We bathe in, recreate in it, drink, dive, and dip our toes in it.

It's no surprise then that more and more active individuals are turning to water for exercise, rejuvenation, and rehabilitation after injury.

What may be surprising, however, is that it's taken this long for aquatic exercise and therapy to take their rightful place on the menu of therapeutic options.

The notion of water workouts was once considered sports science's cutting edge for high-end athletes.

"Back as early as 1993, 1995, I was working with Mia Hamm, and she was in the water when she had an ankle injury," said Kathy DeBlasio, Lifestyle Enhancement Director at UNC Hospitals Wellness Center at Meadowmont. "She was doing the same sprint workout that (teammates) were doing, but in water.

"Rex (Hospital) has also been doing physical therapy in their pool for years too. Maybe it hadn't hit the mainstream, but it's been a rehabilitation tool for a long time."

As early as 1984, the Aquatic Exercise Association was established to provide professionals with information and instruction. Now, AEA is an internationally recognized organization that has certified over 45,000 professionals worldwide.

Load Bearing

The benefit of aquatic exercise is water's buoyant quality, virtually eliminating the adverse ramification of impact and weight-bearing. In terms of rehabilitation, water provides "active recovery" from grueling workouts.

"Pool workouts give bodies a break between grueling land sessions, while helping to increase speed and sharpen form," the online medical self-help site WebMD.com said. "College runners and basketball and volleyball players also can routinely be found training in water."

Pools also provide a medium in which recovering athletes can maintain fitness while convalescing from injury.

"When we stop moving around, our muscle strength normally starts to atrophy," said Carolina Hurant, the Chapel Hill-Carrboro YMCA's Health Enhancement Director. "That makes it that much more challenging to regain that mobility we've lost, a lot of which is just from muscular atrophy."

Benefits Package

"One of the basic aspects of water exercises is that you can exercise without having to undergo the jolting impact that occurs when exercising on the ground," according to Rita Putatunda, writing for the information clearinghouse Buzzle.com.

"When the heel strikes the ground while running, the weight of the body is heightened by up to five times. Water's buoyant attributes allow you to perform exercises without experiencing impact of any significance at all."

In addition to zero gravity conditions, which cannot be created as easily anywhere below the International Space Station, water also creates another tool which is unavailable in the open air: a thick atmosphere of resistance.

"The viscosity of water provides an excellent source of resistance that can be easily incorporated into an aquatic therapy program," About.com stated. "This resistance allows for muscle strengthening without the need of weights."

While weights can create unidirectional resistance against the pull of gravity or against inertia on land, water resists movement in any direction -- up to 12 times the amount of resistance on land, says one web site.

In short, you get out of it what you put into it.

"The harder and faster your body works against the water, the more the resistance you will experience," Putatunda explained, "hence, the harder your workout will be."

More Pressure

DeBlasio added that one can also add resistance by increasing one's surface area.

"You can buy paddles like the ones we use in aqua-aerobics classes," she said, "or just for running in the water.

To a certain degree, water also offers pressure so integral to the notion of the "R-I-C-E" prescription for injury treatment: Rest-Ice-Compression-Elevation.

"Aquatic therapy utilizes hydrostatic pressure to decrease swelling and improve joint position awareness," About.com stated. "That pressure produces forces perpendicular to the body's surface, providing joint positional awareness."

And pressure = heat

Warm water is also soothing to most people, especially those with muscle or joint pain.

"In our new pool, we have two different wells," said Robb English, Aquatics Supervisor at Chapel Hill's Homestead Aquatic Centers. "We keep our program pool, with a zero-depth entry, a little bit warmer than the Community Center pool and also warmer than the lap pool, and that provides an alternative for those recovering from injuries. Plus, just being in the water seems to offer an effect people just can't get on the land."

"The UNC Wellness Center has what they call a therapy pool, and that's kept at around 90 degrees to achieve what they call the therapeutic designation," English explained.

