results in self acceptance, relaxation, pain reduction, sleep enhancement and positive effect from support group when in a class.

My advice to beginners:
- Set small, achievable goals
- Embrace wellness and commit to health
- Connect with friends or class members
- Enjoy good days, accept bad days
- Celebrate victory
- Expand your activities
- Recapture joy!
- Keep an exercise journal or log. Include comments re: posture, walking, balance, stretches, strength - amount of time spent on each
- Incorporate nutrition & social elements of life if you choose.

Other Techniques:
- Function is our goal, followed by quality of life. Land work may include mat work, standing and seated exercises, exercise ball techniques, Pilates, qigong, gentle yoga and tai chi for example. Transition to the norm - back to the sport and activity enjoyed prior to surgery is a goal. Avoidance of new or acute pain is wise. One should listen to his/her body. Cross training from water to land is a kind progression for the body.
- In order to accomplish one's best level of fitness for a given day, persevere - keep on keeping on.

Courneya, K.S., and J.R. Mackey. (2001) Exercise during and after cancer treatment: Benefits, guidelines, and precautions. International Sport Medicine Journal, 2001, 1(5):1-8.

Bio: Mary Essert, B.A., ATRIC, has been actively involved in teaching aquatics and exercise since 1949. In 1981 she experienced breast cancer and has worked to share exercise for and with that population since. A second cancer experience with a high grade sarcoma on the upper arm and lung cancer in 2007 has made her more determined to assist cancer survivors in their exercise and wellness programs. She is a certified Cancer Wel-Fit Instructor, Red Cross WSI, holds certification from Aquatic Exercise Association and is a Trainer for the Arthritis Foundation She has been honored by AEA, ATRI and twice by the International Swimming Hall of Fame. She is employed as a Water Fitness Instructor and Personal Trainer at Conway Regional Health and Fitness Center. She may be reached at

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