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Cardiovascular disease is the leading cause of morbidity and mortality in the United States, accounting for almost 50% of all deaths (U.S. Department of Health and Human Services, 1995). Although the effects of cardiovascular disorders are severe, risk factors such as hypertension and hyperlipoproteinemia can be easily modified and even eliminated by both medication and life-style changes. Conversion of the general population from a sedentary to an active life style could reduce the incidence of coronary heart disease by as much as 33% (Oldridge, Foster, & Schmidt, 1988). With adequate medical guidance, carefully designed and supervised aquatic activities would be an excellent venue  for the improvement of cardiac conditions.

Pre-Activity Considerations for the Aquatic Environment 

  • Medical permission and advise must be obtained and all contraindicated activities eliminated.
  • Carefully planned and supervised physical activity is medically prescribed and highly recommended for rehabilitation of many cardiac conditions.
  • The adapted aquatic specialist must be aware of the recurrence of symptoms and should report them to the individualís physician before continuing the aquatic sessions.
  • If the physician has advised the individual to take medication before exercise, the instructor should check with the individual to be sure the medication has been taken.

Activity Considerations

  • Best practices in exercise prescription and programming must be used.
  • Frequent rest period may be recommended.
  • Communicate frequently about exertion level.
  • Encourage calorie-burning, low-intensity aquatic exercise.
  • Rest strokes (side stroke; elementary back stroke) may be taught in preference to work strokes for individuals whose exercise tolerance is low.
  • The use of appropriate music is advisable when working with individuals for whom relaxation has been recommended.
  • Efficiency of effort in performing skills should be given high priority.
  • The individual should move slowly when changing body positions as the heart needs time to compensate for the new position.
  • Encouragement should be given often by instructor.

Safety Considerations

  • Monitor pulse rate (before, during, and after) and blood pressure (before and after) to make sure the individual exercises within physician-approved target zones.
  • Be aware that water pressure affects elasticity of the lungs, causing difficulty in expansion and contraction. Aquatic activities may be contraindicated in individuals with heart failure or mitral valve obstruction due to breathlessness resulting from water pressure (Lepore, Gayle, & Stevens, 1998).


Lepore, M., Gayle, G. W., & Stevens, S. (1998). Adapted Aquatics Programming. Champaign, IL: Human Kinetics.

Oldridge, N. B., Foster, C., & Schmidt, D. H. (1988). Cardiac Rehabilitation & Clinical Exercise Programs: Theory & Practice.         Ithaca, NY: Mouvement Publications.

U.S. Department of Health and Human Services. (1995). Cardiac Rehabilitation as Secondary Prevention. Rockville, MD.

The American National Red Cross (1977). Adapted Aquatics. Washington, D.C.

This content was created by You Hwan Kim,
Doctoral Student in Adapted Physical Education at Texas Woman's University,
as part of requirements for
"Aquatics for Special Populations", Huettig, Summer, 1999.
Edited by Gary Christopher, MS, ATC, July 2004

page last updated 1/3/2017 1:00 PM