The runner who wants the pool

The aquatic literature in PD is honest and useful: exercise in water is comparable to land-based exercise — not superior, not a gimmick — and for a man whose fear of falling has already retired the hills and the running club, the pool is the venue where amplitude and balance reactions can be trained without the full price of error. The precautions are real and cheap: lying and standing blood pressure, because orthostatic hypotension is common in PD, supervised entry and exit, and respect for temperature regulation. What you do with it: screen, supervise the edges, prescribe the water like any other dose, and never say “better” when the trials said “comparable”.

• A symptomatic orthostatic drop on screening — prescriber review before the pool timetable starts
• Any syncopal episode, in or out of the water — same-week medical review

• The backward faller — the pull test and the next fallTier 2
• Sixty days in — the first prescription is exerciseTier 1

This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.