The Effectiveness of Water- versus Land-Based Exercise on Specific Measures of Physical Fitness in Healthy Older Adults: An Integrative Review

As the population ages, maintaining an active lifestyle becomes increasingly vital to promote overall health and well-being in older individuals. Water- and land-based exercises have emerged as popular options, each offering a distinct set of benefits tailored to the unique needs of this population group. An electronic database search, including PubMed, Scopus, MEDLINE, and Web of Science, was conducted until 15 September 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to investigate the effects of water-based compared to land-based exercise on selected fitness parameters in older healthy individuals. The eligibility criteria included studies with at least two groups of participants aged 60 and older, with physical fitness outcome measures. A total of ten studies met the inclusion criteria and were analyzed. While both exercise modalities may offer significant benefits, this review's findings emphasized the absence of conclusive evidence and consensus for recommending a single exercise category applicable to aquatic or land environments and providing more definite guidance to improve health-related physical fitness parameters in healthy older individuals. Finally, combining both training approaches may lead to a comprehensive array of health benefits for this age group population by also considering individual's needs, preferences, and fitness goals.

Effects of Aquatic Exercise and Floor Curling on Balance Ability and Lower Limb Muscle Strength in Children with Intellectual Disabilities: A Pilot Study in China

Children with intellectual disabilities often face challenges in balance ability and lower limb muscle strength, which negatively impact their daily lives and motor function. Therefore, it is crucial to enhance the balance ability and lower limb muscle strength of children with intellectual disabilities. This study aimed to investigate the effects of a 12-week aquatic exercise and floor curling intervention on the balance ability and lower limb muscle strength of children with intellectual disabilities. Forty-two participants were randomly assigned to the aquatic exercise group, floor curling group, and control group. The aquatic exercise and floor curling groups received a 12-week intervention, while the control group engaged in supervised free activities. The participants' balance ability and lower limb muscle strength were assessed using the Berg Balance Scale and a muscle strength testing device before and after the intervention. The results showed significant improvements in balance ability and lower limb muscle strength for both the aquatic exercise group and the floor curling group after the intervention. The aquatic exercise group demonstrated an average improvement of 10.84% in balance ability and an overall average improvement of 16.28% in lower limb muscle strength. The floor curling group showed an average improvement of 9.04% in balance ability and an overall average improvement of 15.67% in lower limb muscle strength. These improvement results were statistically significant (p < 0.05) and ranged from medium to large effect sizes (d = 0.5~0.8). The findings of this study validate the positive effects of aquatic exercise and floor curling on the balance ability and lower limb muscle strength of children with intellectual disabilities. These interventions can be considered effective approaches for functional rehabilitation in children with intellectual disabilities.

Effectiveness of Water-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that, due to dyspnea, decreases patients' physical function and quality of life. The aim of the research was to evaluate the effectiveness of water-based exercise (WE) in improving functional capacity and respiratory muscle strength in patients with COPD. It consisted of a systematic review and meta-analysis of eight randomized clinical trials (RCTs) from the last 10 years, found in PubMed, PEDro, Scopus and Web of Science databases. Methodological quality was analyzed using the PEDro scale and the Cochrane Collaboration Risk of Bias Tool. Regarding the evaluation of functional capacity, mainly assessed were lung function, respiratory muscle strength, and maximal or aerobic exercise. The results showed that WE improves functional capacity compared to a non-exercising control group (SMD: 73.42; IC 95%: 40.40 to 106.45; I2: 0%). There are no statistically significant differences between a WE treatment and a land exercise (LE) treatment (p = 0.24) in functional capacity, nor with respect to respiratory muscle strength (p = 0.97). These data should be interpreted with caution, as more RCTs with aquatic intervention in COPD patients are needed to elucidate whether there are differences between WE or LE according to patient characteristics and comorbidities.

Assessing the effect of regular swimming exercise on the micro- and macrovascular physiology of older adults (ACELA II study)

Introduction: Cardiovascular disease (CVD) remains the main cause of death in the Western world. Our recent findings demonstrate potential CVD risk reduction in older adults who undertake regular swimming exercise. Nevertheless, it remains unknown whether an exercise intervention based on swimming is feasible and effective prior to a wider implementation of a CVD risk prevention strategy. Methods: This was a pragmatic, two-group, randomised controlled trial. A total of 40 older adults were randomly split into two groups (n = 20 per group). The swimming exercise group consisted of participants who engaged in swimming exercise (2-3 days/week, for 8 weeks). The control group did not perform any exercise. Flow-mediated dilation (%FMD) was the primary outcome. Secondary outcomes included raw cutaneous vascular conductance. Feasibility outcomes (e.g., recruitment, adherence, and attrition rates) were also assessed. Results: Statistically significant macrovascular (%FMD; swimming group: 9.8% ± 4.2%, p <0.001; control group: 4.6% ± 2.5%) and microvascular function (raw cutaneous vascular conductance; swimming group: 4.1 ± 0.9, p <0.01; control group: 3.2 ± 1.1) improvements were observed in the swimming group compared to the control group. Compliance to twice and thrice weekly in an 8-week swimming exercise was 92.6% and 88.4%, respectively, with no dropouts. Conclusion: Our 8-week, community-based, pragmatic swimming exercise intervention is a feasible and effective exercise programme that could be implemented in older adults for the prevention of age-related CVD. These findings suggest that swimming exercise could significantly reduce CVD risk in older adults, and a large research clinical trial is warranted to establish these findings.

Quantifying physiological and biomechanical responses of shallow water walking: a systematic review and meta-analysis

Detecting the physiological and biomechanical alterations in shallow water walking (SWW) due to water depth and speed is important for health professionals to perform accurate exercise prescription. This systematic review with meta-analysis aimed to investigate the acute physiological and biomechanical responses of SWW at different immersion depths in comparison to dry land walking. The main result (initial search: 1960 studies; systematic review: 42 studies; meta-analysis: 22 studies) indicated that metabolic power was higher in the immersion depth levels of xiphoid process (standardized mean differences (SMD) = 0.90; 95% confidence intervals (CI): 0.26 to 1.54) and waist (SMD = 3.35; 95% CI: -0.18 to 6.87) in comparison to dry land. SWW at xiphoid and waist depths seems to be an adequate exercise if the objective is to increase the energy expenditure and cardiovascular demand while the lower limb impact forces are reduced in comparison to dry land walking. PROSPERO registration: CRD42018113040.

Effects of Aquatic Exercises for Women with Rheumatoid Arthritis: A 12-Week Intervention in a Quasi-Experimental Study with Pain as a Mediator of Depression

BACKGROUND

Rheumatoid arthritis (RA) is characterized by low physical fitness, pain, and depression. The present study aimed to examine the effects of a supervised aquatic exercise program on physical fitness, depression, and pain in women with RA and determine whether decreases in pain mediate depression.

METHODS

Forty-three women with RA, divided into an experimental group (EG; n = 21) and a control group (CG; n = 23), participated in a 12-week exercise program. Treatment effects were calculated via standardized difference or effect size (ES) using ANCOVA adjusted for baseline values (ES, 95% confidence interval (CI)). A simple panel of mediation was executed to determine whether changes in pain mediated improvements in depression after controlling for confounding variables, such as age, physical activity, and body mass index (BMI).

RESULTS

The aquatic exercise program had trivial and small effects on physical fitness, large effects on pain, and moderate effects on depression. The mediation model confirmed the indirect effect of pain on the decrease of depression in the participants of the aquatic exercise program.

CONCLUSIONS

Participants with RA in the aquatic exercise program experienced improvements in physical fitness, depression, and joint pain. Moreover, the improvements in joint pain mediated improvements in depression.

The effects of exercise during water immersion on arterial function in humans

PURPOSE

Flow-mediated dilation (FMD) provides a valid bioassay of vascular function in humans. Although water immersion induces hemodynamic effects that modify brachial artery shear stress, it is unclear whether water-based exercise modifies FMD. We hypothesised that exercise in 32°C water would decrease brachial artery shear and FMD relative to land-based exercise, whereas exercise in 38°C would increase brachial shear and FMD.

METHODS

Ten healthy participants (8 males; 23.9±3.3yrs) completed 30mins of resistance-matched cycle exercise in three separate conditions: Land, and in 32°C and 38°C water. Brachial artery shear rate area under the curve (SRAUC) was measured throughout each condition, with FMD measured pre and post exercise.

RESULTS

Brachial SRAUC increased during exercise in all conditions and was highest across the 38°C condition compared to Land and 32°C conditions (38°C:27507±8350 vs Land:9908±4738 vs 32°C:13840±5861 1/s, P<0.001). Retrograde diastolic shear was greater during 32°C than both Land and 38°C conditions (32°C:-3869±2198 vs Land:-1602±1334 vs 32°C:-1036±1754, P<0.01). FMD increased as a result of 38°C (6.2±1.9 vs 8.5±2.7%, P=0.03), with no change in the Land exercise (6.3±2.4 vs 7.7±2.4%, P=0.10) or 32°C condition (6.4±3.2 vs 6.7±3.2%, P=0.99).

CONCLUSION

Our findings indicate that cycle exercise in hot water attenuates retrograde shear, increases antegrade shear, and FMD. Exercise in 32°C water induces central hemodynamic changes relative to land-based exercise, but these do not translate to increases in FMD in either condition, likely due to the impact of increased retrograde shear. Our findings indicate that modification of shear has direct acute impacts on endothelial function in humans.

