Land-based Exercise Research Articles

Effect of moderate-intensity aquatic treadmill exercise on cognitive function and cerebral blood flow for healthy older adults

To compare the effect of moderate-intensity aquatic treadmill exercise (ATM) on cerebral blood flow (CBF) and cognitive function in healthy older adults to that of moderate-intensity land-based treadmill exercise (LTM). This randomized controlled trial study was conducted between May 2023 and Oct 2023. Twenty-eight participants aged 60–80 were randomly assigned to either ATM group (N = 14) or LTM group (N = 14). Cognitive function and cerebral blood flow were assessed before and after the exercise. The outcome measures used in this study were the Digit Symbol Substitution Test (DSST) and the Digit Span Test (DST) to assess cognitive performance, and the mean middle cerebral artery blood velocity (MCAvmean) to evaluate CBF. A mixed effects model was used to analyze the within-group and between-group differences in cognitive function and CBF outcomes pre-to-post treadmill by SPSS. The DSST demonstrated a statistically significant improvement within both the ATM [β ± SE: −13.643 ± 2.407, 95 % CI: −18.749, −8.537] and LTM [β ± SE: −19.25 ± 3.66, 95 % CI: −26.424, −12.076] groups, indicating clinical significance in both groups. Both ATM and LTM groups exhibited post-exercise improvements within their respective groups for forward Digit Span Test (FDST) [ATM β ± SE: −0.143 ± 0.362, 95 % CI: −0.92, 0.634; LTM β ± SE: −0.286 ± 0.37, 95 % CI: −1.078, 0.506] and backward Digit Span Test (BDST) (ATM β ± SE: −1.741 ± 5.377, 95 % CI: −13.27, 9.792; LTM β ± SE: −6.729 ± 5.370, 95 % CI: −4.788, 18.24). In terms of MCAvmean, there is a higher improvement of CBF in ATM group [β ± SE: −138.669 ± 67.9217, 95 % CI: −288.164, 10.826] than LTM group [β ± SE: −9.305 ± 70.076, 95 % CI: −153.617, 135.007]. Hence, a single bout of moderate-intensity ATM and LTM can enhance cognitive function and CBF in healthy older adults, suggesting their potential as preventive strategies against age-related declines.

Harnessing the Power of Water: A Scoping Review of Hydrokinesiotherapy as a Game-Changer in Knee Osteoarthritis Management.

Background: Knee osteoarthritis (OA) is a prevalent condition that significantly impairs pain, mobility, and quality of life. Hydrokinesiotherapy, a water-based exercise therapy, is gaining traction as a potential alternative to traditional land-based rehabilitation for managing knee OA symptoms. Methods: This scoping review aimed to evaluate the effectiveness of hydrokinesiotherapy compared to standard land-based physical therapy and self-administered exercise regimens in improving pain, joint mobility, quality of life, and physical function in patients with knee OA. Five randomized controlled trials (RCTs) were included, assessing outcomes using measures such as the WOMAC score, Visual Analog Scale (VAS), and SF-12. The studies were critically appraised using the PEDro scale and the RoB-2 tool to determine the quality and risk of bias. Results: Hydrokinesiotherapy consistently demonstrated superior outcomes in pain reduction, joint mobility, and physical function across all studies. Patients in the hydrokinesiotherapy groups reported significant improvements in pain and mobility, which were strongly associated with enhanced quality of life. The review also highlighted the potential for hydrokinesiotherapy to serve as an effective alternative or complement to land-based exercises, particularly in populations experiencing severe symptoms. Conclusions: Hydrokinesiotherapy is an effective intervention for managing knee OA, offering significant improvements in key clinical outcomes. Given its benefits, hydrokinesiotherapy should be considered a valuable addition to knee OA treatment protocols. However, further research is needed to confirm long-term effects and to explore ways to improve accessibility to this therapeutic option.

