How cute is that? Little Jake over there is undergoing aquatic rehabilitation in an underwater treadmill after paralyzing his rear limbs in an unfortunate accident. One veterinarian’s initial prognosis was that Jake would not be able to walk again. But after physical therapy and the underwater treadmill, Jake is back on his feet and happier than ever.

Canines are not the only species that can benefit from aquatic therapy. Whether it is used to help people recover from acute injuries or to maintain health in the face of chronic disease, hydrotherapy is regarded as having “broad rehabilitative potential” that is relatively underused (Becker, 2009).

Water: An ideal medium for exercise.

Swimming is widely recommended by medical experts for its healthful benefits*. According to the American Red Cross, the buoyancy of water results in less stress on the joints, helping to reduce swelling and tissue damage. Warm water can increase circulation, decrease pain, and increase muscle relaxation and soft tissue flexibility.

Patients (and puppies) looking to strengthen muscles should exercise in pools with some turbulence.
Aquatic exercise: Benefits galore

• Lower risk of death In a 2009 Washington State University study of over 40,000 men, exercise swimmers had less than half the mortality risk of sedentary men, and exercise swimmers had half the mortality risk of exercise walkers and runners.
• Aids patients with COPD A 2009 study of patients with chronic obstructive pulmonary disease (COPD) found the swimming pool a “feasible and positive alternative venue for pulmonary rehabilitation”.
• Asthma Many studies have found swimming improves asthma symptoms; LaKind et al. cite Welsh et al. ¹, who reviewed the relevant scientific literature. According to LaKind et al., Welsh et al. note that most studies find “positive effects of swim training on fitness as measured by improved aerobic efficiency, physical working performance, and recovery heart rates.”
• Heart healthy Aquatic exercise strengthens the heart muscle and improves oxygen delivery to the muscles.
• Reduces water and sodium retention Animal data collected in Brazil ² indicate exercise in water might be prescriptive for patients with hypertension, obesity and/or mild renal disease as it reduces water and sodium retention.
• Hand eye coordination and balance According to a study done in Taiwan, swimming can improve hand eye coordination and balance in the elderly, which could lower a senior’s risk of a falling-related injury.
• Bone health Aquatic exercise can maintain or improve bone health in post-menopausal women.
• Better flexibility and range of motion According to the American Red Cross, when accompanied by good stretching habits, aquatic exercise can greatly improve flexibility and aid range of motion.
• Improved mood Swimming can improve the mental state of both men and women, the elderly and women with fibromyalgia, mothers, and parents of children with developmental disabilities.

Swimming may be the BEST and most enjoyable form of exercise, so give it a try!

*The American Red Cross recommends a health assessment from your health care provider before you begin an exercise program.

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

². Fabri et al.,(2010). Aquatic and Land Exercise Training Affects Renal Function in Rats Under Isosmotic Volume Expansion, Journal of Exercise Physiology, vol. 13, no. 2.

With high temperatures plaguing much of the country, the pool seems like the best bet to beat the heat. This blog highlights two interesting and entertaining resources recently found in the media that can help keep swimming healthy and enjoyable.

1. CDC’s Healthy Swimming 2011 Video Contest Winner’s Video!

This summer, the Centers for Disease Control and Prevention (CDC) challenged the public to create a short video to help educate swimmers about pool safety.  The winners, David and Aaron Mathews, worked with friends and family to develop “Recreational Water Illness Police,” a clip that uses humor to inform viewers about the most common recreational water illness—diarrhea. Roger that.

2. Quiz:  Is It Safe To Pee In The Pool … And Other Water Safety Questions

Want to test your water safety knowledge? A Huffington Post online quiz emphasizes key swimming safety issues, some of which are often overlooked, such as showering before entering the pool.  It is important that swimmers shower with soap (especially swimmer “bottoms”) before swimming so they do not introduce harmful bacteria into the pool.  This fact is lost on all but 25 percent of parents according to a recent report.  And no, it is not safe to pee in the pool.



It’s no secret that swimming pools, although fun and refreshing, are essentially communal bath tubs. To help keep water clean and safe, pool operators must adjust pool chemical levels. Maintaining proper pool chemistry can be a challenging task, especially in community pools where the number of swimmers fluctuates wildly from hour to hour.  Add to that the fact that many swimmers are unaware of the role of personal hygiene in keeping waters safe, and one begins to understand the magnitude of the pool operator’s responsibilities.

Chlorine and pH Get it Done

Chlorine is strongly associated with swimming in popular culture.  Although there are persistent myths about chlorine in swimming pools, chlorine is used as a disinfectant in the majority of pools to help prevent waterborne illnesses such as diarrhea, swimmer’s ear and skin infections.  Alternative sanitizers have been introduced in the marketplace over the last several years, but chlorine continues to offer the most effective and economical option to helping maintain safe pools.