"The reason we use a warm pool is because people recovering from injuries are moving more slowly," DeBlasio explained. "It's actually too warm to be doing rigorous exercise in our therapy pool, plus our lap pool is only five feet deep, and if you're running, your feet would be hitting the bottom all the time."

"Our pool is between 86 and 88 (degrees), so it's just a step below the Wellness Center's," English said. The Chapel Hill Community Center's pool is around 82 degrees.

Feeling the Burn

Whichever pool they may choose, many athletes find they can accomplish a highly-rigorous workout in the water.

"If you have an injury or just want a more leisurely workout, you can certainly do the exercises slowly and gently," Putatunda said, "but if it's a demanding workout that you are looking for, you can perform the water exercises as fast and hard as possible."

"'Before I started this routine, I thought of aqua exercise as ... way too wimpy for me," University of Nevada-Reno professor Mary Sanders told WebMD. "While water exercise can be great for older and overweight people, it's equally good for serious -- even competitive -- athletes. It's even a great way to squeeze an intense workout into a short period."

In fact, one of Sanders' studies noted that aqua exercise can burn more calories than a land-based program.

"'A 130-pound person burns about six calories per minute by aerobic dancing," Sanders said. "'The same person running in deep water at an 11-minute-per-mile pace burns about 11 calories per minute.'"

DeBlasio agrees.

"You can keep the cardiovascular system just as fit whether you're doing 120-yard sprints -- the length of a soccer field -- or if you just sprint (in water) for the same length of time," DeBlasio said. You're getting the same cardiovascular stress without the pounding--without the impact."

"Say I'd be sprinting eight 400s in 65 seconds on land," she added, "then I just do my sprints for 65 seconds as fast as I can in place in the water--it may even be more work in the water due to the increased resistance."

Class Act

Those interested in aquatic exercise or rehabilitation will find that there are organized classes based in area pools or individual activities in which one can engage.

"There's aqua jogging, aqua aerobics, aqua cycling, and aqua classes like aqua arthritis," the YMCA's Hurant said, "and all offer resistance without the impact for almost any injury."

"For aqua jogging, what you usually do is to buy a flotation waist-belt so that you're not sinking to the bottom, and then you just jog," Hurant explained. "Aqua cycling is sort of the same thing, except you're simulating the cycling motion."

"We have about a half-dozen aqua jogging belts that people can utilize," English said of the Homestead Aquatic Center, "and they can certainly bring their own too."

"That flotation device keeps your shoulders out of the water," DeBlasio explained, "although you may use some core muscles to help you stay upright."

English said his center also offers aerobics classes and classes for those suffering from arthritis.

"People are standing (in the water), and there are a variety of exercises done for both upper and lower extremities," he said. "The water provides the resistance and slow-moving exercise."

"That arthritis workout at the YMCA's pool is typically a little gentler," Hurant said. "The hands won't come out of the water, the movements are a little smoother, and there's a little more time spent warming up."

Not for everyone

Putatunda said that aquatic-based exercise is the natural choice for so many individuals.

"Even when you have a strenuous workout, the heart rate is relatively lower, which means that aquatic therapy is comparatively safe for those who have heart disease and hypertension, pregnant women, and overweight people," she stated.

But for a select few, a watery workout is not recommended.

"If you have a fear of water, or if you have MS or another neurological disease, it's not suggested," About.com wrote. "People with epilepsy need to be monitored very closely when they are in the water, as do those with heart disease. Those with open wounds or skin infections and those who are sick should not go in the water either."

For every case of an individual for whom aquatic exercise and therapy would not work, there are scores of success stories. Marathon fields are littered with runners who spent time recovering from plantar fasciitis or shin splints in the pool. Indeed, a good portion of triathletes are simply runners who came to learn the value of aquatic therapy during their travels.

While man may have evolved from a physically active ancestor, it's doubtful that Neanderthals were running 30 miles a week on pavement. While remnants of ancient aqua jogging belts have yet to be discovered on the shores of Serengeti watering holes, we need not wait for the proof of what we inherently know already. Paying an occasional visit to those precious healing waters from which we all once emerged can pay us back in ways we are only beginning to appreciate.

- chn -