Land-based Exercise Research Articles

Interventions for preventing and treating low-back and pelvic pain during pregnancy.

More than two-thirds of pregnant women experience low-back pain and almost one-fifth experience pelvic pain. The two conditions may occur separately or together (low-back and pelvic pain) and typically increase with advancing pregnancy, interfering with work, daily activities and sleep. To update the evidence assessing the effects of any intervention used to prevent and treat low-back pain, pelvic pain or both during pregnancy. We searched the Cochrane Pregnancy and Childbirth (to 19 January 2015), and the Cochrane Back Review Groups' (to 19 January 2015) Trials Registers, identified relevant studies and reviews and checked their reference lists. Randomised controlled trials (RCTs) of any treatment, or combination of treatments, to prevent or reduce the incidence or severity of low-back pain, pelvic pain or both, related functional disability, sick leave and adverse effects during pregnancy. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We included 34 RCTs examining 5121 pregnant women, aged 16 to 45 years and, when reported, from 12 to 38 weeks' gestation. Fifteen RCTs examined women with low-back pain (participants = 1847); six examined pelvic pain (participants = 889); and 13 examined women with both low-back and pelvic pain (participants = 2385). Two studies also investigated low-back pain prevention and four, low-back and pelvic pain prevention. Diagnoses ranged from self-reported symptoms to clinicians' interpretation of specific tests. All interventions were added to usual prenatal care and, unless noted, were compared with usual prenatal care. The quality of the evidence ranged from moderate to low, raising concerns about the confidence we could put in the estimates of effect. For low-back painResults from meta-analyses provided low-quality evidence (study design limitations, inconsistency) that any land-based exercise significantly reduced pain (standardised mean difference (SMD) -0.64; 95% confidence interval (CI) -1.03 to -0.25; participants = 645; studies = seven) and functional disability (SMD -0.56; 95% CI -0.89 to -0.23; participants = 146; studies = two). Low-quality evidence (study design limitations, imprecision) also suggested no significant differences in the number of women reporting low-back pain between group exercise, added to information about managing pain, versus usual prenatal care (risk ratio (RR) 0.97; 95% CI 0.80 to 1.17; participants = 374; studies = two). For pelvic painResults from a meta-analysis provided low-quality evidence (study design limitations, imprecision) of no significant difference in the number of women reporting pelvic pain between group exercise, added to information about managing pain, and usual prenatal care (RR 0.97; 95% CI 0.77 to 1.23; participants = 374; studies = two). For low-back and pelvic painResults from meta-analyses provided moderate-quality evidence (study design limitations) that: an eight- to 12-week exercise program reduced the number of women who reported low-back and pelvic pain (RR 0.66; 95% CI 0.45 to 0.97; participants = 1176; studies = four); land-based exercise, in a variety of formats, significantly reduced low-back and pelvic pain-related sick leave (RR 0.76; 95% CI 0.62 to 0.94; participants = 1062; studies = two).The results from a number of individual studies, incorporating various other interventions, could not be pooled due to clinical heterogeneity. There was moderate-quality evidence (study design limitations or imprecision) from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability, and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain.When reported, adverse effects were minor and transient. There is low-quality evidence that exercise (any exercise on land or in water), may reduce pregnancy-related low-back pain and moderate- to low-quality evidence suggesting that any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy-related pelvic pain, and osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit.Clinical heterogeneity precluded pooling of results in many cases. Statistical heterogeneity was substantial in all but three meta-analyses, which did not improve following sensitivity analyses. Publication bias and selective reporting cannot be ruled out.Further evidence is very likely to have an important impact on our confidence in the estimates of effect and change the estimates. Studies would benefit from the introduction of an agreed classification system that can be used to categorise women according to their presenting symptoms, so that treatment can be tailored accordingly.

