Aquatic exercise

S

Aquatic exercise (Hydrotherapy)

Nora alwohayebMashael alrayesSalma almkainzi

Aziza alamriFay albuainin

Outlines:

Defining aquatic exercise. Facilities and Equipment. Goal and indications for aquatic exercises\contraindications. Advantages\Disadvantages. Articles

Definition:

It refers to the use of multi-depth immersion pools or tanks that facilitate the application of various established therapeutic interventions.

It includes:

Stretching. Strengthening. Joint mobilization. Balance and gait/endurance training.

Notes:

Therefore, any jogging, walking or other impact exercises will likely not cause any injuries when done underwater.

Goal and indications for aquatic exercise

Initiate resistance training.

Facilitate weight-bearing activities.

Useful in early stages of rehabilitation.

Provide three-dimensional access to the patient.

Facilitate cardiovascular exercise.

Minimize risk of injury or reinjury during rehabilitation.

Extremely useful with lower-extremity injuries

Contraindications for aquatic exercises.

Fear of water. Neurological disorders. Seizures. Cardiac dysfunction. Small open wound and lines.

Facilities and Equipment

Facility must have certain characteristics Should be at least 10 x 12 Adequate access Shallow and deep areas Flat pool floor with marked gradients Adequate temperature (79-82 degrees)

Ancillaries Prefabricated pools with treadmill or current

producing device Pool toys – limited by imagination

Aquatic Rehabilitation: Advantages

AROM exercises supported through buoyancy Minimizes discomfort Sense of security

Useful in early stages of rehabilitation Supportive environment

Extremely useful with lower-extremity injuries Provides gradual transition from non to full weight-

bearing May allow earlier locomotion due to decreased

compressive forces

Psychological impact Increased confidence due to increased function

allowed by water Strengthening and muscle re-education Energy expenditure

Aerobic workout possible to maintain CV fitness

Aquatic Rehabilitation: Advantages

Aquatic Rehabilitation: Disadvantages

Building and maintaining a rehabilitation pool Space and personnel

Aquatic training may be too challenging if athlete unable to stabilize body

Thermoregulation May impact tolerance for participation in heat

S

VO^sub 2^ Prediction and

Cardiorespiratory Responses During

Underwater Treadmill Exercise

Greene, Nicholas P;Greene, Elizabeth S;Carbuhn, Aaron F;Green, John S;Crouse, Stephen F Research Quarterly for Exercise

and Sport; Jun 2011; 82, 2; ProQuest Centralpg. 264

They compared the cardiorespiratory responses to exercise on an underwater treadmill (UTM) and land treadmill (LTM) and derived an equation to estimate oxygen consumption (VO2) during UTM exercise

55 men and women completed on LTM and five UTM session on separate days .

The UTM session consisted of chest-deep immersion with 0,25,50,75, and 100% water-jet resistance . All session treadmill velocities increase every 3 min from 53.6 to 187.8 m.min-1

Method

First part : designed to compare and contrast submaximal and maximal cardiorespiratory responses to UTM and LTM exercise

Second part : designed to develop and equation to estimate VO2 .

Recruited additional 11 participants to exercise in a second UTM system ( different model ) to strengthen their ability to accurately estimate vo2 across other UTM systems

Participant were then fitted on a HR monitor and a mask connected to an automated metabolic gas analyzer .

The gas analyzer was calibrated after each exercise session

During the exercise session expired metabolic gases were measured continuously and HR and RPE were during last 30 s of each exercise stage

Each participant completed six

experimental exercise session on different days

LTM at 0% grade

UTM at 25% jet resistance

UTM at 50% jet resistance

UTM at 75% jet resistance

UTM at 100% jet resistance

VO2 max for UTM exercise was taken the highest VO2 achieved at volatile exhaustion during UTM exercise session

treadmill velocities increase every 3 min from 53.6 to 187.8 m.min-1 for every season

equations

0-25% jet Weight-relative VO2(mlo2 x kg-1

xmin-1 )= 0.26144 x height (cm2 ) + 0.13482 x velocity (m.min-1 )-0.11966 x weight (kg)-33.72236

