August 2016 Issue

Focus on Fitness: Swimming
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 18 No. 8 P. 58

It's one of the best exercises for cardiovascular health and total body conditioning.

In hot weather, nothing beats a dip in the water to cool off. But splashing around in the pool shouldn't be seen only as summer fun; swimming is one of the best exercises for total body conditioning and calorie burning. Unlike intense exercises on land that involve impact, swimming is easy on the joints; the Arthritis Foundation strongly recommends swimming for this reason. Anyone can learn to swim and add a water workout to his or her exercise regimen—from young children to very frail older adults. In fact, swimming is considered a lifetime sport. The US Masters Swimming organization has a competitive age category up to 100 to 104 years old.

Due to the support and cushioning from the water, swimming is a great option for clients who may be unable to do land exercises. Consider specifically recommending swimming to clients who are pregnant, have movement limitations from an injury or a medical condition like arthritis, have physical disabilities, want more intense cardiovascular exercise without impact, are overweight/obese, or have osteoporosis.

According to the Centers for Disease Control and Prevention, swimming provides the following health benefits:

• reduced joint and muscular pain associated with chronic conditions like rheumatoid arthritis and osteoarthritis;
• improved mental health for children and adults;
• decreased disability and increased quality of life in older adults; and
• improved balance and reduced likelihood of falls.1

As a nonweight-bearing activity, swimming generally isn't considered a good exercise to increase bone density and prevent osteoporosis. However, for those already diagnosed with osteoporosis, swimming is a safe exercise to build muscular strength and obtain cardiovascular conditioning. Those with osteoporosis live with a higher risk of fractures and may avoid land-based exercises for fear of falling and fracturing a bone. Exercising regularly in the pool may not only help build strength and improve physical functioning but also improve confidence and reduce fear so that some land exercises can be performed.

Surprisingly, swimming also appears to help improve balance and lower the risk of falling, even though it doesn't involve balance training. A 2014 longitudinal study compared leisure activities like golf, swimming, walking, gardening, and other physical activities in more than 1,000 men. The researchers found that golfers and swimmers both had a significantly decreased risk of falling, but swimming was the only activity that had a protective effect. Swimmers in the study were documented as having lower postural sway and better performance in a walk test (both indicators of good balance) than men who participated in other leisure physical activities.2

With the water's buoyancy, swimmers can exercise longer and harder than they can on land with no additional joint or muscle pain. It's possible to get an intense, nonimpact cardiovascular workout in the water. Swimming isn't only a cardiovascular workout; the water's resistance builds strength in the upper body, as is evident from the well-muscled shoulders and arms of competitive swimmers. Therefore, swimming is an excellent alternative for injured athletes who must maintain cardiovascular endurance and upper body strength while recovering from lower body musculoskeletal injuries. The water's resistance when performing swimming strokes works upper body and core muscles while also elevating the heart rate. Swimming also is an excellent cross-training exercise for advanced exercisers who do impact activities. Replacing one or two running workouts per week with a swimming workout will give joints a break from impact and work upper body muscles that often are neglected when running.

The same buoyancy and resistance properties that make swimming a great workout for athletes also make it the perfect exercise for those who are physically disabled. Additional flotation devices can assist in keeping individuals with almost any physical disability afloat enough to perform basic swimming strokes. Most YMCAs and other indoor swimming facilities can make accommodations for disabled swimmers, although not all pools will have the appropriate flotation equipment. If the client's local pool doesn't have the proper equipment, the client and their caregivers can purchase their own from online swimming supply companies and disability equipment vendors. Swimming doesn't have to be only recreational for those with disabilities. The US Paralympics has a swim team for athletes with disabilities who wish to compete in swimming. Team members include amputees, blind/visually impaired, spinal cord injured, wheelchair users, and those with cerebral palsy, brain injury, or who have suffered a stroke.

Getting Started
What if a client is interested in the health benefits of swimming but never learned how to swim? Many individuals can't swim, not because they're afraid of the water, but simply because they never had the opportunity. YMCAs, community recreation centers with pools, and high schools with swimming pools generally offer swimming lessons and swimming times for those of varying abilities. However, children's swimming lessons are more available than adult swimming lessons. Adult clients that require swimming instruction may need to do some research in their area for opportunities and consider hiring a swimming instructor as they would a personal trainer for one-on-one lessons. While learning how to swim, clients can take water walking and water aerobics classes to become more accustomed to moving in the water and build confidence in their abilities.

Once clients have progressed to being able to swim a basic freestyle, breaststroke, or backstroke, they can begin swimming laps for exercise. At first, they may be able to only complete one length of the pool without rest. As with any other exercise activity, swimming requires gradual increases in intensity and distance or duration. As clients improve in ability and conditioning, they can incorporate interval training—swimming a certain distance within a certain time and then resting and repeating. Or, they can add accessories like kickboards and hand paddles for variety and added resistance.

Depending on the community, adult swimming teams or clubs may be available for those clients who want a more structured workout and additional instruction. Competition generally isn't required to participate in swimming club or team practices, unless there's interest in doing so.

Safety
Lap swimming in public pools (eg, YMCA, community centers) usually is permitted only under lifeguard supervision. For clients swimming in private or home pools without lifeguards, or in open water lakes or the ocean, safety is a high priority. Even experienced and strong swimmers shouldn't swim alone, especially in open water, and should have a swimming "buddy" or at the very least a companion on shore in case assistance is needed. Before venturing out into open water swimming, clients should have passed advanced swimming tests with a certified instructor and be confident in their swimming abilities. Open water swimming involves currents, waves, and unpredictable debris or wildlife that swimmers must be prepared to handle. Swimmers with any hesitation or concerns about open water swimming should just stick to the pool for safety's sake.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Reading, Pennsylvania, area.


References
1. Health benefits of water-based exercise. Centers for Disease Control and Prevention website. http://www.cdc.gov/healthywater/swimming/swimmers/health_benefits_water_exercise.html. Updated May 4, 2016.

2. Merom D, Stanaway FF, Handelsman DJ, et al. Swimming and other sporting activities and the rate of falls in older men: longitudinal findings from the Concord Health and Ageing in Men Project. Am J Epidemiol. 2014;180(8):830-837.
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