무릎 골관절염 환자를 대상으로 한 수중 운동과 지상운동 비교: 체계적 문헌고찰 및 메타분석

본 연구는 무릎 골관절염 환자를 대상으로 수중운동과 지상운동의 효과를 비교하기 위해 수행된 체계적 문헌고찰 및 메타분석 연구이다. 문헌은 Ovid-Medline, Cochrane Library CENTRAL, CINAHL과 국내 DB인 RISS와 KISS를 통해 ((osteoarthriti* OR OA) AND (aqua* OR water OR hydrotherap*)), (골관절염 AND 수중운동) 등을 주요어로 조합하여 검색하였으며, 선택배제과정을 거쳐 최종 7편(n=449)의 문헌이 분석에 포함되었다. 문헌에 대한 질 평가는 SIGN의 무작위임상시험평가도구를 사용하였으며, 질 평가 결과는 6편에서 ++, 1편에서 +로 평가되어 전반적으로 비뚤림 위험은 없는 것으로 판단하였다. 메타분석결과 운동 중재 후 수중운동군과 지상운동군의 통증변화에 대한 차이는 Standardized mean difference (SMD) -0.26(95% CI -0.49, -0.03, p=0.03, <TEX>$I^2=14%$</TEX>)으로 수중운동군이 지상운동군에 비해 통증이 통계적으로 유의하게 감소하는 것으로 나타났으나, 그 외 두 군간 굴곡 관절가동범위, 신전 관절가동범위, 신체기능, 삶의 질의 SMD는 각각 -0.12(95% CI -0.51, 0.27, p=0.53, <TEX>$I^2=0%$</TEX>), -0.04(95% CI -0.55, 0.48, p=0.89, <TEX>$I^2=43%$</TEX>), -0.12(-0.44, 0.19, p=0.44, <TEX>$I^2=0%$</TEX>), -0.15(-0.54, 0.24, p=0.46, <TEX>$I^2=0%$</TEX>)로 두 군간 통계적으로 유의한 차이가 없는 것으로 나타났다. 현재 시점에서 무릎 골관절염환자를 대상으로 수중운동과 지상운동의 효과를 분석한 무작위 대조군 실험 연구 수가 비교적 적어 효과크기에 대한 확증적 결과를 얻는 데에는 다소 제한이 있었으므로 향후 이와 관련된 무작위 임상시험연구와 장기적인 효과검증에 대한 노력이 지속적으로 이루어져야 할 것으로 사료된다. This study was a systematic review and meta-analysis comparing the effects of aquatic exercise and land-based exercise in the treatment of knee osteoarthritis. 7 studies (n=449) met selection and exclusion criteria out of 287 potential studies obtained from the literature search via Ovid-Medline, Cochrane Library CENTRAL, CINAHL, RISS and KISS. The overall risk of bias of selected studies using SIGN (Scottish Intercollegiate Guidelines Network) checklist for randomized controlled trials (RCT) was regarded as low. As a result of meta analysis, Standardized Mean Difference (SMD) for pain was -0.26(95% CI -0.49, -0.03, p=0.03, <TEX>$I^2=14%$</TEX>), which implies that aquatic exercise groups had significant less pain than land-based exercise groups. On the other hand, there was no significant difference between aquatic exercise groups and land based exercise groups for flexion Range of Motion (ROM) (-0.12, 95% CI -0.51, 0.27, p=0.53, <TEX>$I^2=0%$</TEX>), extension ROM (-0.04, 95% CI -0.55, 0.48, p=0.89, <TEX>$I^2=43%$</TEX>), physical function (-0.12, 95% CI -0.44, 0.19, p=0.44, <TEX>$I^2=0%$</TEX>), Quality of Life (QOL) (-0.15, 95% CI -0.54, 0.24, p=0.46, <TEX>$I^2=0%$</TEX>). This study has some limitations due to few RCTs comparing aquatic exercise groups and land-based exercise groups in the treatment of knee osteoarthritis. Therefore, further RCTs should be conducted along with long-term outcomes.

Exercise for osteoarthritis of the knee: a Cochrane systematic review

ObjectiveTo determine whether land-based therapeutic exercise is beneficial for people with knee osteoarthritis (OA) in terms of reduced joint pain or improved physical function and quality of life.MethodsFive electronic databases...

Effect of aquatic and land-based exercise programs on the pain and motor function of weight lifters with patellofemoral pain syndrome

Background: Patellofemoral Syndrome (PFPS) is one of the most common knee joint problems among the athletes. The present study was aimed to compare the effect of aquatic and land-based exercise methods on the pain level and motor function of the weight lifters with patellofemoral syndrome. Methods: A total of twenty weight lifters with patellofemoral syndrome participated in this quasi-experimental study. They were randomly divided to two groups of aquatic exercise and land-based exercise. Visual Analog Scale (VAS) and Kujala Scale were used before and after the exercise period to measure the pain and motor function, respectively. To compare the pre-test and post-test scores of the participating groups, dependent t-test was used and to compare the differences between groups, ANOVA was applied. Results: The results of post-test showed a significant difference in both groups in terms of pain level and motor function compared to pre-test after eight weeks of strength exercise. However, the comparison of data indicated no significant difference between groups with regard to pain level and motor function. Conclusion: According to the findings of this study, exercise in water and on land can reduce the pain and improve the performance of the patients with patellofemoral syndrome.

