Cool benefits of a swimming machine for multiple sclerosis

by Robert F. Goldberger, MD
(Part 2 of 2)

People with disabilities find that immersion inwater allows them to move in many ways they had thought impossible.

The swimming machine is a compact aquatic exercise pool for home hydrotherapy and swimming. It provides a new and powerful form of help for people with a wide variety of disabilities and sports injuries, but it's especially helpful for people with MS. Measuring as little as 8 by 15 feet, it can be installed in a room only slightly larger than that. Its small size is possible because of the way it makes use of recent technological advances in controlling the flow of water. The moving water provides an endless lane for the swimmer, just as a treadmill provides an endless track for the jogger. Because earlier versions of the swimming machine had to be completely assembled before delivery, they were too large to fit through doorways; a home had to be built around them, or at least a home addition had to be constructed as an enclosure. But a recent model, known as the Endless Pool, designed by an engineer in Philadelphia for Endless Pools, Inc., is assembled from small modular parts at the site where it is to be installed, so it can fit into almost any house.

Because of the body's buoyancy in water, people can accomplish many physical activities in water that may be difficult, painful, or even impossible for them to carry out on dry land. This is true even of able-bodied people, but is much more dramatic for people with disabilities, who find that immersion in water allows them to move in many ways they had thought impossible. Swimming machines can also provide hydrotherapy jets for massaging tense or sore muscles. And the water temperature may be adjusted to suit the user's individual purposes and medical needs.

The makers of the Endless Pool also provide several ways to facilitate access to the water, such as steps or handrails, individually tailored to suit the type and severity of the user's disability. Even a fully automated hydraulic chair-lift is available for customers like me who use a wheelchair. I have the same model hydraulic lift for the swimming machine in my basement as I have for my outdoor pool.

An exciting feature of the Endless Pool is that it provides a smooth, steady current. The pool allows you to swim at your own speed without interference from other people as in a public pool. Using a simple dial, the swimmer adjusts the speed of the water flow from zero to that for an Olympic competitor. (As a matter of fact, the Endless Pool at Columbia University is in heavy use by the swim team, who find it an ideal way to train for intercollegiate competitions.) Of course, automatic circulation, filtration, and chemical purification keep the water clean at all times.

As they cool down, many people with MS gradually become stronger, and are then able to swim more and more vigorously.

The machine is helpful for a large number of different medical conditions, but its potential for people with MS is quite special, owing to the increase in strength many achieve when their body temperature is lowered. People with MS typically begin their daily sessions with about 15 minutes of floating and splashing gently in 78° water. This is warm enough for a comfortable swim yet low enough to cool the swimmer, since normal body temperature is more than 20° higher. As they cool down, many people with MS gradually become stronger, and are then able to swim more and more vigorously. They are then able to perform exercise that their physicians or physical therapists have designed to move joints, stretch muscles, and provide the proper amount of exercise. Typically, people end their sessions with a sustained swim for up to half an hour. Or they may exercise by walking in the 3 1/2' deep water while holding on to a bar or utilizing other optional exercise equipment in the pool, depending on their preferences and on the severity of their disabilities. In any case, they get out of the pool much stronger and feel truly invigorated from the workout-effects that persist for hours. Those with access to the pool every day report that they no longer feel so cramped or stiff, and experience far less spasticity.

An important bonus for users of the swimming machine is that they may be able to engage in sufficient sustained exercise to obtain cardiovascular conditioning. Results from recent medical research demonstrate that such conditioning saves lives by preventing heart attacks, and is now routinely prescribed by many physicians as an integral part of a comprehensive program of medical care. Such conditioning is rarely prescribed for disabled patients, however, largely because physicians often have no way to get such people to engage in exercises that are sufficiently strenuous. (An additional problem is that exercising out of water causes an elevation of body temperature and thereby increases the weakness of people with MS.) But now, using swimming machines, which utilize the buoyancy of water to facilitate movement, vigorous exercise is often possible, especially if strength can also be increased (as by lowering temperature in people with MS) or if pain can be decreased (as by raising water temperature for people with arthritis).

Another advantage of swimming for disabled people is that, for them, as for the able-bodied, swimming produces an improvement in mood. The reason for this effect is not known but has been well documented by medical research. It is especially important for the disabled because high spirits increase one's coping ability, and coping well is a disabled person's key to independence.

There is no doubt that swimming machines are a boon to patients with MS. Ideally, each person would have a machine in his or her home, but in many cases it would be more practical to provide access to a communal swimming machine in the basement of apartment buildings, in physical therapy installations, in independent living centers, MS care centers, and exercise gyms of all types.

Hydrotherapy programs for people with MS are not new. One very successful one, which may have been the first, has been in operation for more than 10 years in the School of Nursing at the University of New Mexico; others have sprung up here and there around the country. Unfortunately, little objective evidence is available to define the effects of such hydrotherapy and to help patients and therapists improve the methods used. The pioneering studies of Dr. Richard Edlich and his colleagues at the University of Virginia School of Medicine concerning the effects of various exercise regimens in water of various temperatures (in normal volunteers) have not been followed up by many others trained to do medical research. Recently, however, under the aegis of the New York City Chapter of the MS Society, a group of physicians at the Columbia-Presbyterian Medical Center in New York have begun a study of people with MS in a swimming class led by a physical therapist, to document how changes in strength may be related to changes in body temperature, and to quantify the effects they observe. The results of this research, as well as other studies now in progress elsewhere, may be helpful in refining the advice that can be given to people with MS.

Trained as a biochemist and physician, Dr. Robert Goldberger was director of research at the National Institutes of Health and also served as provost of Columbia University until his retirement. He purchased an Endless Pool in April 1989.

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