25-100% jet Weight-relative VO2(mlo2 x kg-1

xmin-1 )= 0.19248 x height (cm2 ) + 0.17422 x jet resistance (%) + 0.14092 x velocity (m.min-1 )-0.12794 x weight (kg)-26.82489

Conclusion

Considering that no weight-bearing exercise is recommended for therapy and training in some populations , the buoyant unloading provided by the UTM may offer a good alternative to tradional LTM exercise

S

Comparative Efficacy of Water and Land

Treadmill Training for Overweight or Obese

AdultGREENE, NICHOLAS P.; LAMBERT, BRAD S.; GREENE, ELIZABETH S.; CARBUHN, AARON F.; GREEN, JOHN S.; CROUSE, STEPHEN F. ©2009The American College

of Sports Medicine

Purpose

No known previous research has been published to explore the efficacy of underwater treadmill (UTM) exercise training for the obese. Thus, the purpose of this study was to compare changes in physical fitness, body weight, and body composition in physically inactive, overweight, and obese adults after 12 wks of land treadmill (LTM) or (UTM )training.

UPON ENTRY 57 physically inactive,

overweight, and obese men (n = 25) and women (n = 32) participated.

Later Subjects were randomly assigned to exercise three times per week for 12 wk on either LTM (n = 29) or UTM (n = 28)

Diet: stay the same as before

AGE 44± 2 yrWEIGHT 90.5 ±

2.4 kg,BMI 30.5 ±

0.7 kg·m-2,

VO2 MAX 27.1 ± 0.7 mL O2·kg-

1·min-1

Physiological assessments.

Body composition, including regional and whole-body percent fat and lean body mass, Waist girths and waist-to-hip ratios

An incremental maximal graded exercise test (GXT) Oxygen consumption during exercise was assessed

using an automated metabolic gas analysis. Each subject was tested using the same metabolic equipment at pretraining and posttraining assessment periods.

V·O2max was taken as the highest 15-s average oxygen uptake achieved during the exercise test.

HR and rhythm ,RPE , blood pressures.

Exercise training

Subjects exercised three times per week during the 12-wk period

The UTM water depth was standardized to the level of each subject's fourth intercostal space

LTM exercise training was conducted on a standard motor-driven treadmill.

Results

Conclusion

UTM and LTM training are equally capable of improving aerobic fitness and body composition in physically inactive overweight individuals, but UTM training may induce increases in LBM.

S

The Effects of Underwater Arm-

Cranking Exercise on Cardiac Autonomic Nervous Activity.

Kumiko Ono, Kuniyoshi, and Y. Tanigaki.2013

Presented by: Fay AlBuainain

Purpose

To determine the beneficial effects of exercise underwater on cardiac autonomic nervous activity during arm cranking.

Subjects

Age 21 ± 1.5 yrs Height = 171.0 ± 5.7 cm Body mass= 60.7 ± 3.8 kg BMI = 20.4 ± 1.7n= 10 men

The experiment was done on 2 sessions each session was done on separate days.

Method

Control condition

Water condition

Resting in setting position for 5 minutes. 10 min exercise 50 revolution/min

Resting in setting position for 10 minutes Then they started arm cranking exercise for 10 minutes

arm ergometer monark portable ergometer 881E

XIPHOID PROCESS

Recovery time was allowed for 30 sec. in the same position.

Cont.

Parameters that was measured : VO2 Heart rate (HR). Rating of perceived exertion ( RPE ) Rating of perceived fatigue sense ( RPFS ) by using borg

scale Cardiac parasympathetic nervous activity (HF)

Result

Conclusion

Arm cranking exercise in the sitting position in water could lead to

faster recovery of heart rate than on the ground.

S

Effects Of Underwater Treadmill Exercise On

Mobility OfPeople With Knee

OsteoarthritisJaimie Roper. Utah State University

Logan, Utah.2010

Presented by: Fay AlBuainain

Purpose

To determine the effectiveness of aquatic therapy on in OA patients.

Subjects

Inclosion criteria : Previously

diagnosed with knee OA.

Able to walk a city block

n= 14 men

Exclosion criteria : Currently exercised on

an aquatic treadmill. CVD, NMD Stroke Surgeries to the lower

limb. Intra-articular

corticosteroid injections in the past month. WHY?