Water-Based Training Programs Improve Functional Capacity, Cognitive and Hemodynamic Outcomes? The ACTIVE Randomized Clinical Trial

Purpose: To compare the effects of 16 weeks of aerobic training (AT) to 8 weeks of AT followed by 8 weeks of combined training (CT), as well as to a control group (CG), on the functional, cognitive and hemodynamic responses of older women exercising in the aquatic environment. Materials and Methods: The study is a three-armed parallel randomized controlled clinical trial. For this, 52 older women were first randomized in an aerobic training (AT; n = 35) or control group (CG; n = 17). After 8 weeks of intervention, participants from AT group were again randomized into another 8-week period of either AT (n = 17) or combined training (CT; n = 18). AT was performed at the percentage of the heart rate corresponding to the anaerobic threshold, resistance training was performed with sets at maximal effort and the control group performed low-intensity therapeutic exercises in water. All outcomes were assessed before (week 0) and after the intervention (week 17). In addition, some outcomes were also investigated in the middle timepoint (week 9). Generalized Estimating Equations (GEE) and Bonferroni post-hoc tests (α = 0.05) were used to compare timepoints and groups. Results: All groups similarly improved functional capacity (3-11%) and blood pressure (-4 to -10%), whereas cognitive function was not modified for any group. Conclusion: Water-based training programs and therapeutic exercises (i.e., CG) improve functional capacity and blood pressure responses in older women. Clinical Trials NCT03892278.

Effects of aquatic exercise on the improvement of lower-extremity motor function and quality of life in patients with Parkinson's disease: A meta-analysis

Objective: To systematically evaluate the effect of aquatic exercise interventions on the improvement of lower-extremity motor function and quality of life in patients with Parkinson's disease. Methods: Two researchers independently searched the literature using the PubMed, Web of Science, Embase, and Cochrane Library databases. The search period was from the establishment of the database to December 2021. The subject heading search included "hydrotherapy," "hydro therapies," "hydro therapeutics," "water therapy," "aquatic exercise therapy," "aquatic therapy," "water-based exercise," "Parkinson," "Parkinson disease," "Parkinson's disease," "Parkinson's syndrome," "primary Parkinsonism," "paralysis agitans," and "randomized controlled trial (RCT)." Result: A total of 698 articles were retrieved from the four databases by searching for subject headings, and 10 RCT articles were finally included. The balance ability of aquatic exercise in patients with Parkinson's disease (weighted mean differences [WMD] = 2.234, 95% CI: 1.112-3.357, Z = 3.9, p < 0.01), walking ability (WMD = -0.911, 95% CI: -1.581 to -0.241, Z = 2.67, p < 0.01), and quality of life (WMD = -5.057, 95% CI: -9.610 to -0.504, Z = 2.18, p = 0.029) were improved, but there was no significant difference in motor function (WMD = -0.328, 95% CI: -1.781 to 1.125, Z = 0.44, p = 0.658). Conclusion: Compared with conventional rehabilitation therapy, aquatic exercise can effectively improve balance, walking ability, and quality of life in patients with Parkinson's disease. However, it had no obvious effect on improving motor function. This study was limited by the number and quality of the included studies, and more high-quality studies are needed to verify this. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022365103.

Association of Co-Living and Age on the Type of Sports Practiced by Older People

Introdution: The environment and the type of co-living of older people are crucial to understanding how the nature of their context influences a healthy lifestyle. However, no studies have investigated to what extent their type of co-living may be associated with the sports and the profile practice according to their age. Objective: This study aimed to assess the association between the types of co-living and the age of the physically active elderly and the sports they practice. Hypothesis: It is thought that the age, situation, and satisfaction with the way of living in physically active older people differ according to the type of sport they practice. Methods: Cross-sectional study. We included 358 individuals aged between 61 and 93 years old (M = 69.66, SD = 4.74). Type of co-living was classified as living alone or living with others. The sports activities evaluated were: gym, dance, water activities, and yoga/pilates. Differences in the type of co-living and sports practiced were evaluated by ANOVA or Chi2. Results: Among the elderly who practice gymnastics, most of them live alone and in a tight core (p < 0.001) (Phi = 0.244). Furthermore, those who practice aquatic activities are more frequently the youngest (p < 0.001) (Phi = 0.198). Conclusion: Older people who do gymnastics have smaller living groups, those under 69 opt for gymnastics and aquatic activities, while those aged 70 and over prefer dance, yoga, and pilates.

The Effect of Aquatic Plyometric Training on Jump Performance Including a Four-week Follow-up in Youth Female Volleyball Players

This study aimed to analyze the effect of aquatic plyometric training (APT) on jump performance in volleyball players. Twelve female athletes (16.6 ± 0.9 years) were assessed through the following jump tests: spike height (SH), squat jump (SJ), countermovement jump (CMJ) and CMJ with an arm swing (CMJA). Jump height in each test and the eccentric utilization ratio (EUR) were the outcome measures. APT consisted of sets of drop jumps for 6 weeks (2 sessions/week) at a water depth of 0.75 m. Tests were performed at the beginning of a five-week pre-season period, before and after APT, and four weeks later for the follow-up. Repeated measures ANOVAs were used to analyze data and Hedges’ g to estimate effect size (ES). Performance of all jumps did not change from baseline to Pre-APT. Performance improved in SH (p < 0.001, ES: 1.09), the SJ (p = 0.045, ES: 0.76) and the CMJA (p < 0.001, ES: 0.78) after APT when compared to Pre-APT. No changes were observed after the follow-up period. In conclusion, including six weeks of APT in the training routine of youth volleyball players improved performance of a sport-specific task (SH), the SJ and CMJA, with gains preserved after a four-week follow-up.

Effects of Different Exercise Therapies on Balance Function and Functional Walking Ability in Multiple Sclerosis Disease Patients-A Network Meta-Analysis of Randomized Controlled Trials

The objective of this research is to assess the effects of seven different exercise therapies (aquatic exercise, aerobic exercise, yoga, Pilates, virtual reality exercise, whole-body vibration exercise, and resistance exercise) on the balance function and functional walking ability of multiple sclerosis disease patients. Materials and Methods: The effects of different exercise interventions on the balance function and functional walking ability in people with multiple sclerosis were assessed by searching five databases: PubMed, Embase, Cochrane Library, Web of Science, and CNKI; only randomized controlled trials were included. The included studies were assessed for risk of bias using the Cochrane assessment tool. Results: The RCTs were collected between the initial date of the electronic databases’ creation and May 2022. We included 31 RCTs with 904 patients. The results of the collected data analysis showed that yoga can significantly improve patients’ BBS scores (SUCRA = 79.7%) and that aquatic exercise can significantly decrease patients’ TUG scores (SUCRA = 78.8%). Conclusion: Based on the network meta-analysis, we suggest that although each type of exercise is useful, yoga, virtual reality training, and aerobic training are more effective in improving the balance function of people with MS; aquatic exercise, virtual reality training, and aerobic training are more effective in improving the functional walking ability of people with MS.

Exercise Prescription and the Minimum Dose for Bone Remodeling Needed to Prevent Osteoporosis in Postmenopausal Women: A Systematic Review

The aim of this review is to analyze previously conducted randomized controlled trials and investigate the relationship between various exercise regimes and their effect on bone mineral density in postmenopausal women. To determine whether exercise can be used as a non-pharmacological modality for osteoporosis prevention, a thorough search was performed on various databases (PubMed, ScienceDirect, and Google Scholar). Only bone mineral density studies and trials with intervention versus control groups were included, and 13 randomized controlled trials were deemed relevant. The majority of trials concluded that exercise positively impacted bone mineral density in postmenopausal women. High-impact exercises seem to have the most significant effect on bone mineral density due to compression, shear stress, and high loading on the bone, causing bone remodeling. Considering all the limitations, exercise seems to be an effective tool for preventing postmenopausal osteoporosis.

Water-based therapeutic exercise in stroke: a scoping review

PURPOSE

To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) for people living with stroke, (2) describe the content and structure of interventions, (3) summarize the effects of interventions described in the literature, and (4) identify gaps in the literature limiting application and implementation.

MATERIALS AND METHODS

Scoping review methodology described by Arksey and O'Malley (2005) and Levac et al. (2010). Electronic databases were searched for articles with eligibility criteria including: (1) adult stroke survivors (18 years or older) of any type (ischemic/hemorrhagic) or stage (acute/chronic) in any setting, and (2) the study intervention involved WBTE to address a post-stroke deficit.

RESULTS

40 articles were included in this review. Five trials had a treatment control, 20 had an active comparison. Calculated intervention effect sizes demonstrated a strong effect of WBTE on balance and gait related outcomes in 80% of controlled and comparison trials.

CONCLUSIONS

This scoping review highlights common parameters of WBTE interventions and provides an inventory of the differences in the treatment approaches utilized in this population. Opportunities for future work include the development of a standardized treatment protocol, qualitative or mixed methodology research, and greater inclusion of more individuals with more severe stroke-related impairments. IMPLICATIONS FOR REHABILITATIONWater-based therapeutic exercise is an approach that may allow stroke survivors to carry out challenging activities in a safe and accessible environment.Water-based interventions for stroke survivors appear to have a beneficial impact on walking and balance.Given that an aquatic environment offers an opportunity for individuals with more significant physical impairments to carry out early practice of walking and balance related tasks, clinicians should explore the feasibility and effectiveness for this subset of stroke survivors.

Metabolic and cardiopulmonary impact of aquatic exercise and nutritional guidance for four individuals with chronic motor incomplete spinal cord injury: a case series

BACKGROUND

Persons living with chronic spinal cord injury (SCI) demonstrate an increased risk of cardiovascular diseases.

