Working in the water with elderly clients, whether for rehabilitation, wellness or ?pre-habilitation,? has shown me that these most fragile members of our population need and deserve to work with well-trained aquatic therapists. The professionals can help them gain the confidence and the skills they need to prevent balance-related falls on land.

The trouble is that the fear of falling and breaking a hip can make balance training frightening to those who need the training the most. Beginning balance training in the water has many benefits, including reducing the ?fear factor.?

Thirty percent of persons over age 65 fall each year, with nearly 15,000 resulting in deaths and 1.8 million requiring emergency room evaluations. A quarter of a million of these persons, half of whom are over 80, sustain hip fractures each year, three quarters of them women, according to the Centers for Disease Control and Prevention in Atlanta.

While not all hip fractures are due to poor balance aquatic pre-hab can help prevent many of the falls that are due to slipping or tripping. Balance and strength training are recommended at any age, but it is critical for at-risk people,especially women over 65 who have never engaged in exercise-related activity.

Certainly, there are many active older women today, but weight-bearing exercise, flexibility training and the like weren?t part of the youth culture of several generations, particularly for women. Most females today in their 70s, 80s and beyond are not lifelong athletes, and thus now need to learn the balance skills and confidence of movement.

There?s a national trend toward lengthening of total life span U.S. life expectancy rose 2.1 years between 1993 and 2003, largely due an older population living longer with chronic diseases such as heart disease, cancer and stroke. But the very persons who are often at greater risk of falling because of their conditions also are less likely to survive the injuries from a fall, according to ?Fatalities and Injuries from Falls Among Older Adults? in the journal Medscape.

Besides reducing the fear factor, aquatic balance training for seniors provides strength and flexibility work. Aside from building confidence, participating in aquatic exercise is attractive to seniors who otherwise may not be able to comfortably exercise on land. By exercising regularly in the water, seniors can improve overall health.

Because the population of senior exercisers, prone to osteoporosis, osteoarthritis, and wear-and tear orthopedic injury, is generally more fragile than the younger population, it is critical that persons teaching aquatic exercise are properly trained in the needs of this special population. Physical therapists trained in aquatic exercise beyond traditional aquatic therapy are perfectly positioned to segue into pre-habilitation training with the senior population. With unparalleled knowledge of biomechanics and kinesiology, physical therapists who teach aquatic balance training and other forms of aquatic exercise to seniors, will be able to spot and correct dysfunctional movement patterns to ensure exercises are performed properly for each participant.

But qualified therapists are just about the only barrier to launching aquatic balance training programs. Any pool can work for such programs, with depth and warmth the critical factors. Most movements for this population would be performed in water depths of 31/2 feet to 4 feet, and a temperature of at least 86 degrees Fahrenheit.

Railings, pool ledges and steps are used for some movements, but absent any of these features, programs will be successful with creative and well-trained instructors or therapists.

Instructors or facilities also will want to have a selection of small equipment on hand, such as aqua versa tubes and aqua dumbbells; a Pilates ring also may be useful. Equipment is not always necessary; however, it is readily available and relatively inexpensive.