A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study

Purpose: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. Method: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age–sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. Results: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). Conclusion: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.Implications for RehabilitationAn 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients.Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles.Core stability exercises could be performed in water as well, no differences were found between methods due to environment.

Non pharmacological knee osteoarthritis treatment

Osteoarthritis (OA) is a chronic disorder which mostly results with functional impairment and disability. The goal of the treatment program is to decrease pain and disability and to increase functional capacity and quality of life. One of the main parts of the treatment is nonpharmacological treatment modalities. These are weight loss, educational programs in modifying lifestyle and joint protective techniques, assistive devices, physical therapy (superficial and deep heat-cold applications, electrotherapeutic modalities, neuromuscular electrical stimulation), exercise and balneotherapy. Exercise therapy includes both aerobic exercise and strengthening programs. Choosing an appropriate exercise program depends on the patient's clinical evaluation and need. Although quadriceps muscle group is the primary stabilizer of knee joint, hamstring group exercises should also be recommended for a full performance. Progressive resistive exercise programs are found to have beneficial effects in pain and mobility. There are large evidence trials on the positive effects in the symptoms of OA of home-based exercise programs. Most of the studies reported the effectiveness of land-based exercises in knee OA patients. However aquatic exercises are another alternative for knee OA patients as it is safe, enjoyable and has no side effects. One of the widely used treatment option is balneotherapy and spa therapy. It was found to be effective on pain relief, functional capacity and quality of life parameters. Thermal action and chemical minerals play a significant role in its beneficial effect, however there is not an accepted clear concept about its mechanism. There is growing level of evidence about balneotherapy and spa therapy in the management of knee OA and it seems to take part in some of the treatment recommendations.

Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis.

Rheumatoid arthritis (RA) fatigue is not being well-managed currently, and evidence of effective interventions is limited. Aerobic exercise may provide benefit to treat fatigue in RA. Therefore, the purpose of this meta-analysis is to analyze the effect of aerobic land-based exercise on fatigue in RA. A literature search was conducted using PubMed, Cochrane Library, Embase, and trial registers to identify randomized controlled trials (RCTs) with a supervised land-based aerobic exercise program performed with an intensity between 50% and 90% of maximal heart rate, of at least 15 minutes' duration, performed at least 2 times a week, and lasting for a time period of at least 4 consecutive weeks. Risk of bias was assessed using the Cochrane tool. A meta-analysis of fatigue outcomes was performed by calculating the standardized mean difference (SMD) using a random-effects model. Five RCTs were included. None of the trials selected patients with RA for having fatigue. Risk of bias was low in 3 RCTs and unclear in 2. Land-based aerobic exercise programs had a positive effect on fatigue in RA compared to no exercise at 12 weeks, SMD -0.31 (95% confidence interval [95% CI] -0.55, -0.06). At 24 weeks, the effect of aerobic land-based exercise was smaller and not statistically significant: SMD -0.15 (95% CI -0.33, 0.02). There is evidence with low risk of bias that an aerobic exercise program is effective in reducing fatigue among patients with RA, especially in the short term; however, effects are small. To substantiate the evidence, RCTs should be performed in patients with RA selected for having fatigue.

Prescribing and Regulating Exercise with RPE after Heart Transplant: A Pilot Study.