Exercise for patients with arthritis

Background: Osteoarthritis and rheumatoid arthritis are major causes of pain and disability globally, and exercise is known to be effective at alleviating symptoms and improving physical function.Current Concepts: Knee osteoarthritis is a common degenerative disease, and comprehensive clinical practice guidelines have been established. Most studies strongly recommend appropriate weight management combined with exercise therapy. Aerobic, strength, resistance, isometric, neuromuscular, and balance training have been used. However, the current evidence is insufficient to recommend specific prescriptions regarding the exercise type and dose. Many guidelines group knee and hip osteoarthritis together for exercise recommendations. Evidence supporting the use of exercise for hand osteoarthritis is relatively scarce, and reports on its adverse effects are rare. Weight loss is not recommended for hand osteoarthritis, because its effectiveness has not yet been established. For patients with polyarticular osteoarthritis, exercise is recommended as a core treatment, with systematic land-based exercises being particularly advised. For rheumatoid arthritis, both general exercises and hydrotherapy are recommended to improve joint flexibility, muscle strength, and functional outcomes.Discussion and Conclusion: Exercise is a powerful treatment tool for various types of arthritis. However, further research is required to develop more specific exercise intervention protocols.

Comparison of water- vs. land-based exercise for improving functional capacity and quality of life in patients living with and beyond breast cancer (the AQUA-FiT study): a randomized controlled trial.

Patients living with and beyond breast cancer frequently exhibit several side effects that can impact quality of life and physical functioning way beyond diagnosis and cancer therapies. Traditional on-land exercise has shown to be effective in reducing several symptoms of BC but little is known about the role of water-based exercise in improving physical and psychological well-being. To compare land- vs. water-based exercise training for BC survivors to improve Health-Related Quality of Life (HRQoL), cancer-related fatigue (CRF), physical functioning, body composition and physical activity in patients with BC. A randomised, parallel group (1:1) controlled trial was conducted between 2020 and 2022. Patients were randomly allocated to complete a similar exercise training twice weekly during 12 weeks either on land (LG) using traditional gym equipment or in a swimming pool (WG) using body-weight exercises and water-suitable accessories. Both groups were supervised and monitored by an experienced physiotherapist. Main outcome was HRQoL (EORTC QLQ C30 and B23 module) and CRF measured with the Piper Scale. Secondary variables included functional capacity with the 6 Minutes Walking Test (6MWT), upper and lower body strength (handgrip strength and 30″ Sit-to-Stand (STS) test), body composition and objectively measured physical activity. 28 patients were assessed and randomised during the study period. One patient did not receive the allocated intervention due to skin issues and one patient was dropped out during the intervention. A significant effect of time was found for both symptom severity (F(2,52) = 6.46, p = 0.003) and overall functioning (F1.67,43.45 = 5.215, p =0 .013) but no interaction was found between group and time. No effects were reported for CRF. Similar findings were reported for functional capacity (time effect F1.231,32.019 = 16.818, p < 0.001) and lower body strength (time effect F2,52 = 15.120, p < 0.001) as well as fat mass (time effect F2,52 = 4.38, p = 0.017). Notably, a significant time per group interaction was reported for physical activity (F2,52 = 6.349, p =0.003) with patients in the WG significantly improving PA levels over time while patients in the LG exhibited a marked decreased. Exercise training either in water or on land can decrease symptom severity and improve functionality and body composition. Water-based training seems more effecting than land-based exercise to improve physical activity patterns over time.

Aquatic versus Land-Based Exercise for Knee Osteoarthritis: A Randomized Controlled Trial.

Whether land- or aquatic-based rehabilitation is more effective in improving knee osteoarthritis (OA) is still unclear. This study assessed the effectiveness of aquatic-based treatments in patients with knee OA. The participants were divided into a land-based exercise group (G1, n=30) and a water-based exercise group (G2, n=30). The exercises were performed for 8 weeks. The primary endpoint was a response to physical therapy, defined as a 20% decrease in the summed score for the Western Ontario and McMaster Universities-Osteoarthritis Index (WOMAC) pain subscale from T1 (before the start of the rehabilitation program) to T2 (8 weeks later). The secondary endpoints included the Visual Analog Scale (VAS) for pain, WOMAC functional and stiffness subscales, Lequesne Index, and Medical Outcome Study Short Form (SF-12) for physical and mental health. A 20% decrease in the summed WOMAC pain subscale score was noted in 33% of patients in G1 (n=10) and 93% in G2 (n=28) (P<0.001). VAS scores at walking decreased by 14% in G1 vs. 37% in G2 (P<0.001), WOMAC stiffness subscale decreased by 18% in G1 vs. 53% in G2 (P<0.001), and the Lequesne index decreased by 10% in G1 vs. 33% in G2 (P<0.001). Quality of life improvement was greater in G2 than in G1; SF-12 (physical) increased by 2.3 in G1 vs. 5.4 in G2 (P=0.023), and SF-12 (mental) increased by 6.3 in G1 vs. 10.9 in G2 (P=0.022). Both aquatic and land-based exercises improved pain intensity, functional impairment, degree of handicap, and quality of life impairment caused by OA. However, the improvement was more significant in the aquatic-based exercises group.

