How does one do "aqua therapy"
August 15, 2017 9:01 AM   Subscribe

I have postural orthostatic tachycardia syndrome (POTS) and chronic fatigue. My doctor has prescribed 10-15 minutes of aqua therapy 2x, to be gradually increased as it becomes more tolerable for me. YANMD, but do I need a physical therapist, or is this something that I can do on my own?

Full text of the prescription:

"Aquatic therapy: gentle and gradual water jogging and/or swimming. Exercise is the most important treatment (as important as any medication). Regular exercise is the only treatment that has long term benefit. Cardiovascular exercise may include water jogging, rowing, reclining, bike, etc. We recommend to start gently with a water jogging program or swimming for example before transitioning to land in a reclining or sitting position (rowing, reclining bike, etc.). Start at 10-15 minutes 2 times per week, and gradually build up over 6 months until you are at 45 minutes 4 times per week. You may need a physical therapy appointment or exercise trainer to help you. Avoid reaching the point of shortness of breath, profuse sweating or exhaustion during an exercise session. If exercise session results in extreme fatigue for the next couple of days, reduce duration of session and intensity of training. Rest at least one day between sessions early in the process. Drink fluids prior and after exercising. Goal is to get your heart rate to 75%. [includes a chart of heart rate in beats per minute for each intensity zone]"

The "you may need a physical therapist" is what's tripping me up. What would a physical therapist actually do in this instance, and would it be worth the cost (especially for something that happens multiple times a week) to seek one out? Keep in mind I have no injuries that I need to be careful of or anything; my body is just not used to exerting itself at all, because for approximately 10 years my body has not had enough "fuel," as my doctor describes it (in this case, I haven't had enough salt + my blood is all pooling in my legs) to be able to do so. I'm also extremely unlikely to find a physical therapist with any familiarity with my physical condition. So at that point would a physical therapist or exercise trainer really be doing anything I couldn't do myself in any pool? I've got a $5000 deductible and I'm a poor graduate student, so I'd really like to avoid spending a ton of money on this if it's not going to provide me a lot of benefit.

If I don't really need a physical therapist for this, would any gym with a pool be suitable for aqua jogging? Do I need any special equipment? I also haven't been in a pool for at least four years, so is there anything I would need to take into consideration (alone the lines of "shower before and after entering" which I totally forgot was a thing until someone mentioned it)?
posted by brook horse to Health & Fitness (8 answers total) 2 users marked this as a favorite
There are aqua joggers in the pool where I swim a lot so I can speak to that part of the question. Usually people who do this wear normal swim suits (and you're supposed to shower before you get in the pool but there are signs everywhere and you will be fine) and there are belts you wear which are like this (the other stuff can be helpful but don't worry about it) this keeps you upright in the pool and then you can sort of jog around. Very nice low-intensity exercise. Most pools that I have been to have this sort of equipemnt availabe but sometimes it's in a little room or something and you might feel it's not for you to use. It is for you to use! There's also stuff like kickboards, sometimes pool noodles, etc. You can call and ask if you are concerned/curious.

More pool stuff: some pools have towel service and some do not. You may want special swimmer shampoo for your hair. There is probably a thing where you can dry off your suit before you pack it with you, or maybe get a locker to keep your gear in. I kept all my best shampoos and soaps at the gym which encouraged me to go there.

My read on what you got is that some of those things listed really require someone to show you how to do it right or you risk injury. I don't think saquajogging is one of those things. However, I'm just a swimming enthusiast and not na medical person.
posted by jessamyn at 9:09 AM on August 15, 2017 [2 favorites]

My interpretation of that instruction is that if you try this out and are struggling to make it work (for example, you find that no matter what you do, you always end up extremely fatigued the next day, or you can't figure out how to do the aqua jogging without shortness of breath/exhaustion, or you're trying to do the exercises but they just don't feel right), then you might seek out a trainer/therapist. But, from your description, it doesn't sound like you're in serious danger of, say, a major injury by just giving it a try on your own and seeing how it goes. If you do that and for some reason it's not working out, you can then seek out more help.

You can also call your doctor and ask him/her to clarify -- do they recommend a trainer/therapist, and if so, can they refer you to someone with knowledge/expertise of your condition, do they feel it would be unsafe for you to at least try doing it on your own first, etc. etc. They should not charge you for a phone call clarifying your prescription.
posted by rainbowbrite at 9:24 AM on August 15, 2017

You could start with youtube just to give yourself some relief from the anxiety of not knowing what you're being told to do.

Call around your local gyms and Ys. There are aqua jogging programs, often targeted at seniors, where you can learn the basics, or at least orientation programs so the joggers/walkers and the lap-swimmers don't escalate to fisticuffs getting in each others' way.

That's also what a PT would do: teach you how to do it, probably with some tips about starting easy and increasing the difficulty for yourself as you're ready. Not go to the pool with you every time, just show you what to do once, maybe twice if you need follow-up.

