Table 1 Aqua-cycling programme

Interventions goals (ICF):

 - b710: mobility of joint functions

 - b715: stability of joint functions

 - b740: muscle endurance functions

 - b760: control of voluntary movement functions

 - b620: proprioceptive function

Exercises

1. Cycling at self-chosen rpm

2. Mobilisation of upper body

3. 60-rpm cycling = participants focus on pedalling at a minimum of 60 rpm

4.Lower leg exercises (1-2 exercises per session)

 4. 1one-leg pedalling

 4.2 emphasis on upward or downward pedalling movement

 4.3 out-of-the-saddle position: standing climb

 4.4 out-of-the-saddle position: standing flat

5. Arm exercises (1 exercise per session)

 5.1 shoulder abduction/adduction = arm lifts

 5.2 shoulder transverse abduction/adduction = fly backs

 5.3 shoulder flexion/extension = walking arms/ arm pendulum (one-sided)

 5. 4 elbow flexion/extension = curl

 5.5 shoulder flexion and extension = arm pendulum

   ➢ arm exercises will be combined with different hand positions (from less intense to more intense): sweeping on water surface, hand slicing sideways through the water (‘cutting’), ‘fisting’, cupped hands (‘scoop’), open hand (‘fan’)

6. Backward pedalling

7. Knee range of motion exercise = sitting on the aqua bike, feet out of the pedals, flexion and extension of unloaded knees

8. Calf and hamstring stretching

General information:

 -Main focus is on correct aqua-cycling technique, i.e. cycling with a cadence of 60 rpm, a good alignment of the lower legs and an upright posture

 -Set-up:

   • Warm-up: exercise 1, 2

   • Conditioning: exercise 3, 4, 5

   • Cooling-down: exercise 1, 6, 7, 8

 -Total programme duration: 12 weeks (2 sessions per week)

 -Frequency (exercise time/repetitions) and resting time:

   • Warm-up: 5–10 min

   • Conditioning: exercise 3: 5–8.20 min

      exercise 4: 4 sets of 30–45 seconds, 1 min resting

      exercise 5: 4 sets of 1 min (~20–40 repetitions) , 1 min resting

   • Cooling-down: 5–10 min

 -Intensity (conditioning): 11–13 Borg Scale/70% of maximum heart rate ((220-age) x 0.7))

 -Progression:

 • exercise 3: weekly increase of 15–20 seconds in cycling time

 • exercise 4: pedalling resistance (after session 6, depending on performance of the exercise plus no signs of overload in ongoing and previous sessions)

 • exercise 5: hand position > length of lever arm > speed/small to big amplitude > increased surface area using aqua gloves or discs (depending on performance of the exercise plus no signs of overload in ongoing and previous sessions)

 -Training devices:

 • Timer

 • Borg Scale

 • Aqua bike ‘AquaCruiser II®’

 • Aqua discs

 • Aqua gloves

 • Aqua dumbbells