The objective of this study is to analyze the use of the 6-20 RPE scale for prescribing and self-regulating heated water-based exercise (HEx) and land-based exercise (LEx) in heart transplant recipients. Fifteen (five females) clinically stable heart transplant recipients (time since surgery = 4.0 ± 2.5 yr) age 46.7 ± 11.8 yr underwent a symptom-limited maximal graded exercise test on a treadmill to determine their HR at anaerobic threshold (HRAT), respiratory compensation point (HRRCP), and maximal effort (HRmax). After a week, patients were randomized to perform 30 min of both HEx (walking inside the pool) and LEx (treadmill walking) sessions at a pace between 11 and 13 on the 6-20 RPE scale and had their HR measured every 4 min. The interval between sessions was 48-72 h. No significant differences between sessions were found in the average HR during HEx and LEx. Patients showed a delay in HR increase during both interventions, with the stabilization beginning after 8 min of exercise. Exercise HR was maintained between the HRAT and HRRCP (in the aerobic exercise training zone) for the most part of both HEx (72% of HR measurements) and LEx (66% of HR measurements). Only a few HR measurements stayed below HRAT (HEx = 9%, LEx = 13%) or above HRRCP (HEx = 19%, LEx = 21%) during both exercise sessions. Exercise HR was maintained in the aerobic exercise training zone (between HRAT and HRRCP) for the most part of both sessions, suggesting that the 6-20 RPE scale may be an efficient tool for prescribing and self-regulating HEx and LEx in heart transplant recipients.

Hydrotherapy vs. conventional land-based exercise for improving walking and balance after stroke: a randomized controlled trial

Objective: To investigate the effects of hydrotherapy on walking ability and balance in patients with chronic stroke. Design: Single-blind, randomized controlled pilot trial. Setting: Outpatient rehabilitation clinic at a tertiary neurological hospital in China. Subjects: A total of 28 participants with impairments in walking and controlling balance more than six months post-stroke. Intervention: After baseline evaluations, participants were randomly assigned to a land-based therapy (control group, n = 14) or hydrotherapy (study group, n = 14). Participants underwent individual sessions for four weeks, five days a week, for 45 minutes per session. Main measures: After four weeks of rehabilitation, all participants were evaluated by a blinded assessor. Functional assessments included the Functional Reach Test, Berg Balance Scale, 2-minute walk test, and Timed Up and Go Test. Results: After four weeks of treatment, the Berg Balance Scale, functional reach test, 2-minute walk test, and the Timed Up and Go Test scores had improved significantly in each group (P < 0.05). The mean improvement of the functional reach test and 2-minute walk test were significantly higher in the aquatic group than in the control group (P < 0.01). The differences in the mean values of the improvements in the Berg Balance Scale and the Timed Up and Go Test were not statistically significant. Conclusion: The results of this study suggest that a relatively short programme (four weeks) of hydrotherapy exercise resulted in a large improvement in a small group (n = 14) of individuals with relatively high balance and walking function following a stroke.

Acute Effects of Water- Versus Land-Based Exercise on Heart Rate Variability in Heart Transplant Recipients

BACKGROUND AND PURPOSE: Heart transplant (HT) results in complete cardiac denervation, promoting autonomic nervous system (ANS) imbalance follows transplantation surgery, despite signs of partial cardiac reinnervation. Land-based exercise (LEx) is a well-established intervention for HT recipients, and the regular practice improves heart rate variability (HRV). On the other hand, water-based exercise (HEx) promotes important muscular and cardiovascular benefits in several diseases. However, its acute effect on ANS activity of HT recipients is unknown. Our purpose was to analyze the acute effects of HEx versus LEx on HRV in HT recipients. METHODS: Eighteen (6 female) clinically stable HT recipients (age: 46±10years; body mass index: 26±5; time of HT: 5±3 years) performed 30 min of HEx (heated swimming pool), LEx (treadmill walking) and no-exercise control sessions in a random order (2-5 days between each sessions). HEx and LEx aerobic exercise intensity was set between “relatively easy and slightly tiring” (11-13 in Borg scale). Instantaneous HR and RR interval were acquired before, immediately after and in the recovery (30 minutes after) of each session. HRV was analyzed by frequency domain methods and power spectral density was expressed as normalized units (nu) at low (LF) and high (HF) frequencies, and as LF/HF. RESULTS: Baseline and post-exercise HRV were not different between interventions. However, increased LFnu and decreased HFnu (P=0.01) were observed post 30 minutes of HEx (LFnu: 34.7±36; HFnu: 65.3±36), but not after LEx (LFnu: 27±30.1; HFnu: 72.2±29.8), when compared with control session (LFnu: 23.1±20.3; HFnu: 73.7±23.8). CONCLUSIONS: Increased LFnu and decreased HFnu were observed only after HEx. These results suggest that HEx may have a potential as a new therapeutic approach to attenuate ANS imbalance after heart transplantation.

Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis

Abstract Objective To investigate the effectiveness of aquatic exercise in the management of musculoskeletal conditions. Data Sources A systematic review was conducted using Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and The Cochrane Central Register of Controlled Trials from earliest record to May 2013. Study Selection We searched for randomized controlled trials (RCTs) and quasi-RCTs evaluating aquatic exercise for adults with musculoskeletal conditions compared with no exercise or land-based exercise. Outcomes of interest were pain, physical function, and quality of life. The electronic search identified 1199 potential studies. Of these, 1136 studies were excluded based on title and abstract. A further 36 studies were excluded after full text review, and the remaining 26 studies were included in this review. Data Extraction Two reviewers independently extracted demographic data and intervention characteristics from included trials. Outcome data, including mean scores and SDs, were also extracted. Data Synthesis The Physiotherapy Evidence Database (PEDro) Scale identified 20 studies with high methodologic quality (PEDro score ≥6). Compared with no exercise, aquatic exercise achieved moderate improvements in pain (standardized mean difference [SMD]=−.37; 95% confidence interval [CI], −.56 to −.18), physical function (SMD=.32; 95% CI, .13–.51), and quality of life (SMD=.39; 95% CI, .06–.73). No significant differences were observed between the effects of aquatic and land-based exercise on pain (SMD=−.11; 95% CI, −.27 to .04), physical function (SMD=−.03; 95% CI, −.19 to .12), or quality of life (SMD=−.10; 95% CI, −.29 to .09). Conclusions The evidence suggests that aquatic exercise has moderate beneficial effects on pain, physical function, and quality of life in adults with musculoskeletal conditions. These benefits appear comparable across conditions and with those achieved with land-based exercise. Further research is needed to understand the characteristics of aquatic exercise programs that provide the most benefit.

Comparing Energy Expenditure During Land and Shallow Water Walking in Overweight and Obese Women

Physical activity is an important behavior for overweight and obese individuals. Aquatic exercise, including shallow water walking, is a popular form of aerobic activity in this population not requiring swimming skill. Although it has been shown to provide metabolic, cardiovascular, and psychological benefits, few studies have compared the responses to this form of exercise to land-based exercise. PURPOSE: To compare the energy expenditure (kcal/min) of a bout of shallow water walking to bouts of land walking in overweight and obese women. METHODS: Nineteen women (42.11 ± 10.30 yrs; 30.91 ± 3.78 kg/m2) completed three 10-minute trials including: a 1) shallow water walking at a self-selected pace; 2) land walking matched (± 10bpm) to the HR response of the shallow water walking bout; and 3) land walking at a self-selected pace. Oxygen uptake (mL·kg-1·min-1), ventilation (L·min-1), and respiratory exchange ratio (RER) were collected using a portable metabolic unit adapted for use in water. RESULTS: Results showed no difference in energy expenditure between shallow water (6.46 ± 1.38 kcal/min) and land walking (6.92 ± 1.61 kcal/min) at self-selected paces. However, significantly lower energy expenditure (p= 0.046) was observed for shallow water walking compared to matched HR response land walking (7.26 ± 1.29 kcal/min). When the difference in relative energy expenditure (kcal/kg/min) between shallow water walking and the matched HR response land walking was correlated with BMI and percent body fat, a moderate relationship was shown (r= 0.551, p= 0.014; and r= 0.556, p= 0.013) suggesting that the difference was reduced at higher levels of BMI and percent body fat. There were no correlations observed between body composition and differences in energy expenditure between shallow water and land walking at a self-selected pace. CONCLUSIONS: Findings suggest that shallow water walking is a viable alternative to land walking and can elicit an increase in energy expenditure performed at a moderate intensity in overweight/obese women. Since the difference in shallow water vs. land-based energy expenditure was reduced at higher levels of BMI and percent body fat, future studies should examine whether there is a threshold of obesity or body fatness that alters the response to water exercise compared to land-based exercise.