Purpose The aim of this report was to assess the cardiopulmonary and metabolic impact of prescribed aquatic exercise in combination with dietary guidance for four individuals experiencing chronic SCI.

CASE DESCRIPTION

We measured peak oxygen consumption (peak VO₂), resting energy expenditure (REE), weight, food logs, fasting glucose, insulin and glycated hemoglobin (HbA1C) in four men with incomplete SCI, aged 34 to 63 years.

INTERVENTION

The men received a group aquatic exercise program three times per week for 10 weeks, and a weekly individual nutritional consultation by phone.

OUTCOMES

Peak VO₂ increased by 7.9% and 34.4% in participants #3 and #4 and decreased by 12% and 16.4% in #1 and #2. Glucose values decreased by 19.6% and 14.2% for #1 and #3, and increased by 9.3% for both #2 and #4. Body mass decreased by 9.9%, 3.0% and 5.7% for participants #1, #2 and #3, but demonstrated no change for participant #4. Dietary guidance and education produced positive changes, including reduced fat, carbohydrate, daily sugar, and average calorie intake.

CONCLUSION

Moderate exercise with weekly nutritional guidance appeared to positively impact body mass and dietary selections with varied metabolic and cardiopulmonary results.

Effects of aquatic exercise on mood and anxiety symptoms: A systematic review and meta-analysis

OBJECTIVE

Exercise has beneficial effects on mood and anxiety symptoms. However, the impact of aquatic exercise on mood and anxiety symptoms has not been clearly confirmed. Therefore, this study aimed to synthesize and systematically analyze evidence available on boosting mental health through aquatic exercise.

METHOD

A systematic review and meta-analysis were conducted under the PRISMA 2020 guidelines. PubMed, BIOSIS Previews, PsycINFO, Medline, SPORTDiscus, Education Source, and Web of Science Core Collection (WoSCC) were searched in May 2022. The research included the influence of aquatic exercises on mood and anxiety symptoms. After assessing trial quality and completing data extraction, a meta-analysis was carried out through R software. The results were presented as a standardized mean difference (SMD) and the corresponding 95% confidence interval.

RESULTS

A total of 18 original trials were included. People who received aquatic exercise intervention had a statistically significant reduction in mental disorder symptoms compared with before. The results were aquatic exercise [SMD = -0.77, 95% CI (-1.08, -0.47), I² = 77%, P < 0.01], swimming [SMD = -0.51, 95% CI (-1.14, 0.12), I² = 78%, P < 0.01], aquatic aerobics [SMD = -0.92, 95% CI (-1.32, -0.53), I² = 78%, P < 0.01], moderate intensity [SMD = -0.75, 95% CI (-1.07, -0.43), I² = 67%, P < 0.01], and low intensity [SMD = -1.07, 95% CI (-1.08, -0.47), I² = 85%, P < 0.01].

CONCLUSION

Aquatic exercise could statistically significantly improve mental health. Light aquatic aerobics probably has a better effect on mood and anxiety symptoms. However, given the number and quality of included research, verifying the aforementioned conclusions requires a larger sample of high-quality studies.

Effect of Aquatic Exercise Training on Aortic Hemodynamics in Middle-Aged and Elderly Adults

Aquatic exercise is an attractive form of exercise that utilizes the various properties of water to improve physical health, including arterial stiffness. However, it is unclear whether regular head-out aquatic exercise affects aortic hemodynamics, the emerging risk factors for future cardiovascular disease. The purpose of this study was to investigate whether head-out aquatic exercise training improves aortic hemodynamics in middle-aged and elderly people. In addition, to shed light on the underlying mechanisms, we determined the contribution of change in arterial stiffness to the hypothesized changes in aortic hemodynamics. Twenty-three middle-aged and elderly subjects (62 ± 9 years) underwent a weekly aquatic exercise course for 15 weeks. Aortic hemodynamics were evaluated by pulse wave analysis via the general transfer function method. Using a polar coordinate description, companion metrics of aortic pulse pressure (PPC = √{(systolic blood pressure)² + (diastolic blood pressure)²}) and augmentation index (AIxC = √{(augmentation pressure)² + (pulse pressure)²}) were calculated as measures of arterial load. Brachial-ankle (baPWV, reflecting stiffness of the abdominal aorta and leg artery) and heart-ankle (haPWV, reflecting stiffness of the whole aortic and leg artery) pulse wave velocities were also measured. The rate of participation in the aquatic training program was 83.5 ± 13.0%. Aortic systolic blood pressure, pulse pressure, PPC, AIxC, baPWV, and haPWV decreased after the training (P < 0.05 for all), whereas augmentation index remained unchanged. Changes in aortic SBP were correlated with changes in haPWV (r = 0.613, P = 0.002) but not baPWV (r = 0.296, P = 0.170). These findings suggest that head-out aquatic exercise training may improve aortic hemodynamics in middle-aged and elderly people, with the particular benefits for reducing aortic SBP which is associated with proximal aortic stiffness.

Physical fitness changes induced by thermal aquatic standardized exercise in chronic venous disease patients

BACKGROUND

Lack of physical activity represents a risk factor for both cardiovascular and chronic venous diseases (CVD), nevertheless a specific exercise protocol for CVD patient is still missing. This investigation was aimed to assess the impact of a standardized exercise protocol in a thermal water environment on physical fitness and quality-of-life (QoL) in CVD patients.

METHODS

Sixteen (16) CVD patients performed 5 standardized exercise sessions in a thermal water pool. Before starting the exercise protocol, the cohort filled International Physical Activity Questionnaire (IPAQ) to determine their physical activity level. At baseline and at the end of the exercise program, leg volume, QoL, musculoskeletal and cardiovascular physical fitness were assessed by means of water plethysmography, validated questionnaire and functional test, blood pressure and heart rate at rest were also reported.

RESULTS

All the patients were categorized as physically inactive: average activity time 235.6 (155.2) MET-minutes per week. At the end of the study, a significant leg volume reduction was found (-16%; p < .002). Significant improvement in lower limb strength (p < .0001), endurance (p < .006), rapidity and balance (p < .05) together with decrease in resting heart rate (-1.8%, p < .0001) and systolic blood pressure (-1.1%, p < .04) were reported, significant improvement in bodily pain (p < .0005) and social function (p < .002) QoL items were observed.

CONCLUSIONS

The proposed exercise protocol in thermal aquatic environment demonstrated to be an effective treatment modality improving both cardiovascular and musculoskeletal outcomes and QoL in sedentary CVD patients. Aquatic environment investigations require proper analysis of the various factors involved, in a standardized and reproducible way. The herein report can be a reference for further studies on different health related conditions.

Effects of Aquatic Exercise and Land-Based Exercise on Cardiorespiratory Fitness, Motor Function, Balance, and Functional Independence in Stroke Patients-A Meta-Analysis of Randomized Controlled Trials

The aim of this study was to evaluate the efficacy of aquatic exercise (AE) and land-based exercise (LE) on cardiorespiratory fitness, motor function, balance, and functional independence in stroke patients. Design: Through searching PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP and Wanfang Database, only randomized controlled trials (RCTs) were collected to study the effects of AE and LE on cardiorespiratory fitness, motor function, balance, and functional independence in patients with stroke. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool, and statistical analysis was carried out by the Review Manage 5.3 and Stata 15.1 software. Results: The RCTs were collected between the earliest available date and April 2021. Eleven RCTs were included, including five studies with low risk and six studies with moderate risk. The total sample size used in the study was 369, which included 187 patients undertaking AE and 182 patients undertaking LE. The results of the meta-analysis showed that AE can significantly improve patients’ Berg Balance Scale (BBS) (MD = 5.19, 95% CI: 2.66 to 7.71, p < 0.0001), peak oxygen uptake (VO₂peak) (MD = 3.49, 95% CI: 0.17 to 6.8, p = 0.04), Fugl–Meyer Assessment (FMA) (MD = 3.84, 95% CI: 1.64 to 6.04, p = 0.0006), and Functional Independence Measure (FIM) (MD = 6.1, 95% CI: 4.05 to 8.15, p < 0.00001). However, there was no statistically significant difference between the two exercise modes in the Timed Up and Go Test (TUGT) (MD = −2.52, 95% CI: −5.95 to 0.91, p = 0.15) or the Functional Ambulation Category scale (FAC) (MD = 0.28, 95% CI: −0.21 to 0.76, p = 0.26). Conclusion: Based on the improvement in the Berg Balance Scale, peak oxygen uptake, Fugl–Meyer Assessment, and Functional Independence Measure, we can state that aquatic exercise offers better advantages than land-based exercise for patients’ balance, motor function, cardiorespiratory fitness, and functional independence.

Force Production and Coordination from Older Women in Water Fitness Exercises

The aim of this study was to compare bilateral propulsive forces and coordination while exercising at static and dynamic conditions in the water. A total of 27 older women (age: 65.1 ± 6.7 years old) performed the following exercises: (i) horizontal upper-limbs adduction (HA; static condition) and (ii) rocking horse (RH; dynamic condition) through an incremental protocol with music cadences from 105 up to 150 b·min⁻¹. The duration of each trial was set at 30 second (sec). Propulsive peak force (in Newton, N) of dominant (PF_D) and nondominant (PF_ND) upper limbs was retrieved using hand sensors coupled to a differential pressure system. Significant differences in force production were found between static and dynamic exercises at higher cadences (120, 135, and 150 b·min⁻¹). The static condition elicited higher bilateral propulsive forces and a more symmetric pattern. The in-water static exercise with bilateral action from the upper limbs proved to be the most appropriate strategy for older women to work strength and to reduce asymmetries.