Method

3 sessions/week 3 sessions/week Week #2 Week #2 Week #3

Rest

20 min Intensity to X 0.26 m/s

Xiphoid process

Cont.

The parameters were measured before and after the experiment:

Gait kinematics: To measure step length, step rate, joint angles, and velocities.

Pain scale Self-efficacy scale: were asked to how many

times they could walk around the gymnasium without stopping. And their level of certainty.

very severe pain

no pain1 2 3 4 5 6 7 8 9 10 11 12

Result Self-selected speeds during exercise indicated they were not

different between aquatic (0.76 ± 0.24 m/s) and land (0.80 ± 0.26 m/s) treadmill exercise (p = 0.13).

Velocity gain scores that were significantly different at the p = 0.05

Left knee extension significantly higher for aquatic treadmill exercise by 38.1% (p = 0.004) during both of stance and swing.

During stance, the joint angle gain score for left hip flexion was greater for land exercise by 7% (p = 0.007)

During swing, the angular velocity gain score for right hip extension was significantly greater for aquatic exercise by 28% (p = 0.01).

During stance, joint angle gain score for left ankle abduction was significantly higher for land exercise by 4.72% (p = 0.003)

Result

Pain was 100% greater for land than aquatic treadmill exercise (p =0.02)

Self-efficacy gain scores were not different between conditions (p= 0.37).

Step rate and step length gain scores were not different between conditions (p =0.31-0.92).

Conclusion

Acute training period on an aquatic treadmill tended to increase select joint angular

velocities and decrease arthritis related joint pain. But un clear until now if the aquatic

exercise is a better than land over long time.

S

Lower Extremity Muscle Activity during Different Types and Speeds of Underwater

Movement

Koichi Kaneda, Hitoshi Wakabayashi, Daisuke Sato and Takeo Nomura

Purpose

To compare lower extremity muscle activity during land walking (LW), water walking (WW), and deep-water running

(DWR) at self-determined intensity.

“ The water temperature was set at 27°C and the water depth was set at 1.1 m throughout the experiment”.

Methods

Nine healthy young males participated in this experiment as subjects.

Methods

The subjects performed LW, WW, and DWR at self-determined low, moderate, and high intensities for 8 sec with

two repetitions.

Aqua jogger .

Surface electromyography (EMG).

Six muscles

Results

SOL and GAS showed significantly lower activity (p<0.05) during DWR than LW and WW at all intensities

During WW, SOL showed significantly lower activity (p<0.05) than LW at all intensities.

GAS showed significantly lower activity (p<0.05) than LW at low intensity.

BF showed significantly higher activity (p<0.05) during DWR than LW and WW at low and moderate intensities, and than LW at high intensity (p<0.05).

Conclusion

The lower activity of SOL and GAS depended on water depth.

Higher activity of BF occurred by greater flexion of the knee joint or extension of the hip joint during exercise.

S

Water-based exercise is more effective than land-based exercise for people

with COPD and physical comorbidities Karin Wadell

Department of Community Medicine and Rehabilitation, Physiotherapy, Umea University, Umea, Sweden

Purpose

To compare the improvement of exercise capacity and health-related quality of life in water based exercise and

land based exercise in COPD patients with comorbidities.

Methods

Inclusion criteria : Adults with stable COPD were included if they had at

least one physical comorbid condition (eg, musculoskeletal conditions, peripheral vascular disease).

Exclusion criteria :

unstable cardiac disease or a contraindication to water-based exercise, such as open wounds.

Participants

20 to the land-based exercise

(LBE)

18 to the water-based exercise

(WBE)

15 to the control group

Methods

Both WBE and LBE required participants to attend three 60-minute sessions each week, for 8 weeks.

The WBE group and LBE group were matched as closely as possible in terms of intensity and the muscle groups exercised.

Results

A total of 45 participants completed the study.

Greater gains were seen in the distance walked in the WBE group but not in the LBE group.

Conclusion

In people with COPD and physical comorbidities, WBE appears to confer greater gains in exercise capacity when compared with

LBE.