Chlorine actually serves two purposes: it destroys algae and most waterborne germs, and it reacts with—oxidizes—small bits of organic debris and impurities introduced into pool water by swimmers.  Chlorine does this work in the form known as free chlorine, a combination of hypochlorous acid and hypochlorite ion.  Free chlorine is produced in pool water when chlorine disinfectant is added.  When free chlorine reacts with nitrogen-bearing or organic substances, the product is known as combined chlorine, a much weaker disinfectant and oxidant. The World Health Organization recommends free chlorine levels up to 3 mg/l be maintained in swimming pools.

As pool operators know, hypochlorous acid¹ is a more effective disinfectant and oxidant than the hypochlorite ion ², and their relative proportions fluctuate with the pH (acidity) of the water in the pool (low pH is more acidic and high pH is more basic).   To maintain optimal levels of hypochlorous acid for germ and algae destruction while at the same time keeping the water comfortable for swimmers, pool operators should maintain pH in the slightly basic range of 7.2 to 7.8.

Monitoring, Monitoring, Monitoring

One of the most important tasks of the swimming pool operator is vigilantly monitoring the pH and free chlorine level of pool water to ensure germs are being destroyed.  This is critical because chlorine may be depleted, for example, by a heavy “bather load”.  A crowded swimming pool adds more organic debris (e.g., perspiration, body oils, trace urine and fecal matter), which can lower the chlorine level or even deplete it, leaving little or no protection against waterborne germs.

A 2010 report from the Centers for Disease Control and Prevention (CDC) found one in eight public pool inspections conducted in 13 states in 2008 resulted in pools being closed immediately due to serious code violations, including insufficient disinfectant.  That is why CDC encourages swimmers to take matters into their own hands and (1) shower and thoroughly wash their bottoms before entering the pool and (2) use portable pool test strips to monitor for adequate free chlorine and pH.  As a public service, the Water Quality and Health Council is making these strips available free to the public this summer at www.healthypools.org/freeteststrips.  Swimmers will have to wash their own bottoms.

Fred Reiff, P.E., is a retired official of the Pan American Health Organization.

¹Hypochlorous acid is HClO.

²An ion is an atom or molecule with a net electric charge due to the loss or gain of one or more electrons. Hypochlorite ion is OCl-.

A Guest Blog by Mom and Swimmer Kristen Swope

I grew up believing some pool-related myths that I realize rather belatedly were my parents’ bizarre, yet caring way to keep me from drowning or getting injured during unsupervised swims.  A few childhood pool story-swapping moments with friends revealed other gems that were also considered truths at the time. I’ve decided to compile the top three ones I believe are worth correcting even if some of them seem downright funny.

1. If you urinate in a swimming pool, the chlorine will turn the water around you blue.

My childhood friends and I actually fell for this one hook, line and sinker!  What can I say?  It was an effective tool to make us use the toilet instead of just hoping our bladders wouldn’t betray us as we relieved our childhood selves in the pool. So finally, the truth:  No “special” chlorine makes the water blue (or green, if we were to go by primary color combinations) when urine mixes with pool water.  It would be great if someone came up with a formula to make this possible.  How quickly we would correct this unhygienic practice!

2. Chlorine in pool water causes rashes and eye irritation.

Research and personal experience as an adult would tell me that properly chlorinated pool water will do no such thing, and that kiddie rash, red eyes, and other forms of skin and eye irritation are usually due to irritants formed when disinfectants combine with pool water contaminants, such as urine, perspiration and body oils. This can be remedied by making sure the pool water pH is in the right range (7.2-7.8), and appropriate chlorine levels (1 – 4 parts per million).

3. You should not swim right after eating.

If you grew up in a family like mine, chances are you know how frustrating it was during those times when the pool seemed to be calling out your name and you just want to jump in, but couldn’t…because you’d just eaten a sandwich. Unfortunately, this old wives’ tale stayed with me right until adolescence, when I hemmed and hawed at a swimming party because I had eaten two slices of pizza and was terrified that cramps would cause me to drown in the pool. My friends laughed at my apprehension and plunged right into the pool water, their bellies full of pizza.

Several interviews with competitive swimmers revealed that they, in fact, eat normal-sized meals (definitely not just one sandwich or a couple of slices of pizza) before going about their fitness routines in the pool. While more complex swimming styles such as the butterfly stroke admittedly are harder to execute on a full stomach, none of the athletic swimmers I talked to ever experienced cramping because they ate something prior to casual swimming.

I am now the mom of an inquisitive and swimming pool-crazy little girl named Isabel.  I realize that telling her tall tales about the pool is silly, and that it’s best to communicate tried-and-tested and fact-based rules to ensure her safety whenever she’s in or near a swimming pool.