Effect of aquatic versus conventional physical therapy program on ankle sprain grade III in elite athletes: randomized controlled trial

IntroductionAnkle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball.PurposeTo investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training.MethodsThirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18–30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups.ResultsThere was a significant interaction effect of Aquatic therapy and time for VAS (p < 0.001), single hop (p < 0.001), triple hop (p < 0.001), cross-over hop (p < 0.001), IAT (p = 0.019) and ATT (p < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected (p = 0.923), and nonaffected (p = 0.140). There was a significant main effect of time for all dependent variables (p < 0.001) except for 6-MHT of affected (p = 0.939), nonaffected (p = 0.109), and IAT (p = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides (p < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group (p < 0.001*).ConclusionAquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III.

Comparative study between aquatic therapy and land-based exercises in hemiplegic patients after stroke: a randomized controlled trial.

This study aimed to assess the effects of aquatic therapy in individuals with hemiplegia compared to those of a conventional land-based exercise program. This was a blinded, randomized controlled study of chronic stroke patients with hemiplegia. The participants were randomized in to aquatic therapy (experimental) or conventional therapy (control) groups. The aquatic therapy group conducted the exercise program in a swimming pool, and the conventional therapy group performed to an exercise on the land environment three times per week for six weeks. Both interventions focused on posture, balance, and weight-bearing exercises. Outcomes included the Berg Balance Scale, Brunnstrom scale, Motricity Index, muscle strength tests, Modified Ashworth Scale, Postural Assessment Scale for Stroke, Trunk Control Test and Functional Independence Measure. Also, postural sway was evaluated by using the variables of center of pressure displacements in the mediolateral and anteroposterior directions. The findings of the present study show that the experimental group (26 patients) exhibited significant improvements in spasticity compared to the control group (25 patients) (p = 0.01). The conventional therapy group also achieved significant improvements (p < 0.05) in anteroposterior deviation, mediolateral velocity, and total velocity of center of pressure in a sitting position with eyes closed. Land-based exercises were more beneficial in the spasticity of chronic stroke patients.

Perturbation-based Balance Training in Adults Aged Above 55 Years with Chronic Low Back Pain: A Comparison of Effects of Water versus Land Medium - A Preliminary Randomized Trial.

'Rapid balance reaction' or 'perturbation' training is an emerging paradigm in elderly back pain rehabilitation due to its connection to postural stability. This study aimed to inform the feasibility and practicality of perturbation-based balance training (PBT) using a stratification approach and to determine the effectiveness of land versus water-based PBT in elderly individuals with chronic low back pain (CLBP). Elderly CLBP participants (n=24) received exercise interventions as per treatmentbased classification (TBC) and were randomly allotted into water-based perturbation exercises (WBPE, Mean age=63.0±2.6years, n=12) and land-based perturbation exercise group (LBPE, 62.3±2.6 years, n=12). Pain intensity, disability, scores of fear-avoidance beliefs, fall efficacy, and rate of perceived exertion (RPE) were assessed before and at the end of 6 weeks. WBPE group reported a significant reduction in pain score (median difference(MD)):2, p<0.03), fear avoidance behaviour for work (MD:9, p<0.01) and fear avoidance behaviour for physical activity (MD:10, p< 0.05), improved straight leg raise right (SLR) (MD:37.5°, p<0.05), and improved modified fall efficacy scores (MFES, MD:25, p<0.05) compared to the LBPE group at post-intervention. Within-group analysis in both groups revealed significant improvement in clinical outcomes except for fear-avoidance beliefs related to physical activity in the LBPE group. Subgroup analysis revealed that the high BMI elderly CLBP group of LBPE had significant improvements similar to the WBPE group except for scores of FABQ physical activity scores and SLR. Possible key factors for future research are discussed in the realms of perturbation exercise in the elderly with CLBP.