Improvements in Vascular Function with Swimming vs. Cycling Training in Patients with Osteoarthritis

Osteoarthritis (OA) is the leading cause of disability in older adults and is associated with increased risk of vascular disease. Aerobic exercise is widely recommended for patients with OA, but OA and its associated joint pain acts as a significant barrier for performing a variety of land-based exercises. Swimming can be an ideal form of exercise for patients with OA adults as it includes minimum weight-bearing stress and reduced heat load. However, no study has investigated if swimming exercise improves markers of vascular function in patients with OA. PURPOSE: We compared the effects of swimming exercise and cycling exercise on key markers of vascular function, central arterial stiffness and endothelial vasodilatory function. METHODS: Forty-eight patients with OA were randomly assigned to swimming (n=24, age=59±8 yr) or cycling (n=24, age=61±4 yr) training groups. Supervised exercise was performed for 45 min/day 3 days/week at 60-70% heart rate reserve, for 12 weeks. Cycling training was included as a non-weight bearing land-based comparison group. Central arterial stiffness was determined by carotid-femoral pulse wave velocity. Brachial flow-mediated dilation (FMD) was used as a marker of endothelial vasodilatory function. RESULTS: Before the exercise interventions, there were no significant group differences in any of the physical characteristics and dependent variables. After 12-weeks of exercise training, carotid-femoral pulse wave velocity decreased significantly after both swimming (12.9±1.9 vs. 12.0±2.1 m/sec) and cycling (12.0±1.9 vs. 11.0±2.4 m/sec) training (both p<0.05). Brachial FMD increased significantly after swimming (3.0±3.5 vs. 6.0±4.0 %, p<0.05) but not after cycling training (2.9±3.1 vs. 3.3±3.2 %). CONCLUSION: Swimming exercise intervention was effective in reducing central arterial stiffness and improving endothelial dependent vasodilatory function in middle-aged and older adults with osteoarthritis. This is a clinically important finding since swimming is a desirable exercise mode for patients with OA in whom vascular disease is highly prevalent. Supported by the National Swimming Pool Foundation.

Effectiveness of aquatic exercise for treatment of knee osteoarthritis: Systematic review and meta-analysis.

This paper presents a systematic review and meta-analysis of the effectiveness of aquatic exercise for treatment of knee osteoarthritis (OA). PubMed, the Cochrane Library, Embase, CAMbase, and the Web of Science were screened through to June2014. Only randomized controlled trials (RCTs) comparing aquatic exercise with control conditions were included. Two authors independently selected trials for inclusion, assessed the included trials, and extracted data. Outcome measures included pain, physical function, joint stiffness, quality of life (QOL), and safety. Pooled outcomes were analyzed using standardized mean difference (SMD). There is a lack of high quality studies in this area. Six RCTs (398participants) were included. There was moderate evidence for a moderate effect on physical function in favor of aquatic exercise immediately after the intervention, but no evidence for pain or QOL when comparing aquatic exercise with nonexercise. Only one trial reported 3months of follow-up measurements, which demonstrated limited evidence for pain improvement with aquatic exercise and no evidence for QOL or physical function when comparing aquatic exercise with nonexercise. There was limited evidence for pain improvement with land-based exercise and no evidence for QOL or physical function, when comparing aquatic exercise with land-based exercise according to follow-up measurements. No evidence was found for pain, physical function, stiffness, QOL, or mental health with aquatic exercise immediately after the intervention when comparing aquatic exercise with land-based exercise. Two studies reported aquatic exercise was not associated with serious adverse events. Aquatic exercise appears to have considerable short-term benefits compared with land-based exercise and nonexercise in patients with knee OA. Based on these results, aquatic exercise is effective and safe and can be considered as an adjuvant treatment for patients with knee OA. Studies in this area are still too scarce and too short-term to provide further recommendations on how to apply this therapy.

Efficacy of Brain Gym Training on the Cognitive Performance and Fitness Level of Active Older Adults: A Preliminary Study.

This study evaluates the impact of Brain Gym (BG) training in active older adults. Eighty-five participants were assigned to four training groups: BG (n = 18), BG plus water-based exercise (n = 18), land-based exercise (n = 30), and land plus water-based exercise (n = 19). The effects of the programs on the attention and memory functions were assessed by means of the symbol digit modality test. The two-min step and the eight-foot up-and-go tests were used to evaluate their impact on fitness level. No program had a significant influence on the participant's cognitive performance, while different effects on the sample' fitness levels were observed. These findings suggest that the effects of BG on the cognitive performance and fitness level of active older adults are similar to those obtained after the practice of a traditional exercise program. Whether BG is performed in isolation or combined with other exercise programs seems to have no influence on such effects.

The effect of water immersion during exercise on cerebral blood flow.

