Swimming

If you have not gone swimming for some time, and you want to add swimming to your exercise routine, start with a short s[[ession in shallow water. Even if you are (or were) a strong swimmer, PD-related motor impairments—such as bradykinesia, rigidity, and impaired coordination—can make swimming challenging and even pose safety risks like near-drowning.

I know, it happened to me. After more than 10 year as a life guard, water safety instructor and waterfront director, and able to handle myself in any water conditions, I lost my sence of "up" after swimming for about 20 minutes. I was able to stop and find the top of the water, but I have found other types of exercise that don't cause that knd of worry.

Swimming is a beneficial form of aerobic and resistance exercise for people with Parkinson’s Disease. It offers support to joints due to buoyancy, improves cardiovascular health, and can aid in muscle strengthening and flexibility. However,  Dopaminergic medications, compensation strategies (like using swim fins or internal cueing), and supervision significantly improve safety and swimming ability. Consulting a healthcare provider and incorporating swimming thoughtfully into an exercise regimen can enhance physical and emotional wellbeing in PD

Benefits of Swimming in Parkinson's Disease

Swimming is an excellent low-impact aerobic exercise, which is especially valuable for individuals with PD who may suffer from joint pain or muscle stiffness. The water's buoyancy reduces stress on weight-bearing joints, providing a supportive environment for exercise. Swimming can:

• Increase cardiovascular and respiratory fitness.

• Improve muscular strength and flexibility.

• Aid balance and coordination through resistance from water.

• Enhance mood and reduce fatigue through physical activity.

This can lead to improvements in stamina, mobility, and quality of life.

Challenges and Risks Specific to PD

Despite its benefits, swimming poses unique challenges to people with PD due to:

• Bradykinesia (slowness of movement): This can impair limb coordination and reduce swimming speed.

• Muscle rigidity and stiffness: May cause difficulty in stroke fluidity.

• Impaired interlimb coordination: Increases the risk of difficulty maintaining balance and propulsion in the water.

• Postural instability: May cause difficulty floating or maintaining horizontal position.

• Fear of falling or drowning: Real concerns as near-drowning events are reported.

A survey of 309 people with PD showed that nearly 88% noticed swimming capacity decline, and about half experienced near-drowning events, highlighting safety concerns [ https://pmc.ncbi.nlm.nih.gov/articles/PMC7328419/ ].

Medication and Compensation Strategies

Dopaminergic therapy (like levodopa) improves bradykinesia, which can enhance swimming ability but usually does not fully restore coordination. Nonpharmacological compensation strategies are valuable:

• Using swim fins to increase leg propulsion and water displacement.

• Internal cueing techniques, such as counting strokes to improve rhythm.

• Using a floatation aid or focusing on leg-only strokes to bypass impaired arm-leg coordination.

• Having supervision or swimming with a buddy for safety.

Practical Considerations for Swimming with PD

• Consult healthcare professionals before starting swimming; physiotherapists can provide personalized advice.

• Warm-up and stretching before swimming reduce stiffness and aid posture.

• Swimming aids: Floats, noodles, or fins can help maintain safety and improve movement.

• Swimming environment: Pools with ramps, non-slip tiles, less crowded times, and warm water are preferable.

• Start slowly and increase duration from 10-15 minutes to longer as tolerated.

• Adapt to outdoor swimming cautiously, with safety measures such as swimming with others and using wetsuits if needed.

If you are considering swimming as part of your PD management plan, discussing with your healthcare team is essential.