Update on Rehabilitation Strategies for Swimmers' Shoulder: A Narrative Review

AbstractSwimmers' shoulder is one of the common overuse injuries having multifactorial causes with a gradual onset. Swimmers' experience pain in the pull-through phase, during the mid-stroke wherein the arm is maximally internally rotated and adducted. This occurs due to a significant amount of force generated by the pectorals, latissimus dorsi, subscapularis, serratus anterior, rhomboids, and supraspinatus for this movement. The repetitive use of shoulder muscles during the swim strokes predisposes it to overuse injuries among which shoulder impingement is common. It hinders participation of athletes in competitive events and reduces the efficiency of the swim performance. This review aims to provide a consolidated overview and identify various rehabilitation strategies and exercise programs for swimmers' shoulder. A thorough search was done on PubMed, ScienceDirect, Web of Science, Cochrane, CINAHL, and Clinical Key to find relevant articles in relation to the rehabilitation strategies available for swimmers' shoulder. Overall, this review suggests that aquatic concentric-eccentric exercise, Kinesio taping, land-based strengthening exercises, and rhythmic stabilization exercises significantly improve pain and functional activity in individuals with swimmers' shoulder.

Effects of aquatic versus land-based exercise on irisin and fibroblast growth factor 21 expression and triiodothyronine and free fatty acid levels in elderly women.

This study investigated the impacts of exercise on irisin and fibroblast growth factor 21 (FGF-21) expression, as well as triiodothyronine (T3 ) and free fatty acid (FFA) levels in elderly women. Thirty women aged 65 to 70 years (10 per group) were randomly assigned to aquatic exercise, land exercise, and control groups. The aquatic and land groups engaged in 3 exercise sessions per week (60 min/session) for 16 weeks. The intensity was progressively increased every 4 weeks. Irisin and FGF-21 levels significantly increased in the aquatic exercise group. In the posttest, the aquatic exercise group had the highest irisin levels. Significant findings were observed for irisin and FGF-21 for the main effect between aquatic and band exercise groups (p<0.05 for both), the main effect between measurement times (p<0.01 and p<0.001, respectively), and the interaction effect (p<0.05 and p<0.001, respectively). The irisin level was significantly higher in the aquatic than in the land group 30 minutes after the last session (p<0.05). In both exercise groups, T3 levels were significantly higher 30 minutes after the final session (p<0.05) than before the program. The FFA level was significantly higher in the aquatic exercise group than the others. In the aquatic group, FFA levels were significantly higher 30 minutes after both the first (p<0.01) and the last (p<0.001) session compared to pre-program values. Differences in exercise type and environment can promote fat metabolism by stimulating hormonal changes that induce brown fat activity and browning.

Comparing the effects of aquatic-based exercise and land-based exercise on balance in older adults: a systematic review and meta-analysis.

