Effectiveness of Aquatic Exercise in Improving Lower Limb Strength in Musculoskeletal Conditions: A Systematic Review and Meta-Analysis

Global research trends in aquatic exercise therapy for musculoskeletal disorders: a bibliometric analysis

OBJECTIVE

Aquatic exercise therapy has gained recognition as a valuable non-pharmacological intervention for managing musculoskeletal disorders. Despite the growing body of evidence supporting its efficacy, research on aquatic exercise therapy remains fragmented, with limited understanding of key trends, influential studies, and evolving themes within the field. This study aims to conduct a comprehensive bibliometric analysis to identify publication trends, key authors, and the evolution of research themes in aquatic exercise therapy for musculoskeletal disorders.

METHODS

A total of 117 articles were selected based on predefined search terms and inclusion criteria, resulting in 3,985 citations, with an average of 35.9 citations per article and an H-index of 37.

RESULTS

Publications surged between 2013 and 2024, accounting for 88.3% of total output. Peaks occurred in 2019 (n = 14) and 2022 (n = 368 citations). Key contributors include Mariana Arias Avila and Basia Belza, with journals such as BMC Musculoskeletal Disorders and Arthritis & Rheumatism-Arthritis Care & Research playing pivotal roles. Research trends shifted from disease-specific studies to broader quality-of-life outcomes, with keywords such as "rheumatoid arthritis", "balneotherapy", and "quality of life" emerging as focal points.

CONCLUSION

The findings underscore the growing importance of aquatic exercise therapy in clinical rehabilitation and suggest that future research should focus on long-term outcomes, underrepresented populations, and the integration of aquatic exercise therapy with emerging rehabilitation technologies.

Effects of aquatic high-intensity interval training on aerobic capacity in adults with rheumatic and musculoskeletal diseases: the AquaHigh randomised controlled trial

OBJECTIVES

To examine the effects of 12 weeks aquatic high-intensity interval training (AHIIT) compared with aquatic moderate-intensity continuous training (AMICT) on aerobic capacity and lower limb functional strength in adults with rheumatic and musculoskeletal diseases (RMDs).

DESIGN

An assessor-blinded randomised controlled trial.

SETTING

Community-based setting.

PARTICIPANTS

89 participants (91% female, mean age 62 (SD 13) years) with RMDs were randomly allocated to AHIIT (n=44) or AMICT (n=45).

INTERVENTIONS

Both groups participated in group-based peer-led exercise programmes two times per week for 12 weeks. The AHIIT group included four intervals of 4 min at high intensity (Borg scale 14-18). The AMICT group maintained moderate continuous intensity level (Borg scale 12-13).

MAIN OUTCOME MEASURES

Peak aerobic capacity (VO2peak) was estimated by time to exhaustion and lower limb functional strength with the 30-second sit-to-stand test (30sSTS) at baseline, 3 months and 6 months. A linear mixed model for repeated measures estimated the mean difference with 95% CI in VO2peak and 30sSTS.

RESULTS

Mean exercise intensity was Borg scale 15 (SD 2) and 13 (SD 2) in the AHIIT and AMICT, respectively. Mean improvement in VO2peak in AHIIT was 1.9 mL∙kg-1∙min-1 (95% CI 0.045 to 3.77) compared with AMICT after 12 weeks (p<0.05). There was no statistically significant difference between groups in VO2peak after 6 months or in 30sSTS at either 3 or 6 months (p>0.05). No adverse events during exercise were reported.

CONCLUSIONS

AHIIT demonstrated significant improvements in aerobic capacity after 12 weeks, and the intervention was well tolerated with no adverse events reported. However, there was no maintenance of aerobic capacity at 6 months.

TRIAL REGISTRATION NUMBER

NCT05209802.