Acute Blood Pressure Effects in Older Adults with Hypertension After Different Modalities of Exercise: An Experimental Study

This study investigated the acute blood pressure (BP) effects of different exercise modalities in older adults with hypertension. Sixty volunteers were randomly assigned (n = 15/group) into different exercise protocols: resistance, bike, water-based exercise (WE), and a control session-all for ∼45 min. Clinic BP measurements were taken before, immediately after, and 15 and 30 min after protocols. The data were analyzed by one-way analysis of variance; generalized estimating equations, following Bonferroni post hoc (p < .05). Immediately after exercise, the systolic BP (SBP) increased in all exercise protocols (resistance exercise = Δ10.3, bike exercise = Δ5.8, WE = Δ9.5 mmHg; p < .001), while the diastolic BP was not altered. Afterward, the SBP reached the value observed before exercise. In Minute 30, only WE presented a significant reduction for SBP (WE = Δ-4.6 mmHg; p < .05). This study has important clinical implications in hemodynamic safety for acute BP increases immediately after exercises, as well as, in the SBP, reduction benefits for older adults with hypertension.

Aquatic Exercise Positively Affects Physiological Frailty among Postmenopausal Women: A Randomized Controlled Clinical Trial

Frailty is a risk factor associated with aging. Physical exercise is an important lifestyle factor that can help to avoid risks associated with aging. Therefore, we aimed to determine the effects of aquatic exercise for 12 weeks on body composition, cardiovascular disease risk factors, insulin resistance, and aging-related sex hormones in elderly South Korean women. Twenty-two women aged 70–82 years were randomly assigned to groups that participated or did not participate (controls; n = 10 in aquatic exercise for 60 min, three times per week for 12 weeks (n = 12). Exercise intensity defined as the rating of perceived exertion (RPE), was increased from 12–13 to 13–14, and to 14–15 during weeks 1–4, 5–8, and 9–12, respectively. Body composition (skeletal muscle mass, ratio (%) body fat, and waist circumference), cardiovascular disease risk factors (total, high-density lipoprotein, and low-density lipoprotein cholesterol), insulin resistance (glucose, insulin, and homeostatic model assessment of insulin resistance [HOMA-IR]), and aging-related sex hormone changes (dehydroepiandrosterone-sulfate [DHEA-S]) and sex hormone-binding globulin [SHBG]) were assessed. Aquatic exercise safely improved body composition, reduced insulin resistance, and positively affected the sex hormones DHEA-S and SHBG as well as blood lipid profiles. Our findings suggested that the aquatic exercise program positively altered blood lipids, regulated glucose levels, and sex hormone levels. Therefore, regular, and continuous aquatic exercise is recommended to prevent frailty, decrease cardiovascular risk, and provide older women with an optimal quality of life as they age.

Aquatic exercise in patients with haemophilia: Electromyographic and functional results from a prospective cohort study

INTRODUCTION

Recurrent joint bleeds in haemophilia patients often cause musculoskeletal changes leading to functional capacity impairment.

AIM

In this study, we assessed the effects of aquatic activities performed to improve functional capacity in these patients.

METHODS

The interventional protocol consisted of 24 hydrotherapy sessions during three months, in comparison with 24 swimming sessions. The pre- and post-intervention assessment consisted of Functional Independence Score, haemophilia joint health score (HJHS), Pediatric Haemophilia Activities List (PedHAL), surface electromyography (SEMG) of thigh muscles to assess muscle electric activity, and load cell on extensor and flexor thigh muscles to evaluate muscular strength.

RESULTS

Forty-seven haemophilia patients were enrolled in this study, and 32 (23 severe haemophilia A, one moderate haemophilia A and 8 severe haemophilia B), median age 12y (6 to 40y), concluded the aquatic intervention. We observed a statistically significant increase with substantial improvement in functional capacity in the pre- and post-intervention evaluation of hydrotherapy in comparison with the swimming protocol, with HJHS (p = .006 and p = .001 respectively), PedHAL (Sum score) (p = .022 and p = .001) and score FISH (p = .021). The swimming group revealed significant improvements in muscular strength, in all muscles tested (p = .005 and p = .001). SEMG signal amplitude reached significantly higher levels in all muscles evaluated after both interventions except for the vastus medialis (right) in the hydrotherapy group.

CONCLUSION

Our results concluded that both swimming and hydrotherapy were associated with physical improvement in haemophilia patients; however, only hydrotherapy lead to a more significant improvement in functional capacity.

Long-Term Effects of Three Water-Based Training Programs on Resting Blood Pressure in Older Women

The aim of the study was to compare the effects of three water-based training on blood pressure (BP) in older women. A total of 57 participants were randomized into the following groups: (a) aerobic training (AT), (b) concurrent training in which resistance training progresses to the use of resistive equipment (CTRE), and (c) concurrent training in which resistance training progresses to multiple sets (CTMS). The participants trained twice a week for 16 weeks. Systolic BP decreased from pretraining to after 8 weeks of training and, subsequently, to after 16 weeks of training (AT: -6.53 mmHg, CTRE: -10.45 mmHg, and CTMS: -10.73 mmHg). Diastolic BP decreased from pretraining to after 8 and 16 weeks of training (AT: -6.23 mmHg, CTRE: -4.61 mmHg, and CTMS: -6.19 mmHg). Furthermore, 16% of the AT participants, 23% of the CTRE participants, and 28.5% of the CTMS participants were no longer classified as hypertensive. Water-based aerobic and concurrent training are efficient nonpharmacological measures to reduce BP in older women.

Effect of walking speed during gait in water of healthy elderly

BACKGROUND

Walking in water (WW) is frequently used as an aquatic exercise in rehabilitation programs for the elderly. Understanding gait characteristics of WW is of primary importance to effectively design specific water-based rehabilitation programs. Moreover, as walking speed in water is reduced with a possible effect on gait parameters, the age- and environment-related changes during WW have to be investigated considering the effects of instantaneous walking speed.

RESEARCH QUESTION

how do gait kinematic characteristics differ in healthy elderly between WW and on land walking condition (LW)? Do elderly show different walking patterns compared to young adults? Can these kinematic changes be accounted only by the different environment/age or are they also related to walking speed?

METHODS

Nine healthy elderly participants (73.5 ± 5.8 years) were acquired during walking in WW and LW at two different speeds. Kinematic parameters were assessed with waterproofed inertial magnetic sensors using a validated protocol. The influence of environment, age and walking speed on gait parameters was investigated with linear mixed models.

RESULTS

Shorter stride distances and longer stride durations were observed in WW compared to LW. In the sagittal plane, hip and knee joint showed larger flexion in WW (>10deg over the whole stride and ∼28deg at foot strike, respectively). Furthermore, lower walking speeds and stride distances were observed in elderly compared to young adults. In the sagittal plane, a slightly more flexed hip joint and a less plantarflexed ankle joint (∼9 deg) were observed in the elderly.

SIGNIFICANCE

The results showed the importance of assessing the walking speed during WW, as gait parameters can vary not only for the effect environment but also due to different walking speeds.

Aquatic high intensity interval training to improve aerobic capacity is feasible in adolescents with cerebral palsy: pilot randomised controlled trial

OBJECTIVE

To investigate feasibility of aquatic high intensity interval training for adolescents with cerebral palsy, who can ambulate independently but may choose a mobility aid in some circumstances.

DESIGN

Pilot randomised controlled trial.

METHOD

Following baseline assessments, participants were randomised to usual care or ten weeks of twice weekly aquatic high intensity interval training. Each class comprised 10 one-minute exercise intervals separated by one-minute rest. High intensity exercise was defined as the attainment of ⩾80% of peak heart rate measured by telemetry.

SETTING

Tertiary paediatric hospital.

MAIN MEASURES

Primary outcomes related to the feasibility of the protocol to progress to a definitive trial. Consumer feedback was obtained.

RESULTS

Of 119 potential participants, 46 appeared eligible and 17 consented, resulting in a recruitment fraction of 37% (95% CI 23-52). Twelve completed baseline assessments and were randomised (5 males; 14 years 7 months SD 2 years 0 months). In the intervention group, of the 1190 exercise stations (across all participants and sessions), heart rate data were available for 1180 stations and high intensity exercise was achieved during 1111 stations (93%, 95% CI 92-95). All randomised participants completed the study and reported that the intervention was fun and provided friendship opportunities. There were no major adverse events or exacerbation of pain.

CONCLUSIONS

Aquatic high intensity interval training in ambulant adolescents with cerebral palsy is feasible, while maintaining adherence and fidelity. Uncertainty remains on the efficacy of the intervention, highlighting the need for a large definitive trial.

Overview of Systematic Reviews with Meta-Analysis Based on Randomized Controlled Trials of Balneotherapy and Spa Therapy from 2000 to 2019

Background

The objectives of this review were to summarize systematic reviews with meta-analysis of balneotherapy (BT) and spa therapy (ST) based on randomized controlled trials, and to provide a perspective for future research.

Methods

Eligible studies were systematic reviews based on randomized controlled trials with meta-analysis that included at least one group treated with BT or ST. We searched the following databases for articles published in English from the year 2000 to 20 November 2019: Cochrane Database Systematic Review, MEDLINE, CINAHL, Web of Science, and Ichushi-Web.

Results

Eighteen studies met all inclusion criteria. Based on the International Classification of Diseases (ICD)-11, among these 18 studies, 8 (44%) were about “#15 Diseases of the musculoskeletal system or connective tissue”, 5 (28%) were about “#21 Symptoms, signs or clinical findings, not elsewhere classified”, 4 (22%) were about “#11 Diseases of the circulatory system”, and 1 study (6%) was about “#8 Diseases of the nervous system”. Both BT and ST provided significant pain relief and improved quality of life in chronic diseases of the musculoskeletal system and connective tissues. Additionally, BT and ST with exercise under water improved physical fitness and function in patients across diseases.