Balance plays a crucial role in the daily activities of older adults. Aquatic-based exercises (AE) are widely conducted as an alternative to land-based exercises (LE). Previous studies have compared AE and LE as effective ways to improve balance and have yielded inconsistent results. Therefore, this review aimed to compare the effects of AE and LE on balance function in older adults. Electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched. Randomized controlled trials published from January 2003 to June 2023 were included following predetermined criteria. Data extraction was carried out by two independent reviewers. Data synthesis was conducted using RevMan 5.3 software. The fixed-effect model or random-effect model was chosen based on the results of the heterogeneity test. Meta-analysis for the effect sizes of balance outcomes was calculated as standardized mean difference (SMD) with 95% confidence intervals (CI). The quality of the included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. This review was registered at PROSPERO CRD42023429557. A total of 29 studies involving 1486 older adults (with an average age of 66.2years) were included. Meta-analysis results indicated that AE could improve balance ability based on two tests: the Berg balance scale (BBS: SMD = 1.13, 95% CI 0.25 to 2.00, p = 0.01, I2 = 94%) and the 30-s chair stand test (30 CST: SMD = 2.02, 95% CI 0.50 to 3.54, p = 0.009, I2 = 96%). However, there were no significant differences between the AE group and the LE group in terms of the 6-min walking test (6 MWT: SMD = 0.13, 95% CI -0.16 to 0.43, p = 0.38, I2 = 62%) and time up to go test (TUGT: SMD = 0.44, 95% CI -0.44 to 0.91, p = 0.07, I2 = 85%). Older adults with different health conditions have different gains in different balance measurements after AE intervention and LE intervention. Although this was influenced by participant health status, transfer effects, sample size, and other factors, AE offers better benefits than LE for improving balance function in older adults.

Effects of Water-Based Exercise on Patients Older than 60 Years Undergoing Cardiac Rehabilitation after Coronary Intervention.

Cardiac rehabilitation (CR) plays a crucial role in managing patients who have undergone coronary intervention (CI) following acute myocardial infarction. While water-based exercise is gaining recognition as an exercise modality in this patient population, its impact on the subgroup of older adults remains unexplored. In this post hoc analysis, we investigated the effects of water-based exercise on adults older than 60 years undergoing CR after CI, comparing it to land-based exercise and a control group. In total, 45 patients aged over 60 participated in 14-day exercise programs, featuring two daily 30-min sessions. We assessed exercise capacity (VO2peak), vascular function (flow-mediated vasodilation (FMD)), heart rate variability (HRV), and blood markers (Interleukins 6, 8, and 10, P-Selectin, ICAM, and High-sensitivity CRP) before and after CR. VO2peak in the water-based group improved significantly after CR in comparison with the land-based group: 1.35 kg/mL/min (95% CI [0.20-2.50], p = 0.022). The significant difference between water-based and land-based groups was observed in several HRV parameters: Total power -1129.20 ms2 (95% CI [-1951.92--306.49], p = 0.008); peak LF 0.04 Hz (95% CI [0.00-0.08], p = 0.036); SD1 -9.02 millisecond (95% CI [-16.86--1.18], p = 0.025); and SD2 -19.71 ms (95% CI [-35.08--4.34], p = 0.013). FMD and blood markers did not vary significantly based on the exercise group. These findings suggest that short-term water-based CR may have potential as an alternative to traditional land-based CR, improving VO2peak and cardiorespiratory fitness among adults over 60 years undergoing CR after CI.

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.

The effect of aquatic training and vitamin D3 supplementation on bone metabolism in postmenopausal obese women

Background/ObjectiveDespite prevalence of studies indicating the positive effect of land-based exercise on bone metabolism, there are limited findings regarding the effect of aquatic exercise. The present study aimed to evaluate the effects of aquatic training and vitamin D3 supplementation on femur bone mineral density (BMD), serum 25(OH)D, and parathyroid hormone (PTH) in postmenopausal obese women with vitamin D insufficiency. Methods40 postmenopausal obese women were randomly divided into four groups of aquatic training + vitamin D3 intake group; (ATD), aquatic training with placebo intake group (AT), vitamin D3 intake group (D), and control group with placebo intake (CON). AT groups performed aerobic aquatic exercises for 8 weeks. Vitamin D3 supplementation groups consumed oral dose of 4000 IU/d for 8 weeks. ResultsThe femur BMD was significantly higher in the ATD than the AT and D and CON groups; in AT it was higher than the D and CON groups. Serum 25(OH)D level in the ATD was more than AT and CON, and in the D was more than the CON and AT. PTH in the ATD group was lower compared to AT, D, and CON groups. PTH was lower in the AT and D compared to the CON. ConclusionIn postmenopausal obese women with vitamin D insufficiency or deficiency, combining vitamin D supplementation and aquatic training was the most effective method for improving bone metabolism; Vitamin D supplementation (alone) was not sufficient to affect some of bone metabolism indices; Aquatic training could not improve serum vitamin D. By priority, ATD, AT, and D indicated better bone related metabolism indices.