Effects of aquatic exercise compared with land-based exercise on the body composition and function of older adults with sarcopenia: protocol for a randomised controlled trial

INTRODUCTION

Sarcopenia is a condition that occurs more frequently in older adults. Although many types of exercise have been used in the treatment of sarcopenia, few studies have been conducted on different interventional environments for sarcopenia. The purpose of this study is to investigate the effects of aquatic exercise and land-based exercise on the body composition and function of participants with sarcopenia.

METHODS AND ANALYSIS

This randomised, controlled, single-blinded trial will enrol 45 participants (≥ 65 years) following the diagnostic criteria set by the Asian Working Group for Sarcopenia 2019. Participants will be randomised and assigned to one of three groups (aquatic exercise group, land-based exercise group and control group). Assessments will be conducted four times: initially (before intervention), after 8 weeks (intermediate), after 16 weeks (final) and 16 weeks after the end of intervention (follow-up). The primary outcomes are appendicular skeletal muscle index and handgrip strength, while the secondary outcomes include the Short Physical Performance Battery, 6-minute walk test and the Chinese version of the 36-item short-form of health-related quality of life.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of Chengdu Sport University, with permission number CDSUEC2023-125. This study has been registered with the Chinese Clinical Trial Registry (ChiCTR2300077457). All participants will provide written informed consent.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry ChiCTR2300077457.

Effects of Aquatic Exercise in Older People with Osteoarthritis: Systematic Review of Randomized Controlled Trials

Objective: In this study, the objective is to analyze the efficacy of different aquatic physical exercise programs in the treatment of osteoarthritis in older people. Material and Methods: The systematic review was conducted until April 2024 and updated in November 2024 in five electronic databases. Randomized controlled studies in people over 60 years of age with a diagnosis of osteoarthritis were included. Water-based exercise interventions were assessed for their impact on osteoarthritis symptoms, walking ability, muscle strength, depressive symptoms, range of motion, body composition, fear of falling, fall risk, quality of life, range of motion, and dual task function. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database. Results: A total of 12 studies were included, with sample sizes ranging from 35 to 312 participants. The presence of osteoarthritis in the sample was manifested in different joints. The methodological quality of the included studies varied from fair to good. Based on the results of this review, aquatic exercise significantly improved balance, stiffness, pain, and walking ability compared to non-exercise controls (p < 0.05). Compared with land-based exercise groups, only one study found significant differences between the two groups. Conclusions: Water-based exercise programs do not provide significantly superior benefits compared to other exercise modalities and appear to have limited effectiveness in the management of OA. However, the feasibility and high adherence make these programs a recommendable option for older people with OA. Future studies should investigate the impact of exercise intensity on the short- and long-term efficacy of aquatic therapy.

The effects of open/closed kinetic chain exercises in water on the electrical activity of selected lumbar muscles, lumbopelvic control, ground reaction force and psychological factors in men with chronic non-specific low back pain: A study protocol for a randomized clinical trial

BACKGROUND AND AIM

Research has documented chronic non-specific low back pain (CNSLBP) as one of the primary causes of absenteeism at work, often accompanied by the use of health insurance and healthcare services. Considering little research on the consequences of open/closed kinetic chain (O/CKC) exercises in water on CNSLBP improvement, the present study is to investigate the effects of such interventions on the electrical activity of selected lumbar muscles, pain, lumbopelvic control (LPC), ground reaction force (GRF), and psychological factors in men with CNSLBP.

MATERIALS AND METHODS

This is a randomized controlled trial that involves individuals with CNSLBP between the ages of 40 and 60 years. Participants are randomly assigned, using block randomization, to one of the following groups: open kinetic chain (OKC) exercises, closed kinetic chain (CKC) exercises, or controls. The training groups engage in the exercises for eight weeks, with three sessions per week and 60 min each at the University of Bu-Ali Sina pool, following the prescribed workout routine. The primary outcomes of the electrical activity of the multifidus (MF), transversus abdominis (TrA), gluteus medius (GM), and quadratus lumborum (QL) muscles are measured by an electromyography (EMG) device. Additionally, the pressure biofeedback (BFB) device and the visual analog scale (VAS) are utilized to assess LPC and pain intensity, respectively. The secondary outcomes of the GRF, along with foot pressure and kinesiophobia, are subsequently measured by the Tampa Scale of Kinesiophobia (TSK).

