For generations, swimming has been the exercise recommendation of choice for children born with cystic fibrosis.

But strangely, during the same time period, very few investigators examined the benefits of any vertical aquatic exercise for the cardiopulmonary compromised patient.

In fact, most patients with congestive heart failure, circulatory insufficiencies or respiratory disease often were warned vehemently against getting in the pool.

Over the past 10 years, however, it has been shown repeatedly that vertical aquatic exercise does not offer the same risks to the cardiopulmonary compromised patient as swimming does.

In effect, the pool just became vogue for this growing population.

The concept of vertical exercise in the pool (called hydro-gymnastics) gained greater exposure in the early 1900s. By the 1950s and 1960s, the age of space exploration did much to stimulate research into the effects of “reduced gravity environments” on breathing and circulation.

It wasn’t until the 1990s that a new organization, the Aquatic Exercise Association, brought the same popularity to vertical aquatic exercise as horizontal swimming had enjoyed.

To provide efficient cardiopulmonary training in your pool, you will need water temperature no greater than — and preferably less than — 93 degrees Fahrenheit.

Most therapy pools hold their temperatures between 90 and 94 degrees. However, because cardiopulmonary training can elevate the body’s core temperature, cooler waters will allow for more intensive training.

Traditional swimming pools, with temperatures near 80 degrees, can be used for very vigorous aerobic training. Otherwise, pools ranging between 85 and 90 degrees make excellent sites for cardiopulmonary workouts. Humidity levels exceeding 50 percent will make it more difficult for patients to disperse heat during workouts.

A pool with a sloping bottom running between 3-feet and 4-feet deep will work just fine, unless deep-water work is desired. Cardiopulmonary training can be performed in almost any position — or depth — in the pool. There is no single exercise that defines this kind of training.

Some of the more popular training methods include:

1 Breath-control while swimming beneath the surface. This should be done only with careful supervision.

2 Forceful exhalation of air through PVC piping (1/2-inch to 3/4-inch diameter) into progressively deeper water.

3Propulsion of an object across the pool’s surface using sustained breaths. The object can be as low-tech as a ping pong ball or as elaborate as an Egg-Flip, a toy that flips on its axis when bombarded withair.

4Circuit training,consisting of brief bursts of strength-training“stations” interspersed with aerobic exercise.

5Calisthenics performed in waist- or chest-deep water.

6 Water walking in waist- or chest-deep water.

7“Charging the hill,” in which participants stride from chest-deep water to thigh-deep water and back again.

8Deep-water running using a noodle or buoyancy belt.

9 Lap swimming, recommended for the skilled swimmer only.

At a minimum, your facility will need to stock water noodles, flotation belts and resistive equipment such as barbells, paddles or gloves.

Well-equipped pools also stock PVC piping, Egg-Flips or ping-pong balls, dive toys and heart rate monitors.

Note that 3/4-inch PVC piping can be easily purchased (and cut between 11/2 feet and 21/2 feet long) at any Home Depot or equivalent store. Obviously, patrons should be issued their own pipes for sanitary reasons.

Few commercial seminars are available today to address only cardiopulmonary training; however, many aquatic therapy seminars include cardiac training as part of the package.

Fortunately, there are hundreds of training DVDs that explore aerobic exercise in the pool. Many of these exercises can be extrapolated for use in your pool by a competent therapist.