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Paving the Way for Aquatic Rehab in Canada

I am a physical therapist and passionate about aquatic therapy. I work with clients in the community and I founded the Canadian Aquatic Rehabilitation Instructors to teach other therapists how to incorporate aquatic therapy into their practice.

Aquatic physical therapy offers the client and therapist thermal and mechanical advantages. The water's warmth assists peripheral circulation, induces relaxation and reduces spasticity; the buoyancy provides reduced joint compression and easily graduated weight-bearing activities; while the hydrostatic pressure controls oedema and increases the heart's stroke volume, reducing the heart rate requirement. The aquatic environment is low impact and offers resistance in all planes of movement, primarily working muscles concentrically and trunk muscles isometrically. Once a person is immersed they must immediately engage their trunk musculature to maintain a standing posture. External movement creates a turbulence which challenges stability. The person's goal is often to "keep their hair dry"!

Recent studies have indicated water-based exercises challenge the core balancing mechanisms more than land-based exercises due to more proximal muscle work initiated earlier than peripheral (Han et al, 2014). To add to the balance training advantages, a pool is a low impact environment, enabling individuals to work outside their base of support for more challenging balance exercises with minimal fracture risk. The water also slows movement and allows more time for balance reactions. Some barriers to pool work is access, dressing and cost. However, community aquatic programming popularity and warm water pool numbers are growing. I have seen clients gain functional independence in the water, empowering mobility gains on land. Working in the community I have provided clients with a personal aquatic exercise programs and educated family members about optimal handling to balance patient safety with independence.

It was the question of benefits and risks for the osteoporotic client that drove me to investigate the response of bone outcomes to aquatic exercise during my Masters in Rehab Science at McMaster in 2009. Nine local women attended the Aldershot Public Pool (88 degrees), 3x/week for 6 months and were measured in novel and standard ways to look at their bone quality before and after. The study was powered to produce results about the feasibility of doing a larger study. I worked with Dr Norma MacIntyre whose extensive research includes bone response to exercise. Returning to school after being out for 25 years was more of a challenge than I could of anticipated but it was intense and stimulating. It has set me on a scholarly path that just keeps growing. I presently work at the University of Toronto as Academic Program Coordinator for the Ontario Internationally Educated Physical Therapists Bridging Program. I am very grateful to step into this educator role. I am also excited to share my passion for aquatic therapy with the community of rehabilitation professionals.

Canadian Aquatic Rehab Instructors (CARI) was founded in 2011. The goal is to provide Canadian physical therapists with up-to-date, post-graduate aquatic therapy training, to provide a network to connect therapists and clients, and to promote aquatic physical therapy in Canada. There is a lot of amazing research going on globally, investigating the effectiveness of aquatic physical therapy for clients with many conditions, such as Parkinson's disease, chronic pain and osteoporosis. I have had the honour of presenting at the European Conference on Evidence-Based Aquatic Therapy in 2013 and 2015. Aquatic physical therapy has a strong presence in the World Congress of Physical Therapy.

To date, CARI courses have been held in Montreal, Ottawa, Halifax, Toronto, Peterborough and Mississauga. Post-graduate courses focus on optimizing the use of the water environment in client recovery and can be tailored to the healthcare facility, condition-specific or provide a general update of skills.

The physiotherapy scope of practice and our role as consultants, educators and collaborators is growing as we bridge to the post-rehab setting to achieve successful client outcomes in the community and expand our role in health promotion. It is exciting to hear from community-based, private practice physiotherapists who are successfully integrating their clients into existing aquatic community programs throughout Canada. We also have a role consulting on those programs as the increased prevalence of co-morbidities puts us at the forefront as experts for optimal disease management. I have worked with the City of Mississauga's aquatic department to design special needs aquafit programs. These are well attended and taught by trained group aquafit instructors.

The aquatic environment is a natural fit to address chronic condition management as it controls secondary oedema, off-loads arthritic joints and enables freedom of movement - all this while encouraging physical activity!


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Alison Bonnyman, BScPT, MScRS

Alison Bonnyman is a physiotherapist and Lecturer in the Department of Physical Therapy. She completed her BSc PT from the University of Toronto and MSc in Rehabilitation Science from McMaster University.

Alison is the Academic Program Coordinator of the Ontario Internationally Educated Physical Therapy Bridging Program (OIEPBP). Alison is the founder of the Canadian Aquatic Rehabilitation Institute lecturing, consulting and teaching aquatic therapy in Canada.

If you're interested in learning more about CARI, Alison or Aquatic Therapy, you can get in touch with Alison via email: or check out the CARI website:

Alison's patient specific exercises as well as the highlights of her course is now available on healthSwapp!

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