Comparing the Effects of Aqua- and Land-Based Active Cooldown Exercises on Muscle Soreness and Sport Performance: A Randomized Crossover Study

Objective: Limited research has directly compared the effectiveness of aqua- and land-based exercises for postexercise recovery. This study aimed to fill this gap by comparing the effects of these 2 types of exercises on postexercise recovery. Methods: Sixteen male college athletes participated in an 8-day experimental study. The initial 2 days were dedicated to determining the intensity levels for the muscle-damaging exercise and recovery jogging. In a crossover design, participants underwent 2 sets of experimental trials. They were randomly assigned to either an aqua or land recovery intervention for days 3 to 5, and after a 1-week washout period they switched to the opposite intervention for days 6 to 8. Muscle soreness, creatine kinase, anaerobic performance, countermovement-jump height, and flexibility were assessed at different time points: baseline, immediately after downhill running, within 1 hour after jogging, and 24 hours and 48 hours after aqua or land jogging. Results: Significant group × time interaction effects were detected in the perceived soreness of the hamstring and quadriceps. However, the post hoc analysis showed no significant difference between aqua and land jogging groups. No significant group × time interaction effect was observed in creatine kinase, anaerobic performance, countermovement-jump height, or flexibility. Conclusion: Aqua and land jogging have similar recovery effects on muscle soreness and performance-based parameters.

Water-Based Exercise in Patients With Nonspecific Chronic Low-Back Pain: A Systematic Review With Meta-Analysis

Abstract Babiloni-Lopez, C, Fritz, N, Ramirez-Campillo, R, and Colado, JC. Water-based exercise in patients with nonspecific chronic low-back pain: a systematic review with meta-analysis. J Strength Cond Res 38(1): 206–219, 2024—This study aimed to systematically review and synthesize evidence (i.e., active [land-based training] and nonactive controls [e.g., receiving usual care]) regarding the effects of water-based training on patients with nonspecific chronic low-back pain (NSCLBP). Web of Science (WOS), PubMed (MEDLINE), EMBASE, EBSCO (SPORTDiscus; CINAHL), and PEDro were searched, with no date restrictions, until October 2021. The included studies satisfied the following criteria: (a) NSCLBP (≥12 weeks) patients, (b) water-based intervention, (c) control group (land-based trained; nonactive group), and (d) outcomes related to pain, disability, quality of life, or flexibility. The main outcome analyzed in the meta-analysis was pain intensity. Secondary outcomes included disability, body mass index, and flexibility. The random-effects model was used, and effect size (ES) values are presented with 95% confidence intervals (CIs). The impact of heterogeneity was assessed (I 2 statistic), with values of &lt;25%, 25–75%, and &gt;75% representing low, moderate, and high levels, respectively. Alpha was set at p &lt; 0.05. In conclusion, 15 studies (n = 524) were meta-analyzed. After intervention, pain intensity was reduced compared with nonactive controls (ES = −3.61; p &lt; 0.001) and a similar reduction was noted when compared with land-based trained group (ES = −0.14; p = 0.359). Greater decrease in disability (ES = 2.15; p &lt; 0.001) and greater increase in sit-and-reach (i.e., flexibility; ES = −2.44; p &lt; 0.001) were noted after intervention compared with the nonactive group. In conclusion, water-based exercise therapy reduces pain intensity, disability, and increases flexibility in NSCLBP compared with nonactive subjects and was equally effective compared with land-based exercise to reduce pain. Favorable effects may be expected at ≤8 weeks. However, due to several methodological issues (e.g., high heterogeneity), for the improvement of most outcomes, we are unable to provide other than a weak recommendation in favor of intervention compared with control treatment.

A Systematic Review: Does Land based Exercise Improve the Quality of Life in Patient with Knee Osteoarthritis?