Kristen Swope is a freelance writer based in Fremont, California, who has a five year old daughter and is a swimming enthusiast.

But before diving in, it may be a good idea to know just what you are diving into.  Most pools are properly maintained, allowing swimmers to simply enjoy the water.  However, last summer, the Centers for Disease Control and Prevention (CDC) reported pool inspection data from 13 states indicated about one in eight public pool inspections resulted in pools being closed immediately due to serious code violations.

Dip before You Dive!

How do you know if a pool is properly maintained? There are hardly enough pool inspectors to go around, so CDC recommends swimmers take matters into their own hands and test pool water before getting in the pool.  It’s easy and free and will only take you a minute. Before swimming, dip a color-coded test strip into the water and check to see if the pH and chlorine readings are at appropriate levels. The pH should register between 7.2 and 7.8, and the free chlorine level should be between 1.0 and 4.0 parts per million (ppm).  If levels are out of those ranges, pool staff should be notified immediately. Pool staff should ascertain and correct the problem; if swimmers are unsatisfied with the pool staff response, CDC recommends they contact their local health department.

Swimmer’s Ear:  Listen up

New “swimmer’s ear” statistics provide a good reason to check pools for adequate pH and chlorine levels.  The May 20 Morbidity and Mortality Weekly Report (MMWR) notes that “swimmer’s ear” accounts for 2.4 million doctor visits and nearly $500 million in health care costs annually.  According to CDC, pools with proper pH and chlorine levels are less likely to harbor the bacteria that can cause “swimmer’s ear” and other germs that cause recreational water illnesses, including diarrhea and various skin infections.

Free Pool Test Kit Offer

This summer, the Water Quality & Health Council is offering free pool test kits to swimmers across the country. These can be requested online at http://www.healthypools.org/freeteststrips. Kits include three pool test strips and a pamphlet of information, including CDC’s tips for preventing “Swimmer’s Ear.”  We are asking swimmers to return to www.healthypools.org/freeteststrips to upload their pool chemistry results, contributing to an informal survey of pool health across the country.  We’ve even developed a convenient smart-phone application on that webpage to enable swimmers to upload data poolside.

What We Did Last Summer

Last summer, the Water Quality & Health Council provided more than 43,000 free pool test strips to individuals who requested them via the Healthy Pools website.  Data submitted last summer by close to 800 swimmers who had requested the strips indicated that 40 percent of pools had either unacceptable pH or chlorine readings.  We look forward to this summer’s results and further raising awareness of the importance of proper pool chemistry.

Check www.healthypools.org for more summer swimming tips.

For more information on preventing recreational water illnesses, please visit the CDC website at http://www.cdc.gov/healthywater/swimming/.

Chris Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council.

Pool chemicals help keep swimmers safe by killing bacteria and other germs that can lead to recreational water illnesses (RWIs). However injuries can occur in or out of the pool when critical safety rules for handling and applying pool chemicals are ignored. Inhaling fumes when opening pool chemical containers; attempting to pre-dissolve pool chemicals; and splashing chemicals in the eyes can cause injuries.

Fortunately, most of these injuries are preventable with proper chemical storage and handling practices. If you use pool chemicals, be sure to:

• Always store chemicals as recommended by the manufacturer, and prevent them from mixing or getting wet;

• Always secure chemicals away from children and animals;

• Always read chemical packaging and manufacturer directions before use;

• Always wear appropriate protective gear, such as glasses and gloves

• Never pre-dissolve solid chemicals or add water to liquid chemicals; and

• Never mix chlorine products with each other, with acid, or with any other substance.

While continuing its focus on preventing RWI’s caused by contaminated water, CDC is stepping up its efforts to prevent injuries caused by pool chemicals. To help spread the word to pool operators and backyard pool owners alike, we have developed a poster-sized check-list, which pool owners and operators can download or order for free by visiting Healthy Swimming Posters. This is another important tool to promote healthy swimming. Remember, healthy swimming is no accident!

Michele Hlavsa
Epidemiologist
Centers for Disease Control and Prevention

Why Worry? Unclean water can lead to recreational water illnesses (RWIs) – diarrhea, respiratory illness, and ear and skin infections. According to the CDC, these illnesses are on the rise. Between 2005 and 2006, 78 outbreaks were reported in 31 states –the largest number of outbreaks ever in a two-year period. Close to 4,500 people were affected.

However, most respondents (63%) are unaware of illnesses associated with contaminated pool water. In fact, less than one quarter consider the frequency of pool cleaning and chemical treatment (23%) and even less (16 %) think about chlorine levels to maintain clean pool water. Remember, using your senses and following the CDC’s six simple swimming steps will help lead to a healthy and fun swimming summer.