S

Water-based exercise for adults with asthma

Grande AJ, Silva V, Andriolo BNG, Riera R, Parra SA, Peccin MS. Water-based exercise for adults with asthma.

Cochrane Database of Systematic Reviews 2014,

Purpose

To evaluate the effectiveness and safety of water-based exercise for adults with asthma.

Methods

They included randomized controlled trials (RCTs), regardless of language, age of publication or publication status.

A cross-over RCTs were also included; however they analyzed separately the data obtained from them.

They considered participants who met the following criteria: Adults of either gender. Adults with asthma diagnosed according to clinical criteria

Studies that compared any type of water-based exercise versus another type of water-based exercise, land-based exercise or usual care were included .

They documented the duration and frequency of sessions and the overall length of the programme.

At least one group in each comparison used water-based exercise.

The following possible comparisons were made. Water-based exercise versus land-based exercise. Water-based exercise versus usual care

Result

The primary outcomes of quality of life and exacerbations leading to use of steroids were not reported by these studies.

For exacerbations leading to health center/hospital visits, uncertainty was wide because a very small number of events was reported (in a single study).

Secondary outcomes :symptoms, lung function, changes in medication and adverse effects.

No clear differences were noted between water-based exercise and comparator treatments.

There was an uncertainty about the effects of water-based exercise for adults with asthma

Conclusion

The small number of participants in the three included studies, the clinical and methodological heterogeneity observed and the high risk of bias .

Randomized controlled trials are needed to assess the efficacy and safety of water-based exercise for adults with asthma.

S

Effectiveness of low-intensity aquatic exercise on COPD: A randomized clinical trial

Zenia Trindade de Souto Araujoa, Patricia Angelica de Miranda Silva Nogueirab, Elis Emmanuelle Alves Cabralb, Lourena de Paula dos Santos Ivanizia Soares da Silvab, Gardenia Maria Holanda Ferreirab, 2012

Purpose

To evaluates the impact of low-intensity water and floor exercises on COPD

Method

42 individuals with moderate to very severe COPD, divided into 3 groups: Control Group (CG) Floor Group (FG) Aquatic Group (AG).

Subjects were over 40 years of age From both sexes Gave informed written consent Clinically stable without periods of exacerbation

for at least 8 weeks. Nonsmokers or ex-smokers for at least 3 months. Free of lung infection and had medical supervision.

Spirometry.

Respiratory muscle strength (MIP and MEP).

The 6-Minute Walk Test (6MWT).

Medical Research Council (MRC).

BODE index

The St. George’s Respiratory Questionnaire (SGRQ).

All participants were assessed using:

Result

Pulmonary function : both (FG, AG) significantly improved FEV1 post-

intervention, while the CG exhibited a significant decrease in the FEV1/FVC

However, no significant difference was observed among the three groups after training

Respiratory muscle strength: A statistical difference was observed in

MIP,MEP inthe training groups after the physical exercise program (FG, AG). No significant difference was recorded in the

CG post-intervention.

6MWT: There was no difference between groups for 6MWT

or for mean for dyspnea at rest and after the 6MWT. Only the FG showed a significant reduction in Rate of Perceived Exertion.

After training, the dyspnea index was significantly lower in the AG and higher in the CG.

In regard to risk of death from COPD:

A significant reduction in the BODE index for the physical training groups: (FG,AG).

Increased in the CG

SGRQ scores : There was no significant difference between

groups at the beginning of the study The FG showed improved quality of life

evidenced by the total score on the SGRQ

Conclusion

Results show that both forms of low-intensity physical exercise benefit patients with moderate and very severe COPD.

The AG exhibited additional benefits in physical ability, indicating a new therapeutic modality targeting patients with COPD.

UTM and LTM training are equally capable of improving aerobic fitness and body composition in physically inactive overweight individuals, but UTM training may induce increases in LBM.

Acute training period on an aquatic treadmill tended to increase select joint angular velocities and decrease arthritis related joint pain.

UTM may offer a good alternative to tradional LTM exercise in some cases only

Effect of Underwater exercises on asthma and COPD

Arm cranking exercise in the sitting position in water could lead to faster recovery of heart rate than on the ground.