Quality of Life (QoL) is a crucial aspect of an individual's well-being, and Knee Osteoarthritis (OA) is a chronic degenerative disease that significantly impacts QoL. OA patients experience functional impairment, leading to difficulty and pain in activities such as standing, squatting, walking, and climbing stairs. Land-based exercise is a non-pharmacological intervention recommended for long-term knee pain, as it can improve muscle strength, relieve pain, and improve function. However, excessive exercise can worsen pain. This systematic review evaluates literature on land-based exercise interventions that show significant effects on QoL and decrease in knee pain for patients with knee OA. The review includes six publications with randomized controlled trials and experimental studies that examined the impact of land-based exercise on knee OA. The review focuses on exercises such as yoga, strengthening exercises, Tai Ji, and Wuxinqi Exercise. The review finds that land-based exercise has a positive impact on physical function, pain reduction, and quality of life for patients with knee OA. Three publications with yoga and Wuxinqi Exercise showed significant results in pain management, increasing knee strength, and reducing pain in knee OA patients. The review concludes that land-based exercise is an appropriate intervention for people with knee OA related to pain and functional impairment.

PAIN INTENSITY AND INTERFERENCE PREDICT STAGE OF ENGAGEMENT IN SELF-MANAGEMENT IN OLDER AFRICAN AMERICAN ADULTS

Abstract Osteoarthritis in African American older adults often causes a disproportionate burden of severe chronic joint pain that interferes with physical and emotional/cognitive activities. One tool commonly used in clinical research studies to evaluate patterns in pain intensity and pain interference is the Brief Pain Inventory-SF (BPI-SF). Confirmatory factor analysis validated a three-factor structure of the BPI-SF comprising pain intensity, activity-related pain interference, and affective pain interference. However, what is unclear and novel, is whether these three factors predict stage of readiness to engage in osteoarthritis self-management. Stage of readiness to engage (pre-contemplation, preparation, action) were assessed for seven recommended osteoarthritis self-management strategies: land-based exercise, water exercise, strength training/stretching, assistive devices, warm/cool compresses, medications, and self-management education. Using secondary data from 110 African American men and women (Mean Age 68.4, SD= 12.4), we performed ANOVA and ordinal logistic regression in SPSS. Pain intensity, activity-related pain interference, and affective pain interference were not significantly different between stages of engagement in pain self-management strategies except for medication use and assistive devices (p&amp;lt;.05). After controlling for age and employment, higher pain intensity was significantly associated with 27% reduction in the odds of being in preparation phase for water exercise, and higher levels of activity interference was associated with a 42% increase in the odds of being in the action phase for assistive devices. These results help us understand the relationship between behaviors and pain, particularly the impact of pain intensity and interference with physical activities on which strategies African Americans select to manage pain.

Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol

BackgroundLow back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients’ outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP.MethodsThis study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment.DiscussionThis study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients’ pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP.Trial registrationNCT05823857, registered prospectively on April 27th, 2023.

Effects of Electromyographic Biofeedback-Assisted Exercise on Functional Recovery and Quality of Life in Patients after Total Hip Arthroplasty: A Randomized Controlled Trial.

The goal of the trial was to examine the effects of adding electromyographic biofeedback (EMG-BF) to the conventional program of physiotherapy after total hip arthroplasty (THA) on functional recovery and quality of life. The trial was designed as a prospective, interventional, single-blinded randomized controlled study. Ninety patients were randomized into an experimental group (EG) (n = 45; mean age 63.9 ± 8.8) and control group (CG) (n = 45; mean age 63.9 ± 9). All patients received 21 days of physiotherapy which consisted of therapeutic exercise (land-based and aquatic), electrotherapy, and education. Electromyographic biofeedback was added to a portion of the land-based exercise in EG. The Hip Disability and Osteoarthritis Outcome Score (HOOS), Numeric Rating Scale (NRS), Short Form Health Survey-36 (SF-36), use of a walking aid, 30 s chair stand test (CST) as well as the Timed Up and Go (TUG) test were used for outcome measurement. A higher proportion of the participants in both groups did not need a walking aid after the intervention (p < 0.05). All participants improved their 30 s CST and TUG results (p < 0.001), as well as their NRS and HOOS scores (p < 0.05). No significant differences between the groups were found. There were no additional benefits from adding EMG-BF to the conventional physiotherapy protocol.