Pilot programs offer injured soldiers water-based rehabilitation

OCTORS HAVE FOR DECADES PRESCRIBED AQUATIC THERAPY for rebuilding and strengthening injured bodies while managing pain. Recently, in an effort to standardize alternative therapies for wounded warriors, the U.S. Army has piloted a two-pronged aquatic rehabilitation program. The Aquatic Warrior Exercise Program (AWEP), commissioned by the U.S. Army Surgeon General's office and developed by aquatics and fitness expert Dr. Mary Wykle, is up and running at three Army installations: Fort Belvoir and Fort Eustis in Virginia and Fort Lewis, Washington. Each of these sites has multiple indoor pools and hosts Warrior Transition Units (WTUs) of 250 to 500a manageable number for data collection and follow-up. The pilot program has been completed and the final report submM ted for official review. The Army is currently reviewing the report and is expected to make recommendations and decisions sometime in the next several months concerning the implementation of Wykle's two-phase program.
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Overall, the AWEP program focuses on inclusiveness and individualizationeven while accommodating large groups in a pool at one time. Because no swimming ability is required for any of the exercises, the only thing necessary for participation is a medical clearance. Activities that take place in deeper water include flotation belts, so no heads are ever submerged. And participants are instructed on how to customize the exercises: Since water provides 10 times more resistance than air, it is an ideal medium in which to experiment with different intensities of exercise. Not only is the program flexible and simple to implement, but, given the sheer number and variety of injuries, the case for a standardized aquaticsbased alternative to traditional physical therapy is compelling. "As of mid-December 2010, the number of combined soldier injuries for the Army is about 30,000 wounded, with many seriously wounded," Wykle points out. "The programs would be available [through WTUs and the Army's physical therapy departments] for soldiers recommended for aquatic activity as a part of their recovery. The Marine Corps is also interested in the program because of the everincreasing number of wounded Marines."
The Two Stages of a Soldier's Rehabilitation

The two phases of the pilot aquatic exercise program reflect the stages of recovery that most persons with musculoskeletal injuries go through. The first part is the Aquatic Rehabilitation Program: a set of therapy protocols designed for those under the care of a doctor or physical therapist. Many of the soldiers in need of therapy are returning from service with lower back or joint injuriesand the weight-bearing exercises involved in traditional physical therapy can put additional stress on the back and the body's major joints. Aquatic therapy, on the other hand, relieves joint stiffness and increases range of motion and flexibility Immersion in water also reduces pain, due to water's dispersion of pressure. Furthermore, Wykle's program puts special emphasis on stabilizing the lumbar region of the spine and strengthening those core muscles that help support the spine. The second part of the program is for soldiers who have finished their rehabilitation programs but who continue to need help overcoming limitations and managing pain. Cne of the primary goals of that second phase is to prepare the soldiers for return to their regular units, through an alternative cross-training program that offers the same overall fitness benefits as land-based training. One surprising aspect of the program is its instructor training regimen which requires no background in aquatics. Trainers in the pilot programs

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important facts to remember are that anyone can participate in this program. Soldiers love this programand at my club, senior ladies are participating as well. It is also great crosstraining for swimmers.

untu I broke my neck in a humvee accident. I was no longer able to lift weights or run due to severe muscle atrophy and nerve damage. .. Then, I was introduced to the aquatics program. Since then my strength and endurance are returning, but most important, my confidence in myself." Another participant with lower body weakness from brain surgery speaks proudly of being able, thanks to the strength and cardiovascular benefits of the program, to run up to three miles on land now. The numbers back up the glowing praise from pilot program participants, A variety of pain scale tests showed an average 50 percent reduction in pain levels. And general fitness improvements were just as striking. Study results showed the Pilot Results: Reduced Pain, Greater resting heart rate decreased an average Strengtii and Fitness of 49 percent, the ending heart rate inThe results of the pilot study have been noth- creased 61 percent, and time to complete ing short of dramaticespecially consider- the steps decreased 75 percent. ing that soldiers recommended for aquatics therapy are often those with incapacitating Adapting AWEP to Pari( Aquatics pain, atrophied muscles, and serious inju- Programs ries. As one wounded warrior describes his Wykle stresses that the AWEP program experience, "I enjoyed staying physically fit is easily adaptable to park and recreation
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are soldiers who have themselves reaped the benefits of aquatic therapy for service-related injuries, Wykle personally trained the AWEP instructorsnone of whom had any previous training in water safety, physical therapy, or medicine, "I'll admit, when I was first told that I was picked for the program, I imagined little old ladies in the water, and I was very resistant," says Sgt. 1st Class Robert Sallade, an activated National Guard Soldier who is one of the first training team members at the Eustis WTU certified by Wykle. "After I went through the two days of training, muscles I didn't even know I had were sore, and I had a whole different outlook about it,"

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aquatics programsand not necessarily as a course with a purely military focus. "The important facts to remember are that anyone can participate in this program," she says. "Soldiers love this programand at my club, senior ladies are participating as well. It is also great cross-training for swimmers." The program can be offered as a stand-alone course conducted three times a weekor as a once per week course with tracking options and deep-water time allotted for individual training. Part of the beauty of the program is that step count and training time are determined individually, and in a class format it is possible that no two people will have the same step count. (Neither music nor metronomes are used, so that each participant can have the full training effects of his or her individual step count.) Wykle often arranges training for aquatic leaders in the one-day Deep Water Interval Cadence Running Program (the AWEP component with the greatest cardiovascular benefits). A second day of training is required for those interested in including additional strength training and some shallow water options. Both of these modules are approved for Aquatics Education Association CEU's, and training is available through Wykle and several other certified trainers. To find out more about adapting the AWEP program to your agency's aquatics offerings, visit the website at www.aquaticwarrior.com or contact Dr. Mary Wykle directly at mwykle@aol.com

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