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Columns: Letter to the Editor

Comment on “Exercise is Medicine® – Ten Years and Counting Looking Back, Moving Forward”

Carayannopoulos, Alexios G. D.O., M.P.H., DABPMR; Burdenko, Igor N. Ph.D.

Author Information
ACSM's Health & Fitness Journal: May/June 2018 - Volume 22 - Issue 3 - p 43
doi: 10.1249/FIT.0000000000000385
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To the Editor

In response to Dr. Thompson et al.’s article entitled “Exercise is Medicine® - 10 Years and Counting,” which was published in the November/December issue of ACSM’s Health & Fitness Journal®, we write with zeal to recognize and applaud the phenomenal progress of the Exercise is Medicine® (EIM) campaign. Given the extraordinary trajectory of EIM, we humbly write to add, assert, and to remind the readership that comprehensive exercise includes both land and water modalities and that the full scope of EIM cannot be understood until we appreciate how exercise can also be accomplished in a water environment.

EIM was built on science, which includes an understanding of basic human pathophysiology and biomechanics, as well as research and development to better define the essential qualities of exercise for everyday life and sport. From our perspective, these include balance, coordination, flexibility, endurance, speed, and strength, all of which can be learned and mastered in the water. Water is therapeutic and safe. Water is an extraordinary healing force. It can reduce stress, improve mobility, and prevent injury. Exercise in water can lead to greater success in training and conditioning as well as enhanced outcomes in rehabilitation. Recognition of water as a modality in theoretical and practical application of exercise science has a synergistic affect when combined with any land-based program.

Several studies have demonstrated that therapeutic water-based exercise can be a safe and efficacious modality for patients with painful conditions such as low back and musculoskeletal pain (1–3). This is especially true for patients who may have difficulties with the weight-bearing components of land-based interventions (4). Off-loading of joints, which can occur in the water, may also provide an optimal environment for patients to exercise aerobically and at greater intensities than would be possible on land (5). Water builds up the body’s innate ability to heal itself.

Although ACSM is celebrating 10 years of EIM, neither exercise is medicine nor exercise in the water are new concepts. By way of illustration, The Burdenko method has successfully combined exercise on land and in water for more than 30 years. The program, which combines water and land, is based on six essential qualities including the following: exercise in deep water in the vertical position; different starting positions; all exercises with different speeds; exercises in multiple directions; attention to body alignment; and keeping the client involved in recovery. We have had the privilege of working with clients in clinical settings as well as athletes at all levels of training, including Olympiads and ballerinas. Through our experiences, we strongly assert that exercise without water is akin to being in the shower without soap.

Again, we are thrilled to acknowledge the EIM article, but we assert that it is imperative to not separate land from the water, land from the air, nor water from the air because they all coexist and enhance exercise together. We look forward to more progress of EIM in the coming years. Welcome to the era of Exercise is Medicine®.

Alexios G. Carayannopoulos, D.O., M.P.H., DABPMR

Clinical Assistant Professor of Neurosurgery

Warren Alpert Medical School

Brown University, Providence, RI

Email: [email protected]

Igor N. Burdenko, Ph.D.

Founder and CEO

The Burdenko Water and Sports Therapy Institute, Newton, MA


1. Waller B, Lambeck J, Daly D. Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Cli Rehabil. 2009;23(1):3–14.
2. Baena-Beato PÁ, Artero EG, Arroyo-Morales M, Robles-Fuentes A, Gatto-Cardia MC, Delgado-Fernández M. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Cli Rehabil. 2014;28(4):350–60.
3. Barker A, Talevski J, Mmorello R, Brand C, Rathmann A, Urquhart D. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta analysis. Physiotherapy. 2015;101:e112–3.
4. Nemcić T, Budisin V, Vrabec-Matković D, Grazio S. Comparison of the effects of land-based and water-based therapeutic exercises on the range of motion and physical disability in patients with chronic low-back pain: single-blinded randomized study. Acta Cli Croat. 2013;52(3):321–7.
5. Cuesta-Vargas AI, García-Romero J, Arroyo-Morales M, Diego-Acosta AM, Daly DJ. Exercise, manual therapy, and education with or without high-intensity deep-water running for nonspecific chronic low back pain. Am J Phys Med Rehabil. 2011;90(7):526–38; quiz 535–8.
© 2018 American College of Sports Medicine.