Conclusion

Researchers need to conduct studies on the treatment of many kinds of potential diseases using the keywords of pain relief and QoL. In addition, depending on patients’ symptoms, physical fitness, and disabilities, performing exercise under water may improve treatment effects on physical function and fitness.

Kinetic parameters during land and water walking performed by individuals with Down Syndrome

BACKGROUND

Down Syndrome (DS) is a genetic condition presenting delay in acquisition of main motor milestones, such as walking. Although studies have been investigating the biomechanical parameters during land walking performed by individual with DS, the literature is scarce regarding kinetic parameters analysis in this population, specially during water walking.

RESEARCH QUESTION

This study sought to assess the vertical ground reaction force (Fz) of walking performed in water and on land at different speeds by individuals with DS.

METHODS

Fourteen adults with DS (age: 27.9 ± 7.9 years; body mass: 58.4 ± 12.9 kg; height: 1.4 ± 0.1 m, body mass index: 29.2 ± 5.4 kg.m^-2) completed two sessions of data collection, one on land and another in aquatic environment. The protocol consisted of walking performed at three self-selected speeds (slow, comfortable and fast) in randomized order. The Fz was assessed with a waterproof force plate in each condition. Two-way repeated-measures ANOVA (environment and speed), with Bonferroni's post hoc tests, were used for analysis. A significance level was set as α = 0.05.

RESULTS

Significant differences were observed between environments (p < 0.001), with reduced first peak of Fz (68-73%), second peak of Fz (66-70%), loading rate (75-78%) and impulse (40-41%) in the water walking for all speeds analyzed. In the aquatic environment, no significant difference was observed for the first and second Fz peaks with the increasing speed of walking. Moreover, the loading rate significantly increased (p = 0.019) as the impulse significantly reduced (p < 0.001) in the higher speeds.

SIGNIFICANCE

Individuals with DS present reduced Fz outcomes during water walking in comparison to land. Therefore, water walking may be performed by individuals with DS with safe vertical loads on lower limbs regardless the self-selected speed for rehabilitation, correction of gait and training purposes.

The effect of aquatic physical therapy in patients with stroke: A systematic review and meta-analysis

Objective: The purpose of this study was to evaluate the literature reports of qualitative and quantitative results of physical therapy treatments in the alternative aquatic setting for individuals affected by strokes. Method: PRISMA guidelines were used to carry out the systematic review and meta-analysis. Three bibliographic databases were searched: MEDLINE, PEDro, and the Cochrane Library. Papers included in the study were required to: (a) have a randomized controlled trial (RCT) design of research; and (b) be published in English; (c) be published during the last 10 years (2008-2018). Only randomized controlled trials were employed in the study. The quality of the clinical trials to be included was evaluated according to the Jadad scale. The internal validity was assessed according to the PEDro scale. Results: Eleven RCTs were initially identified in the systematic review. Eight of these were involved in the meta-analysis comparing outcomes and follow-up. Eight studies received a Jadad score of three, indicating a high level of quality. The remaining three studies achieved a lower score which indicated lower qualitative level. Nearly all of the results of the quantitative analysis were statistically significant (P < 0,05) and most of them favored of the experimental group subject to aquatic treatment. Conclusion: Aquatic physical therapy may be a valid means for the rehabilitation of people affected by stroke. The integration of this methodological approach with conventional physical therapy should be considered. However, more studies; a larger number of participants; and varying lengths of follow-up times are necessary.

Comparison of Subjective Workout Intensities between Aquatic and Land-based Running in Healthy Young Males: A Pilot Study

Background and objectives: Aquatic exercises have demonstrated several advantages over land-based exercise, but only a few studies have compared the workout intensities and efficiencies in a stage-specific manner. This study aimed to investigate workout intensity during aquatic and land-based running, based on the rating of perceived exertion (RPE). Materials and Methods: Twenty healthy young male subjects underwent a land-based running test (LRT) and an aquatic running test (ART), in the form of a cardiopulmonary exercise treadmill test and a shallow-water running test. The seven stages of the ART were composed of 3 minutes each of the Bruce protocol performed during the LRT. In the ART, the participants were instructed to run in a swimming pool with matching RPE to that obtained at each stage of the LRT. Results: Heart rate (HR) during both LRT and ART exhibited a linear relationship (r = 0.997 and 0.996, respectively; p < 0.001). During the initial and middle period, HR was higher in the ART than in the LRT. However, in the final period, HR was higher in the LRT than in the ART. Conclusions: In aquatic exercises based on the RPE obtained from the LRT, HR exhibited a linear relationship in both the ART and the LRT. The ART appears to increase cardiac loading more efficiently in the initial period and does not increase cardiac loading abruptly at a later period. Although there is no precise, objective, controlled parameter to compare the ART and the LRT, the RPE may be used as a convenient measurement for workout intensity in aquatic running.

Effects of heated water-based versus land-based exercise training on vascular function in individuals with peripheral artery disease

Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with poor vascular function, walking impairment, and reduced quality of life. Land-based exercise therapy (LBET) is frequently recommended to improve walking and reduce symptoms. Recently, evidence has suggested that heated-water exercise therapy (HWET) is an effective intervention for PAD. However, the efficacy of LBET versus HWET in PAD patients had not been elucidated. Therefore, we sought to compare effects of LBET with HWET on cardiovascular function, exercise tolerance, physical function, and body composition in PAD patients. PAD patients (n = 53) were recruited and randomly assigned to a LBET group (n = 25) or HWET group (n = 28). The LBET group performed treadmill walking, whereas the HWET group performed walking in heated water for 12 wk. Leg (legPWV) and brachial-to-ankle arterial stiffness (baPWV), blood pressure (BP), ankle-brachial index (ABI), 6-min walking distance (6MWD), claudication onset time (COT), physical function, and body composition were assessed before and after 12 wk. There were significant group-by-time interactions (P < 0.05) for legPWV, BP, 6MWD, COT, body composition, and resting metabolic rate (RMR). Both groups significantly reduced (P < 0.05) legPWV, BP, and body fat percentage, and HWET measures were significantly lower than LBET measures. Both groups significantly increased 6MWD, COT, and RMR, and HWET group measures were significantly greater than LBET measures. A time effect was noted for baPWV reduction in both groups (P < 0.05). These results suggest that both LBET and HWET improve cardiovascular function, exercise tolerance, and body composition, and HWET showed considerably greater improvements compared with LBET in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that although land-based exercise therapy is effective for reducing arterial stiffness and blood pressure in patients with peripheral artery disease (PAD), heated-water exercise therapy demonstrates greater benefits on vascular function. The greater improvements in muscular strength, time to onset of claudication, and exercise tolerance after heated-water exercise therapy may have clinical implications for improving quality of life in patients with PAD. The heated-water exercise therapy intervention demonstrated relatively higher exercise training adherence (∼88%) compared with the land-based exercise intervention (∼81%).

Aquatic exercise program-modulated oxidative stress markers in patients with Parkinson's disease

Parkinson’s disease is a neurodegenerative disease. Oxidative stress, i.e., the imbalance between the generation of reactive oxygen species and the antioxidant defense capacity of the body, plays an important role in the pathogenesis of this disease. Physical exercise can regulate oxidative stress. The purpose of this study was to analyze the short- and long-term effects of an aquatic exercise program on oxidative stress levels in patients with Parkinson’s disease. The aquatic exercise program was carried out during 1 month with two sessions per week (1 hour/session). Blood samples were collected at four different time points: pre-intervention, immediately, 48 hours, and 30 days after the first session of aquatic exercise program. Our results revealed that water-based programs modulated antioxidant enzyme activity, increased superoxide dismutase activity, reduced catalase activity, and increased the ratio of superoxide dismutase activity to catalase activity in patients with Parkinson’s disease. Compared with pre-intervention and 48 hours after the first session of aquatic exercise program, superoxide dismutase activity was higher and catalase activity was lower immediately and 30 days after the first session. Our results demonstrated that aquatic exercise program could modulate oxidative stress, mainly by the effect of antioxidant enzyme activity. These results could better help understand the target of oxidative stress in Parkinson’s disease. This study was approved by the Ethics Committee of Centro Universitário Metodista IPA (approval No. 1.373.911) on August 9, 2019 and registered with REBEC (registration number: RBR-6NJ4MK).

The beneficial effects of a water-based aerobic exercise session on the blood lipids of women with dyslipidemia are independent of their training status

OBJECTIVES

To evaluate the acute effects of a session of water-based aerobic exercise on the blood lipid levels of women with dyslipidemia and to compare these results according to their training status.

METHOD

Fourteen premenopausal women with dyslipidemia, aged 40-50 years, participated in two water-based aerobic exercise sessions, the first when they were generally sedentary and the second after they were trained with a water-based aerobic training program for 12 weeks. Both experimental sessions were performed using the same protocol, lasted 45 min, and incorporated an interval method, alternating 3 min at a rating of perceived exertion (RPE) of 13 and 2 min at an RPE of 9. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and lipoprotein lipase enzyme (LPL) were obtained through venous blood collection before and immediately after each session. A generalized estimating equation method and Bonferroni tests were conducted (with time and training status as factors) for statistical analyses.