Regular exercise induces recurrent increases in cerebrovascular perfusion. In peripheral arteries, such episodic increases in perfusion are responsible for improvement in arterial function and health. We examined the hypothesis that exercise during immersion augments cerebral blood flow velocity compared with intensity-matched land-based exercise. Fifteen normotensive participants were recruited (26 ± 4 yr, 24.3 ± 1.9 kg·m). We continuously assessed mean arterial blood pressure, HR, stroke volume, oxygen consumption, and blood flow velocities through the middle and posterior cerebral arteries before, during, and after 20-min bouts of water- and land-based stepping exercise of matched intensity. The order in which the exercise conditions were performed was randomized between subjects. Water-based exercise was performed in 30°C water to the level of the right atrium. The water- and land-based exercise bouts were closely matched for oxygen consumption (13.3 mL·kg·min (95% confidence interval (CI), 12.2-14.6) vs 13.5 mL·kg·min (95% CI, 12.1-14.8), P = 0.89) and HR (95 bpm (95% CI, 90-101) vs 96 bpm (95% CI, 91-102), P = 0.65). Compared with land-based exercise, water-based exercise induced an increase in middle cerebral artery blood flow velocity (74 cm·s (95% CI, 66-81) vs 67 cm·s (95% CI, 60-74) P < 0.001), posterior cerebral artery blood flow velocity (47 cm·s (95% CI, 40-53) vs 43 cm·s (95% CI, 37-49), P < 0.001), mean arterial blood pressure (106 mm Hg (95% CI, 100-111) vs 101 mm Hg (95% CI, 95-106), P < 0.001), and partial pressure of expired CO2 (P ≤ 0.001). Our findings suggest that water-based exercise augments cerebral blood flow, relative to land-based exercise of similar intensity, in healthy humans.

The effects of a brief, water-based exercise intervention on cognitive function in older adults.

Physical inactivity is a modifiable risk factor for accelerated cognitive decline in older adults. Water-based exercise provides the same physiological benefits as land-based exercise with reduced risk of acute injury. The current study evaluated the effects of a brief, water-based exercise intervention on cognitive functioning and cardiovascular fitness in a group of community dwelling older adults. The exercise group (n = 27, M(age) = 63.26 ± 7.64, 78% female) attended one moderate intensity water aerobics class per day for six consecutive days whereas the control group (n = 33, M(age) = 65.67 ± 6.69, 75% female) continued their typical routine. Neuropsychological and cardiovascular fitness tests were given the week before and the week after the intervention to both groups. The exercise group demonstrated significant improvements in cardiovascular fitness, as well as executive function, attention, and memory over controls. This suggests a brief exercise program can provide benefits for older adults.

Exercise for osteoarthritis of the knee.

Exercise for osteoarthritis of the knee.

Physical exercise and weight loss for hip and knee osteoarthritis in very old patients: a systematic review of the literature.

Background : Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient’s age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients.Methods : Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles.Results :We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients.Physical exercise (8 trials): was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation.Aquatic exercise (5 trials): was as effective as land-based exercise.Weight loss (2 trials):only patients under diet + exercise had significant improvement on symptoms.Conclusion : Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70-80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis.

Comparison of the effects of water- and land-based exercises on the physical function and quality of life in community-dwelling elderly people with history of falling: A single-blind, randomized controlled trial

PurposeThe purpose of this study was to identify the effects of water-based exercises on the physical functions and quality of life (QOL) in community-dwelling elderly people with history of falling. Materials and methodsParticipants were randomly assigned to the water-based exercise group (n=34) or land-based exercise groups (n=32). To identify the effects on physical functions, muscle strength, flexibility, and mobility were measured. QOL and fear of falling were evaluated using the Short Form 36-item questionnaire and the modified falls efficacy scale (M-FES). The measurements were performed before and after the 10-week training period. ResultsWithin-group analysis indicated that hip abduction and adduction strength improved significantly in both groups (p=0.005; p=0.007). However, no statistically significant within-group differences were found in the back scratch test (p=0.766) and chair sit-and-reach test (p=0.870). QOL was significantly different in both groups (health transition: p=0.014, physical functioning: p<0.001, role physical: p<0.001, role emotional: p=0.002, bodily pain: p<0.001, vitality: p<0.001, and mental health: p<0.001). There was a significant difference in the M-FES in both groups (p=0.040). ConclusionsThese results indicate that water-based exercises are beneficial to improve the QOL, as well as physical activities, of community-dwelling elderly compared with land-based exercise. Water-based exercises would be useful to improve physical and psychological health in the elderly people with history of falling.