Aquatic Exercise Program as an Effective Alternative Method of Cross Training for Cross Country and Track Athlete   By Michael Mandas, P.T.; Andrew R. Einhorn, P.T. C.S.M.T.; Jon Ellertson, B.S., P.T.A.; Shawn Hickling, B.S. Exercise Physiology; Kirsten Pieters, B.S., Athletic Training; Michael Quinn; Gilbert Orbeso of Los Alamitos Orthopaedic & Sports Physical Therapy PART I INTRODUCTION   Cross country and track athletes require extensive conditioning and training to reach their highest level of performance. Unfortunately, this training is performed on surfaces that can lead to injury. Hard surfaces combined with the frequency of training lead to a variety of "overuse syndromes." This can halt tha training of an athlete and jeopardize his or her ability to compete. Many times, the athlete is advised to seek out an alternative source of conditioning while recovering from injury. An aquatic cross training program can provide treatment for the injury, maintenance of aerobic capacity and sport specific cross training. The properties of water provide support, resistance and assistance in the athlete's training session. Buoyancy devices can further reduce the undesirable effects of weight bearing on an injured extremity. At the same time, athletes can increase the work expenditure during exercise and maximize the cardiovascular conditioning required for competition. An aquatic training program can decrease compression forces, vibration forces and torsional forces that an athlete may endure while training on land. The effects of gravity play a significant role in the overuse syndromes athletes suffer; gravity can also limit and slow a well-designed rehabilitation program for the injured athlete. Pain is something many athletes learn to ignore, however, pain from injury should rarely be ignored, since it can lead to longer disability. Rehabilitation is much more effective when early intervention is available. Properties of water make an aquatic training program center extremely important when it comes to early intervention following injury. Early intervention in the athlete's injury can mean a speedier return to competition. Many times, a nagging injury is ignored by an athlete simply because there is an inadequate system delivering appropriate care. In many instances these nagging injuries can be treated immediately with an aquatic rehab program thus, shortening the period of time where exercise performance is less than optimal. It has been well-documented that performing certain structured therapeutic exercises in water can be used successfully when treating injury. Physiological effects include increased circulation to muscles, increased joint viscoelasticity and decreased joint pain. Muscles can get stronger with less strain and cardiovascular training is accomplished. The physical properties of water have been utilized in aquatic therapy to decrease gravitational forces placed on a weakened extremity and increase body movements. All of this can be extremely helpful to the cross country and track and field athlete when it is combined with known exercise programs, such as open and closed chain exercises. These aquatic exercise programs can produce rapid results in an athlete where land activities are aggravating the present symptoms. Shallow and deep water training can produce sport specific results which can easily carry over to land-based activities or more traditional exercise formats.   Conditioning and Exercise Tool An aquatic training program is an effective form of cardiovascular exercise combining both deep (gravity eliminated) and shallow (buoyancy assisted) water exercises. This unique workout greatly amplifies the natural resistance of water, while maintaining a "target heart rate." Deep and shallow water exercise accommodates high intensity cardiovascular trainng, while reducing the risks that accompany high impact loading (See References 2, 4, 11, 12, 17).   Buoyancy Assistive and Resistive Exercise Training in water enables the athlete to improve upper or lower body strength and cardiovascular endurance while utilizing buoyancy to decrease weight bearing. Standing in neck-deep water reduces lower extremity body weight to about 10%. Standing in chest-deep water reduces weight bearing to 25-30% of body weight. Standing in waist deep water translates to a 50% reduction in the athlete's body weight. (9) Buoyancy allows the athlete to exercise while reducing the effects of gravity. (1, 10, 13) In addition, buoyancy assistive devices (vests) can be used in shallow water to reduce body weight or in deep water training. Buoyancy resistive devices (cuffs or fins) may be used to create additional resistance and increased cardiovascular intensity. Water provides an accommodating variable resistance which automatically adjusts to the degree of force applied. The degree and resistance encountered during aquatic exercise is directly related to the speed and direction at which the equipment is moved through the water. Aquatic exercise provides a true form of isokinetic resistance proportionate to the square of the velocity during movement. For example, moving an extremity at three times the speed generates nine times the resistance. (8) Cross training exercises are conducted in both deep water (6 feet or more) and shallow water (3 1/2 - 4 1/2 feet) levels. A five minute deep water warm up is conducted prior to stretching exercises. The quadriceps femoris muscles, hip flexors-extensors, gastrocnemius, lumbar spine flexors and extensors all require stretching.   Open and Closed Chain Aquatic Exercise Both open and closed chain exercises are conducted in deep and shallow water respectively. Open chain exercise would be illustrated by knee extension. The purpose of this exercise is to strengthen the quadriceps femoris muscle group. During open chain exercise the body is fixed in the machine as the feet move. Open chain exercises tend to isolate an individual joint or muscle group. Closed chain exercises are conducted in the shallow water. (14, 15) A squatting type movement would represent an example of closed chain exercise. The athlete's feet are fixed as the body is moving. Closed chain exercises represent functional type movement patterns that dissipate stress over several moving joints and muscular groups.   