RESULTS

At enrollment, the mean age of the participants was 46.57 years (95% confidence interval [CI] 44.81-48.34). The statistical analyses showed a significant time effect for all variables (TC: p=0.008; TG: p=0.012; HDL: p<0.001; LPL: p<0.001) except for LDL (p=0.307). However, the training status effect was not significant for any variable (TC: p=0.527; TG: p=0.899; HDL: p=0.938; LDL: p=0.522; LPL: p=0.737). These results indicate that the TC and TG levels reduced and the HDL and LPL concentrations increased from pre- to post-session in similar magnitudes in both sedentary and trained women.

CONCLUSIONS

A single water-based aerobic exercise session is sufficient and effective to beneficially modify the lipid profile of women with dyslipidemia, regardless of their training status.

Vertical Ground Reaction Force During a Water-Based Exercise Performed by Elderly Women: Equipment Use Effects

Purpose: The present study aimed to compare the vertical ground reaction force responses during the performance of the stationary running water-based exercise with and without equipment at different cadences by elderly women. Method: Nineteen elderly women (age: 68.6 ± 5.0 years; body mass: 69.0 ± 9.5 kg; height: 154.9 ± 5.6 cm) completed one session consisting of the performance of the water-based stationary running with elbow flexion and extension immersed to the xiphoid process depth. The exercise was performed in three conditions, without equipment, with water-floating and with water-resistance equipment, at three cadences (80 b·min^-1, 100 b·min^-1 and maximal) in a randomized order. Peak and impulse of vertical ground reaction force were collected during the exercise using an underwater force plate. Repeated measures two-way ANOVA was used (α = 0.05). Results: Peak vertical ground reaction force (p < .001) and impulse (p ≤ 0.002) resulted in lower values for the water-floating use (0.42-0.48 BW and 0.07-0.13 N.s/BW) in comparison to the water-resistance equipment use (0.46-0.60 BW and 0.09-0.16 N.s/BW) and to the non-use of equipment (0.45-0.60 BW and 0.07-0.17 N.s/BW), except for the impulse at the maximal cadence. In addition, peak vertical ground reaction force at 80 b·min^-1 (p = .002) and impulse at the maximal cadence (p < .001) showed lower values compared to the other cadences. Conclusion: The use of water-floating equipment minimizes the vertical ground reaction force during the stationary running water-based exercise performed by elderly women regardless of the cadence.

The physiological and perceptual responses of stand-up paddle board exercise in a laboratory- and field-setting

This study quantified the physiological and perceptual responses of stand-up paddle boarding (SUP) during a range of stroke rates in a laboratory- and field-setting. Ten participants (eight male, two female; mean ± standard deviation [SD] age: 23 ± 3 years; body mass: 70.5 ± 9.1 kg; height: 170 ± 9 cm; body mass index [BMI]: 24.3 ± 1.5 kg m²) completed a SUP ⩒O_2peak trial, and two SUP trials in both a laboratory- and field-setting (5-min at 10, 20 and 30 strokes min^-1 per stage). Energy expenditure (EE), metabolic equivalents (METs), heart rate (HR) and rating of perceived exertion (RPE) were recorded throughout. In the laboratory-setting, mean ± SD EE and METs increased (P < .001) linearly when SUP at 10 (3.3 ± 1.0 kcal min^-1, 2.7 ± 0.5), 20 (5.5 ± 0.9 kcal min^-1, 4.4 ± 0.7) and 30 strokes min^-1 (7.6 ± 1.6 kcal min^-1, 6.1 ± 1.2), respectively. During these efforts, mean ± SD percentage of maximal HR were 56 ± 5%, 69 ± 6% and 84 ± 8%, respectively. In the field-setting, mean ± SD EE and METs also increased (P < .001) linearly when SUP at 10 (3.6 ± 0.9 kcal min^-1, 2.7 ± 0.9), 20 (4.3 ± 1.8 kcal min^-1, 3.5 ± 1.0) and 30 strokes min^-1 (6.3 ± 2.1 kcal min^-1, 4.6 ± 1.4). During the three conditions, mean ± SD percentage of maximal HR were 58 ± 8%, 65 ± 7% and 73 ± 9%. SUP at ≥20 strokes min^-1 in the laboratory- and field-setting meet the criteria for moderate-intensity exercise (3.0-5.9 METs). These findings may now be included in the latest Compendium of Physical Activities guidelines and offer the potential to improve cardiorespiratory fitness if SUP is undertaken regularly by young, healthy adults.

Investigation the EMG Activities of Lower Limb Muscles When Doing Squatting Exercise in Water and on Land

(1) Background: Squatting is one of the common closed-kinetic chain (CKC) exercises for knee rehabilitation. Some patients cannot perform squatting exercises on land occasionally due to knee pain. Several studies had suggested that lower limb muscle activities are lower in water than on land while performing CKC exercises. The purpose of this study is to investigate the surface electromyography (sEMG) activities of Rectus femoris (RF) and Biceps femoris (BF) muscles when doing a squatting exercise in water and on land. (2) Methods: This was a cross-sectional experimental study. A total of 20 healthy participants (10 males, 10 females) were recruited by convenience sampling. The sEMG of RF and BF muscles in water and on land were collected and the knee motions were videotaped. Participants were instructed to perform closed kinetic-chain back squatting exercises at a specific speed (30 beats per minute) in water and on land at angular speed of 45°/s. Eight repetitions of the squatting exercise (0–90° knee flexion) were performed. The mean percentage maximal voluntary contraction (%MVC) between two muscles was compared in two conditions. The %MVC of RF and BF muscles at different specific knee flexion angles (30°, 60° and 90° knee flexion) was also identified. (3) Result: Muscle activities of RF (p = 0.01) and BF (p < 0.01) muscles were significantly lower in water than on land. The %MVC of RF and BF muscles was found to be 15.01% and 10.68% lower in water than on land respectively. For different knee angle phases, the differences in %MVC between land and water had significant difference for both RF muscles and BF muscles. (4) Conclusion: This study found a difference of mean percentage MVC of RF and BF muscles between land and water in different phases of squatting. The water medium reduced the two muscles’ activities to a similar extent. The result showed that the aquatic environment allows an individual to perform squatting with less muscle activation which may serve as an alternative knee exercise option for patients who encounter difficulty in land squatting due to lower limb muscle weakness or a high level of knee pain.

Cardiovascular and Perceived Effort in Different Head-Out Water Exercises: Effect of Limbs' Action and Resistance Equipment

The aim of this study was to compare the cardiovascular and perceived effort of head‐out water exercises selecting different limb strategies and using resistance equipment. Ten young women were randomly assigned to perform at 132 bpm during five minutes different head‐out aquatic exercises: (i) horizontal arms abduction (Ab); (ii) horizontal arms abduction with dumbbells (AbD); (iii) frontal kick (Fk); (iv) frontal kick with leggings (FkLeg), and; (v) aquatic skiing (Ski). Cardiovascular effort was measured by monitoring the heart rate, blood pressure and double product. Perceived effort was assessed by the Borg’s scale. Within‐routines comparison was computed using repeated‐ measures ANOVA followed‐up by the Bonferroni post‐hoc test. Considering the percentage of the maximal heart rate, participants reached 72.88 ± 12.90% in the FkLeg, 65.99 ± 10.91% in the Fk, 62.62 ± 7.20% in Ski, 57.27 ± 11.58% in AbD and 57.12 ± 12.09% in Ab. Comparing exercises, higher heart rates were observed in the FkLeg (140.40 bpm) than Ab (110.30 bpm) or AbD (110.00 bpm). Significant differences were found in the systolic blood pressure when compared to the Fk (120.60 mmHg) and Ab (104.50 mmHg). Double product was higher in the FkLeg (16990) showing a meaningful difference when compared to Ab (11608) or AbD (12001). The highest perceived effort was found in the FkLeg (15.80) with meaningful variations compared to Ab (11.70), the Fk (13.70) and Ski (10.40). Thus, different head‐ out water exercises result in different intensities. The actions by lower limbs promote a higher cardiovascular response, whereas the upper limbs actions trigger a lower exertion. Moreover, exercising the four limbs concurrently seems to be less intense than using only two limbs with an aid.

Anti-oxidant and Anti-inflammatory Effects of Aquatic Exercise in Allergic Airway Inflammation in Mice

Oxidative stress and inflammation are key pathways responsible for the pathogenesis of asthma. Aquatic exercise (AE) has been proven to elicit a variety of biological activities such as anti-oxidant and anti-inflammatory effects. However, although proper forms of AE provide beneficial health effects, incorrect forms and types of AE are potentially injurious to health. Several studies have investigated AE, but the relationship between types of AE and asthma has not been fully elucidated. This study evaluated the effects of two types of AE according to resistance on ovalbumin (OVA)-induced allergic airway inflammation in mice. BALB/c mice were subjected to OVA sensitization and challenge, and then to different types of AE including, walking and swimming, in a pool filled with water to a height of 2.5 and 13 cm for 30 min, respectively. AE reduced OVA-induced eosinophilic inflammation, airway hyperresponsiveness, and serum immunoglobulin E level. AE significantly inhibited increases in interleukin (IL)-4, IL-5, IL-13, histamine, leukotriene D4, and tryptase levels in bronchoalveolar lavage fluid (BALF). AE also effectively suppressed mucus formation, lung fibrosis, and hypertrophy of airway smooth muscle within the lung tissues. This exercise markedly reduced the levels of malondialdehyde while increased glutathione and superoxide dismutase (SOD) activity in lung tissues. Furthermore, AE significantly decreased tumor necrosis factor-α, IL-6 levels, and prostaglandin E2 production in BALF. The inhibitory effects of swimming on the levels of biomarkers related to oxidative stress and inflammation were greater than that of walking. These effects may have occurred through upregulation of NF-E2-related factor 2/heme oxygenase-1 signaling and suppression of mitogen-activated protein kinase/nuclear factor-κB pathway. Cumulative results from this study suggest that AE might be beneficial in mitigating the levels of biomarkers related to oxidative stress and inflammation. Thus, this therapy represents a crucial non-pharmacological intervention for treatments of allergic airway inflammation.

Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis

PURPOSE

To evaluate the efficacy of water therapy for disease activity, functional capacity, spinal mobility, and pain in patients with ankylosing spondylitis.

METHODS

PubMed, Ovid, web of science, Cochrane library, Physiotherapy Evidence Database, CNKI, VIP, Wan Fang, and Open Grey were searched for randomized controlled trials that investigated the effects of water therapy on patients with ankylosing spondylitis. Two researchers independently screened the literature databases and then assessed methodological qualities using the Physiotherapy Evidence Database scale and extracted data. Outcomes included were disease activity, functional capacity, spinal mobility, and pain.

RESULTS

A total of eight studies (n = 383) met the inclusion criteria. Analysis demonstrated that water therapy had a significant effect on disease activity and pain, but not on spinal mobility, or functional capacity in patients with ankylosing spondylitis.

CONCLUSION

Water therapy can benefit patients with ankylosing spondylitis by reducing disease activity and alleviating pain. More well-designed randomized controlled trials are needed to confirm the results.IMPLICATIONS FOR REHABILITATIONWater therapy can reduce disease activity and pain in patients with ankylosing spondylitis, but cannot improve functional capacity or spinal mobility.Due to its analgesic effect both during and after treatment, water therapy remains an alternative for patients with ankylosing spondylitis when land-based therapy is not well tolerated.

Short-Term Water- and Land-Based Exercise Training Comparably Improve Exercise Capacity and Vascular Function in Patients After a Recent Coronary Event: A Pilot Randomized Controlled Trial

Background

We hypothesized that a 2-week twice daily aquatic endurance plus calisthenics exercise training program: (i) increases aerobic exercise capacity (peak oxygen uptake/ V ˙ O₂peak), (ii) improves endothelium-dependent flow-mediated vasodilation (FMD), and (iii) reduces circulating markers of low-grade inflammation and hemostasis, as compared to land-based endurance plus calisthenics exercise training or no exercise in patients undergoing short-term residential cardiac rehabilitation after a recent coronary artery disease (CAD) event.

Methods

Patients with a recent myocardial infarction or revascularization procedure were randomized into two interventional groups and a control group. The interventional groups underwent supervised aerobic endurance plus calisthenics exercise training either in thermo-neutral water or on land at moderate intensity (60-80% of the peak heart rate achieved during symptom-limited graded exercise testing) for 30 min twice daily for 2 weeks (i.e., 24 sessions). The control group was deferred from supervised exercise training for the 2-week duration of the intervention, but was advised low-to-moderate intensity physical activity at home while waiting. At baseline and after the intervention period, all participants underwent estimation of aerobic exercise capacity, brachial artery flow-mediated dilatation (FMD, measured ultrasonographically at rest and during reactive hyperemia after 4.5 min of forearm cuff inflation), markers of cardiac dysfunction (NT-proBNP), inflammation (hsCRP, IL-6, IL-8, IL-10), cell adhesion (ICAM, P-selectin), and hemostasis (fibrinogen, D-dimer).

Results

A total of 89 patients (mean age 59.9 ± 8.2 years, 77.5% males, V ˙ O₂peak at baseline 14.8 ± 3.5 ml kg^-1 min^-1) completed the study. Both exercise modalities were safe (no significant adverse events recorded) and associated with a significant improvement in V ˙ O₂peak as compared to controls: age and baseline V ˙ O₂peak-adjusted end-of-study V ˙ O₂peak increased to 16.7 (95% CI 16.0-17.4) ml kg^-1 min^-1 with land-based training (p < 0.001 for change from baseline) and to 18.6 (95% CI 17.9-19.3) ml kg^-1 min^-1 with water-based training (p < 0.001 for change from baseline), but not in controls (14.9 ml kg^-1 min^-1; 95% CI 14.2-15.6; p = 0.775 for change from baseline). FMD also increased in both intervention groups (from 5.5 to 8.8%, p < 0.001 with land-based, and from 7.2 to 9.2%, p < 0.001 with water-based training, respectively), as compared to controls (p for change 0.629). No significant changes were detected in biomarkers of inflammation, cell adhesion or hemostasis, whereas levels of NT-proBNP (marker of cardiac dysfunction) decreased in the water-based training group (p = 0.07 vs. controls).

Conclusion

Endurance plus calisthenics exercise training in thermo-neutral water is safe, and improves aerobic exercise capacity and vascular function in patients undergoing short-term residential cardiac rehabilitation after a recent CAD event.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier NCT02831829.

Effect of a 10-Week Aquatic Exercise Training Program on Gross Motor Function in Children With Spastic Cerebral Palsy

Introduction. Cerebral palsy (CP) is caused by an injury to the developing brain, and abnormal gross motor function is a hallmark of CP. Properly structured exercises on land have been reported to be effective in improving functional performance in children with CP while only few have been documented on aquatic therapy. Objective. To investigate the effect of a 10-week aquatic exercise training program on gross motor function in children with spastic CP. Methods. Thirty participants aged 1 to 12 years were randomized into the experimental and control groups. Both groups received manual passive stretching and functional training exercises, depending on their level of motor impairment, either in water (temperature 28°C to 32°C) or on land. Each exercise training session lasted for about 1 hour 40 minutes, twice per week for 10 weeks in both groups. Measurement of gross motor function was done using Gross Motor Function Measure (GMFM-88) at baseline and after 4 weeks, 8 weeks, and 10 weeks of intervention. Both groups were compared for differences in change in gross motor function using Mann-Whitney U test. The level of significance was set at P < .05. Results. Only the experimental group showed significant improvement (P < .05) in all dimensions of gross motor function except for walking, running, and jumping (P = .112). Statistically significant difference (P < .05) was found between both groups for all dimensions of gross motor function after 10 weeks of intervention. Conclusion. Aquatic exercise training program is effective in the functional rehabilitation of children with spastic CP.

Effects of aquatic exercise on mental health, functional autonomy and oxidative stress in depressed elderly individuals: A randomized clinical trial

OBJECTIVES

The aim of this study was to investigate the effects of aquatic exercise on mental health, functional autonomy and oxidative stress parameters in depressed elderly individuals.

METHODS

Initially, ninety-two elderly individuals were included in the study and were allocated into the depression group (n=16) and nondepression group (n=14). Both groups engaged in the aquatic exercise program for 12 weeks, including two weekly sessions (45 min/session) at a low intensity (between 50% and 60% of maximal heart rate or Borg scale scores of 13 to 14) throughout the intervention. All outcomes were evaluated at baseline and 12 weeks later.

RESULTS

The patients were 63.5±8.8 years old. The following scores were decreased after training in the depressed group: depression (53%), anxiety (48%), and Timed Up & Go (33%). The following scores increased: Berg Balance Scale (9%) and flexibility (44%). Regarding the blood-based parameters, there were decreases in protein carbonylation (46%) and nitric oxide (60%) and increases in glutathione (170%) and superoxide dismutase (160%) in the depression group (p<0.005).

CONCLUSIONS

The aquatic exercise program reduces depression and anxiety, improves functional autonomy and decreases oxidative stress in depressed elderly individuals.

Is aquatic exercise more effective than land-based exercise for knee osteoarthritis?

BACKGROUND

This study aimed to systemically review the effectiveness of aquatic exercise (AQE) compared to land-based exercise (LBE) in treating knee osteoarthritis (OA).

METHODS

The Medline, Embase, Web of Science, Cochrane Central Register of Controlled Clinical Trials, CINAHL, and psyclNFO databases were comprehensively searched for randomized controlled trials (RCTs) evaluating the effectiveness of AQE and LBE for knee OA from their inception date to September 24, 2018. The risk of bias was examined using the Cochrane Collaboration Tool, and Review Manager 5.3 was used for data collation and analysis.

RESULTS

Eight RCTs were included, involving a total of 579 patients. The meta-analysis showed that there was no significant difference between AQE and LBE for pain relief, physical function, and improvement in the quality of life, for both short- and long-term interventions, in patients with knee OA. However, the adherence and satisfaction level for AQE was higher than for LBE. Compared to no intervention, AQE showed a mild effect for elevating activities of daily living (standardized mean difference [SMD]: -0.55, 95% confidence interval [CI] [-0.94, -0.16], P = .005) and a high effect for improving sports and recreational activities (SMD: -1.03, 95% CI [-1.82, -0.25], P = .01).

CONCLUSION

AQE is comparable to LBE for treating knee OA.