PTs will be familiar with POTS since it's co-morbid with a number of conditions. Maybe not with CF specifically but they should have experience with patients who are medically fragile.
posted by Lyn Never at 9:33 AM on August 15, 2017

physios can be hella handy in showing you the ropes with the entire deal. they'll show you the correct technique, will adjust the routine to your body, strength and other capabilities, and teach you to recalibrate when you might be doing something in the wrong form - like if you start getting too tired for instance. oh! and show you stuff that didnt even occur to you! then you can hook up with 'em a few months down the line to check on your progress etc.

i know its an extra buck, but they are worth their weight in gold.
posted by speakeasy at 9:54 AM on August 15, 2017

Is there a teaching hospital at your university or one nearby? I think I paid $40 every two weeks for twice-weekly sessions with an aquatic physical therapist at the university here. There'd be four or five of us in the pool, with one therapist, so it was cheaper than one-on-one therapy.

I was prescribed aquatic therapy in conjunction with some other physical therapy. Even the sports medicine docs I saw seemed not to be aware of it's existence, but there was a small, indoor pool hidden deep in the physical therapy department I used. I think it was a closely guarded secret, because it would be overwhelmed with users if it were widely known. Physical therapists were there to help you in and out of the pool, suggest various kinds of movements based on your needs, watch for signs that you might be pushing too hard, etc... Movement in the water can be deceptively easy, and you can suddenly find you've overdone it, especially if you're deconditioned.

After a few weeks of gentle, guided aquatic therapy, I transitioned to using a pool at another gym. You can just claim the slow lane in a lap pool when it isn't too busy. You may find a scheduled "water aerobics" time somewhere affordable, but I've found the "instructors" at various fitness programs (public pool, YMCA, private gyms...) usually play loud music, shout a lot, and aren't very aware of folks who may be about to pass out from fatigue.

The only special equipment I'd suggest is some kind of footwear, for traction and protection. There are decent water shoes at various price points (try SwimOutlet) but you can use the non-slip bed socks given to hospital patients. Good luck, and enjoy the water.
posted by Atelerix at 10:04 AM on August 15, 2017

The indoor year-round at my community center is 4.5 ft deep at its deepest, so some people literally just walk up and down the length of it. I have no problem swimming in it.

If there's a pool like that near you try it out, start with just walking then build up to water jogging or swimming. If just walking wears you out too much, then try to find an instructor. I don't think it necessarily would have to be a physical therapist, the swim teachers at my pool are very good at teaching people of all ages.
posted by mareli at 10:20 AM on August 15, 2017 [1 favorite]

I am you. I have CFS/ME and NMH (close to POTS, similar issue with fainting during any standing). I have been working out in the pool for 25 years and it's improved my life 100%

I began by working with a PT. While water is a very forgiving environment, you can still do damage through poor technique. Then I graduated to being teaching material for the Kinesiology & PT students at our campus -- they take a course called "Adaptive Exercise" and we were their living assignments. THE CLASS WAS FREE -- maybe your university has something similar? After two semesters of Adaptive Exercise in 1995, I set myself free in a guarded community pool. (I also have asthma, and I sometimes faint on getting out of the pool, so having a guard feels safer for me).

The biggest issue for me was water temperature. "Warm water" pools (over 88°F) make me faint. "Athletic" pools are chillier, between 76° & 80°. My "just right" leisure pool is 83-84°. That would still be too cold if I didn't wear a unitard suit, 100% poly fleece socks & water shoes, 100% poly fleece vest, and neoprene cap.

Shower before entering is a good thing: I use the warmest water that doesn't make me faint, and get thoroughly soaked. This preheats me, and because my skin and hair are drenched in clear water, they tend to absorb less chlorine (or other chemicals) from my time in the pool.

The key for me was doing just enough, and I overdid A LONG TIME. (I'd been a half-mile-a-day swimmer before I got ill.) Because I've never passed out in the water, it was easy for me to get caught up in the joy of movement. I returned to swimming distance, a huge mistake. Now I exercise for a set time: on good days I do more in that time, and on bad days I'm still in the water.

My optimal workout is 23 minutes every other day. Once I jump in, I do brief jumping jacks to warm me up, then stretchy ski-motions, jumping jacks, the Pilates move "The Hundreds" modified for the water, then swim 3-stroke crawl, backstroke, and breaststroke very mindfully, then stretch out with leg circles, toe ladders, and back float.

I don't use a float belt because my body floats well (and I've been a swimmer for 50 years).

tl;dr Definitely worth spending money on a PT, especially if they're fluent in hydrotherapy. Start more slowly than you can possibly imagine, and increase very cautiously. Investing now could enable you to reconnect with the wonders of embodiment.

Memail me!
posted by Jesse the K at 10:35 AM on August 15, 2017 [4 favorites]

also have POTS (and some near ancient physical fitness instruction training).

Seconding (and emphasizing!) Jesse the K's advice about choosing a pool that ISN'T hot (keep away from hydrotherapy pools). POTS and heat is a recipe for fainting. Also keep away from hot showers.

In your shoes I'd look for a PT (who is familiar with POTS. many should be) AND has some background as a physical fitness trainer - to build a very very gradual long term workout plan AND accompany you in the pool for the first two weeks of the plan (to explain and correct AND adjust the plan after seeing how you're doing).

Ten years of no physical exertion is a lot. It would be wise to start a plan that has you walking (not jogging) in the water. I'd build up a few months of stamina walking before attempting any any kind of jumping or jogging in the water.

Be well!
posted by mirileh at 10:59 AM on August 15, 2017 [1 favorite]

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