Land-based Intervention Research Articles

Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson's Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention Program.

Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.

Land-Based Intervention: a Qualitative Study of the Knowledge and Practices Associated with One Approach to Mental Health in a Cree Community

This project is a qualitative study of a land-based intervention used in an Indigenous community in northern Ontario. As previous research suggests, a sense of connection to the land is an integral part of Indigenous well-being, and mental health interventions centered around this connection may be more appropriate for use in Indigenous communities than Western treatment approaches that typically emphasize individuality. The present study gains further insight into how a land-based intervention can be applied to an Indigenous community. Interviews with three community members were conducted and summarized in order to understand their views on the background, components, advantages, and challenges of the program. Results showed a focus on strengthening cultural identity, facilitating intergenerational knowledge transfer, and building relationships with others, similar to other land-based programs across Canada. The importance of reconnecting Indigenous youth with their cultural heritage and developing community-centered programs are discussed.

Effect of water- versus land-based exercise training as a component of a multidisciplinary intervention program for overweight and obese adolescents

To compare water- versus land-based exercise programs, as part of a multidisciplinary intervention, on physical fitness and health-related quality of life in overweight and obese adolescents. A total of 151 overweight and obese adolescents (age: 13.2±1.8years) were divided into: 1) a water-based intervention (WB; n=28); 2) a land-based intervention (LB; n=57); and 3) a control group (CG; n=66). Anthropometric measures, body composition, flexibility, abdominal strength/endurance, cardiorespiratory fitness and health-related quality of life were assessed prior and by the end of a 16-week intervention. Both the water- and land-based interventions were part of a multidisciplinary program focusing on behavioral changes. Fat Mass (%) was significantly reduced in both intervention groups and a higher progression was observed in the WB group (−9.8±7.2% versus −6.1±6.2%; p<0.05 for pre-to-post changes within-groups). However, LB increased more abdominal strength than WB (69.6±165.8% versus 53.4±83.4%; p<0.05) and significantly increased social (19.7±88.8%), psychosocial (5.1±15.1%) and total score (6.3±14.8%), which was observed in neither WB nor CG. The intervention groups did not change body weight (WB: −1.7±5.3%; LB: 0.1±3.4%; p>0.05 for both groups) and increased (p<0.05) fat-free mass (WB: 4.6±4.0%; LB: 4.4±4.1%), VO2max (WB: 9.3±7.8%; LB: 11.0±13.4%), and physical dimension of quality of life (WB: 9.2±17.2%; LB: 8.9±18.0%) differently of what was observed in CG. The physical dimension improvement observed in the land-based and water-based samples was associated with decreased percentage fat mass (r=0.282 and 0.229; p<0.05). We suggest water- and land-based physical exercises within a multidisciplinary program promote similar improvements in body composition, physical fitness and health-related quality of life in overweight and obese adolescents.

Combined Effects of Aquatic and Land-Based Rehabilitation in Female Soccer Players Post ACL Reconstruction: An Overview of Current Evidence

A review of the literature was conducted to assess the effects of a combined aquatic and land-based intervention versus the traditional land-based therapy only for female soccer players in rehabilitation post anterior cruciate ligament (ACL) reconstruction. Female soccer players have an increased tendency to experience ACL injuries because of the mechanism of injury as well as internal contributors of the female anatomy. Many protocols for rehabilitation have been released, but few studies have examined the effects of a combined aquatic and land-based program. Aquatic therapy has been shown to have many positive effects, including the allowance for early intervention, but is inconclusive for early re-entry for sport-specific activities. Peer reviewed journal articles and systematic reviews of ACL rehabilitation were initiated via electronic searches of AcademicOneFile, PubMed, PEDro, PTnow, EBSCOHost, Academic Premier, and CINAHL. Four reviewers independently selected the studies, extracted data, and applied quality criteria. Study quality was assessed by the levels of evidence ranking system, and the evidence synthesis ordered them in importance. Five systematic reviews, six randomized control trials, six case-controlled studies, and one literature review were included. All data was used to assess eight ACL rehabilitation components needed to return to sport-specific activities: pain management, ROM, edema control, muscular strength, neuromuscular function, and improved gait patterns. There was evidence to support the combination of aquatic and land-based therapy as a better intervention for achieving the goals of ROM and strength, and also showed evidence of improved edema control and pain management. These improvements have the potential to assist soccer players in returning to sport-specific activities, yet there was no consensus for a specific timeline for early re-entry into those activities. Recommendations for clinical practice are to consider adding early intervention aquatic therapy for earlier re-entry to sport-specific activities in female soccer players post ACL reconstruction as a safe intervention for improved ROM, strength, pain control, and edema control. Further research must be conducted to generalize these findings to a more diverse population, and for a timeline for re-entry to sport-specific activities.

The Effect of Aquatic and Land-Based Training on the Metabolic Cost of Walking and Motor Performance in Children with Cerebral Palsy: A Pilot Study

Aim. To evaluate the effects of aquatic (AQ) compared to a land-based (LB) intervention programs on metabolic cost of walking (MCW), gross motor function and locomotor performance in children with cerebral palsy (CP). Methods. Eleven children with spastic diplegic CP completed this study, six in the AQ (5.2 ± 1.45 yrs) and five in the LB group (4.1 ± 1.33 yrs). MCW derived from Oxygen uptake (VO2) measured with a Cosmed K4 device and walking speed at steady state. Additional measures included the 10-m test, Gross Motor Function Measure (GMFM), and Pediatric Evaluation Developmental Inventory (PEDI). Non-parametric statistics were used to analyze change in each group. Results. The AQ group significantly decreased MCW (Z=−2.2; P&lt;.05) and increased steady state walking speed (Z=−2.2; P&lt;.05). Both groups significantly increased 10-m walking speed (Z=−2.2; P&lt;.03, and Z=−2.02; P&lt;.05, resp.). The LB group exhibited moderate to large effect sizes in 10-m self-selected and fast walking speeds (Cohen's d=1.07 and 0.73, resp.). Conclusion. Our findings suggest that Both AQ and LB programs were effective in improving 10-m speed, while the AQ training also improved the MCW of walking at steady state in children with spastic diplegic CP.

Exercise Intervention Programs for Children and Adolescents with Cerebral Palsy: A Descriptive Review of the Current Research

Objective: A recently published review (2008) on exercise training in chil- dren and adolescents with cerebral palsy (CP) concluded that more evidence is needed from higher quality studies using more common outcomes. The aim of the current paper is to provide an update of that review with the following specific questions: (a) How are recent exercise interventions addressing the varying severity levels of CP? (b) What is the main focus of current exercise interventions? (c) Is there any basis for a meta-analysis of these studies? Design: A systematic search of electronic databases from September 2006 to January 2010 included all types of exercise programs, including land-based and aquatic programs focusing on cardiovascular, strength, aerobic, and anaerobic training. Nineteen studies met the inclusion criteria and were analyzed in a Population/patient, Interven- tion, Control and Outcome (PICO) fashion. Results: Literature published between 2006 and 2010 focused on land-based intervention programs for children and adolescents with less severe CP, Gross Motor Function Classification System (GMFCS) levels I-III. Both the intervention and outcome measures of these studies show extreme heterogeneity, in- dicating that recent calls for common measures have gone unheeded. Further, there has been no noticeable shift in outcome measures from body function towards daily activity and participation. Conclusion: Serious heterogeneity was found across the entire PICO analysis for exercise programs for children and adolescents with CP. The calls for greater generalizability and meaningful performance outcome measures are still highly relevant for the field of exercise rehabilitation in CP.