A High-Intensity Jump-Based Aquatic Exercise Program Improves Bone Mineral Density and Functional Fitness in Postmenopausal Women

The aim of this study was to verify the effects of a high-intensity jump-based aquatic exercise (HIIAE) program on bone mass and functional fitness in postmenopausal women. We randomly assigned 25 women (65 ± 7 years) into two groups: Training group (T, n = 15) and Untrained group (Un, n = 10). The T group was submitted to 24 weeks of HIIAE program, where each session lasted for 30 minutes. The following parameters were assessed before and 6 months following the intervention: bone and physical fitness; lumbar spine (LS), total femur (TF), and whole body (WB) bone mineral density (BMD); agility (time up-and-go, TUG); and leg strength (chair stand test, CS). We observed a significant increase (p < 0.01) in LS, (Un: -0.88 ± 3.55, T: 3.71 ± 3.68; %), TF (Un: -1.38 ± 17.76, T: 6.52 ± 2.71; %), and WB (Un: 2.09 ± 3.17, T: 3.23 ± 4.18) BMD in the T group. Regarding functional fitness, the T group showed improvements in both TUG (before: 6.86 ± 1.24 vs. after: 6.22 ± 1.13 seconds; p < 0.05) and CS (before: 16 ± 4 vs. after: 19 ± 5 repetitions; p > 0.05) tests when compared with the U group's TUG (before: 5 ± 1, after: 6 ± 1 seconds; p < 0.05) and CS (before: 20 ± 2, after: 19 ± 2 repetitions; p > 0.05) scores. Our data suggest that a high-intensity, jump-based interval aquatic exercise program is able to improve BMD and functional fitness parameters in postmenopausal women.

Does the speed of aquatic therapy exercise alter arm volume in women with breast cancer related lymphoedema? A cross-over randomized controlled trial

OBJECTIVE

To identify whether slow aquatic exercise in the form of modified Ai Chi is more effective than conventional (faster pace) aquatic therapy at reducing arm volume in women with or at risk of breast cancer related lymphoedema.

METHODS

Randomized, cross-over controlled trial with concealed allocation and blinded assessment. Eighteen women with a history of breast cancer related lymphoedema were recruited. Participants received two intervention sessions (randomized order) with one week apart. Interventions were a 50min conventional aquatic intervention or a 50min modified Ai Chi. Arm volume was measured as the difference between affected and unaffected arm; bio-impedance was measured as an index of extracellular fluid; satisfaction was measured via a 12 question form. Outcomes were measured before, immediately after and one hour after intervention.

RESULTS

Comparison between interventions showed larger decreased arm volume of 140mL (95%CI 17-263) immediately after intervention in favor of the Ai Chi intervention, however it was not sustained at 1h follow-up. A post hoc analysis showed 72% of participants had a decrease in arm volume immediately after Ai Chi compared to 28% immediately after conventional aquatic therapy; with a number needed to treat of 3 (95%CI 1.4-6.6). There were no differences between interventions for bio-impedance. Satisfaction was good for both interventions.

CONCLUSION

Slow pace aquatic exercise is more effective than conventional aquatic exercise immediately after intervention for arm volume. Also, undesirable increase in arm volume seems to subside after 1h, which can be beneficial if therapy does not address arm volume.

TRIAL REGISTRATION

ACTRN12614000557639 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000557639).

Acute effects of walking in water on vascular endothelial function and heart rate variability in healthy young men

AIM

Aquatic exercise might improve endothelial function due to hydrostatic pressure increasing blood flow and causing shear stress to the endothelium. However, the acute effect of aerobic exercise in water on endothelial function is unclear. The present study compares the acute effect of aerobic exercise at moderate intensity in water and on land on endothelial function.

METHODS

Nine healthy young men walked on a treadmill for 30 min while immersed in water up to the xiphoid at 30.0 ± 0.2°C and on land at an intensity equivalent to 60% heart rate reserve in a crossover trial. Brachial artery flow-mediated dilation (FMD) was measured at baseline and at 30 and 60 min after exercise. Autonomic nervous activity was compared among conditions at the heart rate variability (HRV) during exercise.

RESULTS

FMD significantly decreased at 30 min after exercise on land trial (p < 0.05), but did not change after the aquatic trial. However, FMD was significantly higher after aquatic trial than land trial (p < 0.05) at 30 and 60 min after exercise, whereas heart rate, blood pressure, and HRV did not significantly differ between them.

CONCLUSION

These findings demonstrate that aerobic exercise in water suppressed the decrease in FMD compared with that on land, regardless of autonomic nervous activity.

The effects of balance and postural stability exercises on spa based rehabilitation programme in patients with ankylosing spondylitis

BACKGROUND

Ankylosing spondylitis (AS) can cause severe functional disorders that lead to loss of balance.

OBJECTIVE

The aim of this study was to investigate the effects of balance and postural stability exercises on spa based rehabilitation programme in AS subjects.

METHODS

Twenty-one participants were randomized to the study (n= 11) and control groups (n= 10). Patients balance and stability were assessed with the Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, Single Leg Stance Test (SLST) and Functional Reach Test (FRT). AS spesicied measures were used for assessing to other parameters. The treatment plan for both groups consisted of conventional transcutaneous electrical nerve stimulation (TENS), spa and land-based exercises 5 days per week for 3 weeks. The study group performed exercises based on postural stability and balance with routine physiotherapy practice in thermal water and in exercise room.

RESULTS

The TUG, SLST and FUT scores were significantly increased in the study group. In both groups, the BASMI, BASFI, BASDAI and ASQoL scores decreased significantly by the end of the treatment period (p< 0.05).

CONCLUSIONS

In AS rehabilitation, performing balance and stability exercises in addition to spa based routine approaches can increase the duration of maintaining balance and can improve the benefits of physiotherapy.

Effects of walking in water on gut hormone concentrations and appetite: comparison with walking on land

The effects of water exercise on gut hormone concentrations and appetite currently remain unclear. The aim of the present study was to investigate the effects of treadmill walking in water on gut hormone concentrations and appetite. Thirteen men (mean ± s.d. age: 21.6 ± 2.2 years, body mass index: 22.7 ± 2.8 kg/m², peak oxygen uptake (VO_2peak): 49.8 ± 7.8 mL/kg per min) participated in the walking in water and on land challenge. During the study period, ratings of subjective feelings of hunger, fullness, satiety and motivation to eat were reported on a 100-mm visual analog scale. A test meal was presented after walking, and energy intake (EI) was calculated. Blood samples were obtained during both trials to measure glucagon-like peptide-1 (GLP-1), peptide YY (PYY) and acylated ghrelin (AG) concentrations. Hunger scores (How hungry do you feel?) were significantly lower during the water trial than during the land trial (P < 0.05). No significant differences were observed in EI between water and land trials. GLP-1 concentrations were significantly higher in the water trial than in the land trial (P < 0.05). No significant differences were observed in PYY concentrations between water and land trials. AG concentrations were significantly lower in the water trial than in the land trial (P < 0.01). In conclusion, changes in gut hormone concentrations during walking in water contribute to the exercise-induced suppression of appetite and provide novel information on the influence of walking in water on the acute regulation of appetite.

Aquatic exercise for residential aged care adults with dementia: benefits and barriers to participation

BACKGROUND

Pilot work by our group has demonstrated that aquatic exercise has valuable functional and psychosocial benefits for adults living in the residential aged care setting with dementia. The aim of the currents study was to advance this work by delivering the Watermemories Swimming Club aquatic exercise program to a more representative population of older, institutionalized adults with dementia.

METHODS

The benefits of 12 weeks of twice weekly participation in the Watermemories Swimming Club aquatic exercise program were assessed among an exercise and usual care control group of residential aged care adults with advanced dementia. A battery of physical and psychosocial measures were collected before and after the intervention period, and program implementation was also investigated.

RESULTS

Seven residential aged care facilities of 24 approached, agreed to participate and 56 residents were purposefully allocated to exercise or control. Twenty-three participants per group were included in the final analysis. Both groups experienced decreases in skeletal muscle index and lean mass (p < 0.001), but exercise stifled losses in muscle strength and transition into sarcopenic. Behavioral and psychological symptoms of dementia and activities of daily living approached significance (p = 0.06) with positive trends observed across other psychosocial measures.

CONCLUSIONS

This study demonstrates the value of exercise participation, and specifically aquatic exercise in comparison to usual care for older, institutionalized adults with advanced dementia. However, it also highlights a number of barriers to participation. To overcome these barriers and ensure opportunity to residents increased provider and sector support is required.

Effects of water-based exercise on bone health of middle-aged and older adults: a systematic review and meta-analysis

BACKGROUND

Age-related bone loss is a major health concern. Only exercises associated with high-impact and mechanical loading have been linked to a positive effect on bone turnover; however, these types of exercises may not always be appropriate for middle-aged and older adults due to physical decline or chronic disorders such as osteoarthritis. Water-based exercise (WBE) has been shown to affect different components of physical fitness, has lower risks of traumatic fracture, and applies less stress to joints. However, the effects of WBE on bone health are unclear.

OBJECTIVE

This study aimed to explore whether WBE is effective in preventing age-related bone deterioration in middle-aged and older adults.

METHODS

A search of relevant databases and the references of identified studies was performed. Critical narrative synthesis and meta-analyses were conducted.

RESULTS

Eleven studies, involving 629 participants, met all inclusion criteria. All participants were postmenopausal women. Eight studies compared WBE to a sedentary control group, and four studies had land-based exercise (LBE) participants as a comparison group. Meta-analyses revealed significant differences between WBE and control group in favor of WBE for changes in bone mineral density (BMD) at the lumbar spine (mean difference [MD] 0.03 g/cm²; 95% confidence interval [CI]: 0.01 to 0.05) and femoral neck (MD 0.04 g/cm²; 95% CI: 0.02 to 0.07). Significant differences were also revealed between WBE and LBE in favor of LBE for changes in lumbar spine BMD (MD -0.04 g/cm²; 95% CI: -0.06 to -0.02). However, there was no significant difference between WBE and LBE for changes in femoral neck BMD (MD -0.03 g/cm²; 95% CI: -0.08 to 0.01).

CONCLUSION

WBE may have benefits with respect to maintaining or improving bone health in postmenopausal women but less benefit when compared to LBE. Further research is required on this topic.