Aquatic Exercise Programming for People with Multiple Sclerosis MATERIALS FOR AQUATIC EXERCISE INSTRUCTORS Edited by Deborah P. Hertz, MPH, National Director, Medical programs Clinical Programs Department National MS Society, New York, NY. 212-476-0468. Contributors: Helen Tilden, RN, National MS Society, Georgia Chapter Clinical Advisory Committee and National MS Society, Special Project Consultant Miranda Mirsec MA, CES, National MS Society Southern California Chapter Programs Manager, Physical Health and Recreation Brian Hutchinson, MS PT, President, Heuga Center and National MS Society Clinical Consultant December 2003 The Professional Resource Center The Professional Resource Center (PRC) of the Clinical Programs Department supports the work of health professionals by providing a range of library and literature search services, as well as information and consultation about the disease and its management, insurance and long-term care issues, and the Society’s professional education opportunities. For more information: • Toll-free number: 1-866-MS-TREAT (1-866-678-7328) • Email: [email protected], [email protected] • Professional website: nationalMSsociety.org/For-Professionals/Clinical-Care Acknowledgements This manual has developed over time thanks to the efforts of many Society chapter staff and volunteers. Connie Divine, TRS, Patricia Finlay, McSP/PT and Helen Tilden, RN, of the Georgia Chapter, developed an aquatics manual in 1993 that was subsequently adopted as a national model. The vision for the new format came from Denise Nowak, RD (certified by the American Council on Exercise) and Miranda Mirsec, MA, CES of the Southern California Chapter. A special thanks is also due to Amy Brown (Mid South Chapter ), Suzanne Carrone (Gateway Area Chapter), Connie Nesbary (Michigan Chapter), and Jo-Ellen Zembruski (New York City Chapter) for their input. Brian Hutchinson, MS, PT, National MS Society Clinical Consultant and Nancy Holland, EdD, RN, MSCN, Vice President, Clinical Programs Department reviewed this manual. Front cover photo: Robert, diagnosed in 1990 © 2016 National Multiple Sclerosis Society. Contents Aquatic Programming for People with MS ................................................................................................2 Why Water Works?!? ..........................................................................................................................................................2 Aquatic Programs for People with MS ........................................................................................................................2 ............................................................................................2 Focus on Function ................................................................................................................................................................3 Benefits and Considerations of an Aquatic Program Strategies for Adapting Movement ..............................................................................................................3 Using the Physical Properties of Water ......................................................................................................................3 .......................................................................................................................................4 ....................................................................................................................................................................4 Considering Functional Levels Impact Options for Aquatic Exercise ...........................................................................................................................5 Body Mechanics Use of Equipment .................................................................................................................................................................6 General Exercise Principles .............................................................................................................................................8 Exercises for People with MS .........................................................................................................................8 Marching/Alternating ..................................................................................................................................9 .............................................................................................................................................................................10 Knee Lifts Static Hamstring Stretch ................................................................................................................................................10 Side Steps .........................................................................................................................................................11 Trunk Twists—Spinal Rotation ..................................................................................................................................11 Active Chest Stretch .........................................................................................................................................................11 Walking .................................................................................................................................................................................11 Leg/Hamstring Curl ............................................................................................................................................................................12 Cross Country Ski ..............................................................................................................................................................12 Pelvic Tilts Rocking Horse ....................................................................................................................................................................12 ..............................................................................................................................................................13 ......................................................................................................................................14 Straight Leg Walk .........................................................................................................................................15 Side Tilt/Lateral Weight Shift Class Structure and Cueing ...........................................................................................................................20 Additional Exercise Options Lesson Planning ...............................................................................................................................................23 Cueing ..................................................................................................................................................................24 Music ....................................................................................................................................................................24 Pool Safety and the Environment ...............................................................................................................24 A National Multiple Sclerosis Society Aquatic Program .....................................................................26 .............................................................................................................................................................................26 Objectives Aquatic Programming for People with MS WHY WATER WORKS?!? for many people with MS. Cool water with MS provides an opportunity to maintain Water is a very inviting exercise environment mobility, prevent secondary symptoms of MS, maintain or improve flexibility, maximize temperatures—80-84 degrees Fahrenheit— muscle strength, and maintain or increase endurance potential. helps to keep coreIntro body to MS temperatures for Fitness andlow, Wellnessreducing the Professionals chances of overheating. As aquatics program for people with MS is 80–84 temporarymentioned worseningin of MS symptoms. The recommended pool temperature for an , overheating can cause degrees.BENEFITS AND CONSIDERATIONS OF AN AQUATIC PROGRAM The natural properties of water—including From Report of the Surgeon General buoyancy or weightlessness combined with learnresistance—create to use the properties an excellent of water environment to best , United for movement and exercise. Participants can States Department of Health and Human Services, (1996), “People with disabilities meet their specific exercise/fitness needs. are less likely to engage in regular moderate Likewise exercise in a pool offers stability and activity than people without disabilities, yet support to practice functional activities such as they have similar needs to promote their health ambulation. Water often provides support many and prevent unnecessary disease.” The report people with MS need to stand and maintain also recommends “community based programs balance for exercises that would otherwise be to meet the needs of persons with disabilities.” tooAQUATIC difficult onPROGRAMS land. A community based aquatic exercise program FOR PEOPLE WITH MS is an excellent way to add activity, strengthen The purpose of an aquatic recreational program the cardiovascular system, reduce body fat, and Waterdecrease offers stress. benefits such as: • senseis socialization of