Deep and Shallow Water Training Initial deep water cross training exercises are conducted for one minute. As the athlete's endurance and techniques improve, the exercise is extended for five minutes. Buoyancy assistive and resistive devices are used to help maintain the athlete above water and increase the exercise intensity. After completing a deep water routine, shallow water exercises are performed. The shallow water exercises are typically conducted for 30-60 seconds. Buoyancy assistive devices can be used if lower extremity pain is present.   Track and Field Aquatic Conditioning Track and field events provide a tremendous amount of impact on the body. The use of aquatic cross training exercise enables the athlete to train at various levels of intensity minimizing the effects of body weight and gravity. To decrease the overall impact on the body, buoyancy assistive devices may be incorporated into the shallow water regime. These devices include rubber flotation belts to foam dumbell buoys, which reduce joint compression forces during closed chain activities. By providing this reduced impact environment, track athletes are better able to perform sport specific plyometric exercises at a reduced risk of injury. In addition, the water provides a more true form of resistance and support which is unparalleled to land activity. This plays an important role to the long jumper, who performs "Squat Jumps" to develop explosive leg power. In the deep water environment, resistive devices are used on the legs to develop or maintain important speed and power in the legs. These devices include buoyancy cuffs, fins, and resistive boots, which increase exercise intensity as the athlete increases his/her speed of repetition. These devices may be incorporated in circuit training to increase or develop the speed and cardiovascular endurance of the training athlete. (5, 17)   Aquatic Exercise Equipment Below is a list of the various equipment one might find in an aquatic exercise program. There are three categories of Aquatic Exercise Equipment: Buoyancy Assistance, Resistive and Buoyancy/Resistive A. Buoyancy Assistance 1. Hydrotone Belts a) Designed to reduce the effects of gravity on the body, thus reducing stress to the involved joints being exercised. These belts can reduce weight up to 50-70% depending on the water level that is displaced. 2. The Float Cushion (Aquatic P.T. Resources) a) Useful in teaching proper postural techniques and proprioception. Useful in developing strong trunk stabilizers. b) Used in conjunction with sculling of the hands to develop important upper back musculature. 3. The Thigh Pillow a) Used with knee extensions through a limited range of motion. that can be progressively increased with speed. b) In addition, the buoyancy of the pillow brings the adductor group into play to keep the position of the pillow throughout the entire exercise. B. Resistive 1. The Hydrotone Bells a) The first of several upper body resistive devices designed to provide smooth resistance as it is pushed, pulled or dragged through the water. The Hydrotone Bells are exceptionally effective with traditional curls, rowing and horizontal abduction/adduction movements. 2. Aquaflex Paddles a) Designed to be fully adjustable to vary the degree of resistance. These are a less aggressive alternative to the bells. b) The paddles work well in a deep water interval training program. 3. The Hydrotone Boots a) Lower extremity resistive device which adds increased resistance to leg strengthening (walking, cross country, half jacks, Hip flexion/extension progressive resistance exercise (PRE). As speed increase so does the resistance factor. 4. Fins (Zoomers) a) Specifically designed stout fin that provides exceptional deep H20 resistance. The fins can be very useful in ankle strengthening (dorsi/plantar motion) as well as providing overall aerobic conditioning in the aquatic environment. C. Buoyancy Assistive/Resistive Devices 1. Hydrofit Dumbbells a) Provides resistance (2.2 lbs. to 5.5 lbs. depending on size) during upper body workouts. b) May be used to support lower body movements such as walking and step-ups for athletes that present difficulty during full weight bearing activities. Acts as a "water walker" emphasizing proper hip/body alignment. 2. The Wonder Board a) Made from a stiff foam, this device is used to develop proprioception through balance and develop important abdominal musculature. b) When stood upon, this device can be used to provide resistance in movements such as squatting. This movement is very dynamic in nature and requires exceptional balance to perform. c) The Wonder Board can be used during push/pull movements to provide added resistance. 3. Buoyancy & Resistance Cuffs a) Designed to add an extra degree of difficulty for deep H20 activities. Part II will explore deep water and shallow water exercises. REFERENCES 1. American Physical Therapy Association. Aquatic Physical Therapy: An APTA Fact Sheet. Alexandria, VA.   2. Awbrey B. J., Dye K. K. Plunging into aquatic exercise: Walking in Water. Training Conditioning, 1996.   3. Bates A., Hanson N. Aquatic Exercise Therapy. Philadelphia. W. B. Saunders & Company, 1996.   4. Baretta R., Robergs, R. Physiological Adaptations to a 14 Week Deep Water Exercise Program. Aquatic Physical Therapy Report: Vol. 3, 1995.   5. Brennan, D. K. Aqua running, no pain, much gain. Master Sports. 1992.   6. Fitness Swimmer: Get a little eccentric during your water workouts. Summer, 1996.   7. Horsley, J. Personal Communication, 1996.   8. Hydro-Tone: The New Science of Total Fitness. Unpublished manuscript. HydroTone Fitness System, Inc., Huntington Beach, CA.   9. Jamison L., Ogden, D. Aquatic Therapy Using PNF Patterns. Tucson. Therapy Skill Builders, 1994.   10. Korel, L.E. The Properties of Water and Their Effect on Aquatic Therapy. Athletic Therapy Today. 1 (2): 1996.   11. Newman, D.J. Moving Through Fluids. Biomechanics. May, 1995.   12. Napoletan, J. Aquatic Therapy: Overview. Rehab and Therapy Products Review. Jan/Feb, 1995.   13. Templeton, M.S., Booth, D. L., O'Kelly, W. D. Effects of Aquatic Therapy on Joint Flexibility and Functional Ability in Subjects with Rheumatic Disease. JOSPT 23 (6): 1996.   14. Tovin, B. J., Wolf, S. L., Greenfield, B. H., et al. Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions. Phys. Ther. 74 (8): 1994.   15. Verstegen, M. Plunging into aquatic exercise: Underwater speed. Training & Conditioning, 1996.   16. Voss, D. E., Ionta, M.K., Myers, B.J. Proprioceptive neuromuscular facilitation patterns and techniques. Philadelphia, Harper and Row Publishers, 1985.   17. Wilder, R. P., Brennan, D., Schotte, D. E. A Standard Measure for Exercise Prescription for Aqua Running. Am J Sp Med 21 (1): 1993. 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