Table 1 Aquatic exercise program group

Warm-Up

(10 min)

Water walking: forwards, backwards, sideways—left and right. Progressively increase walking speed

3 min (30 s / direction)

Small hops: feet shoulder width apart, squat, then jump and bring feet close together and squat back down

1 min (30 s/ direction)

Leg kicks: kick front, kick out by side, kick back

1 min (30 s / leg)

Marching: raise knees, heel to buttocks—as tolerated

2 min (1 min each)

Horizontal kicking: on stomach, while holding onto edge of pool, kick legs and try to maintain body horizontal. Use floating device under the waist to modify difficutly

1 min (30 s each)

Upper body oscillations: Moving both arms in an oscillatory fashion from in front of you to out by your side

1 min

Bow and Arrow: rotate the torso by bringing your arms close to your body as if you’re shooting a bow and arrow. Alternate sides

1 min

Training

Session

(​​40 min)

Multi-directional Lunges: forward, backward, sideways lunges back and forth

2 sets × 10 repetitions / direction

Squats: Place both arms by your side. Bend down in a squat position and then return to starting position. Can control speed of exercise done to make it harder

2 sets × 1 – 2 min

Step-Ups: Using an underwater step, place one foot on the step with hands on your waist and transfer weight to step up

2 sets × 8—12 repetitions / side

Single leg squat: Stand on one leg with both arms by your side. Perform the single leg squat until the knee moves in front of the toes. Remove hand support to increase difficulty

2 sets × 8 – 12 repetitions / side

Standing Hip Abduction: Stand on one leg, while either maintaining your balance or holding on to the side of the pool. Bring the leg that you aren’t standing on outwards as far as possible as long as the movement comes your hip. Use an elastic band above the ankles to make the exercise harder

2 sets × 10 repetitions / side

Standing Hip Extension: Stand on one leg, while either maintaining your balance or holding on to the side of the pool. Bring the leg that you aren’t standing on behind you as far as possible as long as the movement is only coming from your hip. Use an elastic band above the ankles to make the exercise harder

2 sets × 10 repetitions / side

Concentric chest press + row: Lunge or squat down to chest-deep water and hold dumbbell floats vertically between hands with arms fully outstretched in front just below the water surface. Pull dumbbell floats close to the chest (bringing arms backwards towards body) and then push forwards to starting position, while staying put

2 sets × 1—3 min

Underwater punches: Lunge down to have your arms just below the water surface, with one arm fully outstretched in front and the other close to body. Holding Aqualogix dumbbells, perform alternate punching with each arm

2 sets × 1 – 3 min repetitions

Concentric Shoulder Flexion + Shoulder Extension: Place one arm by side and the other outstretched in front just below water surface with palms facing direction of movement. Alternately bring one arm upwards just below the water surface while bringing the other arm to the side. Use hand paddles to increase resistance and change the front leg between sets

2 sets × 10—20 repetitions

Knee Raises: Hold the aquatic dumbbell in each hand with arms by sides while in a seated position. Raise one knee until thigh is parallel to the surface of the water. Alternate legs

2 × 10—20 repetitions

Horizontal Woodchopper: Have your hands with your arms fully outstretched in front just below water surface. Rotate your torso gradually as far to one side as possible and then back to the midline. Alternately do the same with other side

2 sets × 10—20 repetitions / side

Diagonal Woodchopper: Have your hands with your arms fully outstretched in front just below water surface. Rotate your torso gradually as far to one side as possible while bringing the hands down diagonally and then back to the midline. Alternately do the same with other side

2 sets × 10 – 20 repetitions / side

Water Ab Rollout: Start in upright posture with arms outstretched in front of you and your hands resting on the surface holding dumbbell floats. Slowly move the dumbbell floats forwards while keeping your body in a neutral posture tilting on the tips of the toes, and then return to starting position. You should feel the movement working your abdominal muscles

2 sets × 10—15 repetitions

Cool-Down

(10 min)

Free water-activity: walking, standing, swimming

1 min

Stretching / Mobility exercises:

Hip CARs (controlled articular rotations)

2—5 × each leg

Stretching/Mobility exercises:

Standing quad stretch

2 × 30 s per muscle group

Stretching/Mobility exercises:

Standing hamstring stretch (extend leg + lean in)

2 × 30 s per muscle group

Stretching/Mobility exercises:

Anterior chain stretch: grab arms behind back + open up chest

2 × 30 s per muscle group

Stretching/Mobility exercises:

Seated Fig. 4 stretch

2 × 30 s per muscle group

Stretching/Mobility exercises:

Standing open book (hold onto side of pool, lift leg + rotate away)

2 × 30 s per muscle group

Relaxation: Lay on your back with a noodle supporting you under your waist and occiput and take deep breaths

1 – 5 min