CONCLUSION

By comparing the outcomes between the OKC exercise group, CKC exercise group, and control group, this study aims to determine the differential effects of these two water-based exercise interventions on the various physical and psychological parameters in individuals with CNSLBP. The findings provide valuable insights into the most effective approach to water-based rehabilitation for individuals with CNSLBP. By comparing the outcomes of OKC and CKC exercises, healthcare professionals can make informed decisions when designing tailored rehabilitation programs for this patient population. The results also contribute to the development of evidence-based guidelines for the management of CNSLBP using water-based exercises.

Efficacy of aquatic exercise in chronic musculoskeletal disorders: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Aquatic exercise (AE) is becoming ever more popular as a physical therapy, while it is unclear what precise improvements it will produce and how effective it will be in comparison with other non-surgical therapies. The study aimed to assess whether AE positively impacts chronic musculoskeletal disorder patients in terms of pain, physical function, and quality of life.

METHODS

PRISMA guidelines were followed, and our study protocol was published online at PROSPERO under registration number CRD42023417411. We searched PubMed, Embase, Web of Science, and Cochrane library databases for English-language articles published before April 11, 2023, including studies from all relevant randomized controlled trials (RCTs). After screening, we ultimately included 32 RCTs with a total of 2,200 participants. We also performed subgroup analyses for all included studies. This meta-analysis calculated standardized mean difference (SMD) with 95% confidence interval (CI), and the variance was estimated using a random-effects model. The quality of the included studies was assessed by using the Cochrane collaborative "risk of bias" assessment tool (version 2.0). Thus ensuring that the literature included is of high quality.

RESULTS

This meta-analysis included 32 trials with 2,200 participants; these patients were all between the ages of 38-80. The study showed that compared to the no exercise (NE) group, patients in the AE group experienced a remarkable reduction in pain (SMD: -0.64, P < 0.001), a significant increase in physical function (SMD: 0.62, P < 0.001), and a statistically significant improvement in quality of life (SMD: -0.64, P < 0.001). When compared to land-based exercise (LE), AE significantly relieves patients' pain (SMD: -0.35, P = 0.03).

CONCLUSIONS

This is the first systematic review and meta-analysis to study whether AE could improve chronic musculoskeletal disorders. The evidence suggests that AE benefits pain, physical function, and quality of life in adults with chronic musculoskeletal conditions compared to NE. Furthermore, when compared to LE, AE continues to provide a better improvement in patient pain. More long-term clinical trials are needed to confirm AE's positive effects and improvement mechanisms and the more existential advantages compared to LE.

Aquatic high-intensity interval training (HIIT) may be similarly effective to land-based HIIT in improving exercise capacity in people with chronic conditions: a systematic review and meta-analysis

Objective

To investigate the effect of aquatic high-intensity interval training (AHIIT) on exercise capacity in people with chronic conditions.

Design

Systematic review and meta-analysis.

Participants

Adults (age ≥18 years) with any chronic conditions (long duration, continuing health problems).

Data sources

The databases Medline, EMBASE, CINAHL, SPORTSDiscus, PEDro and The Cochrane Library were searched from inception to 11 August 2023.

Eligibility criteria

Randomised or non-randomised controlled trials of adults reporting one or more chronic conditions were included, comparing the effect of AHIIT with a non-exercising control group, land-based high-intensity interval training (LBHIIT) or aquatic moderate-intensity continuous training (AMICT).

Results

Eighteen trials with 868 participants with chronic musculoskeletal, respiratory, cardiovascular, metabolic or neurological conditions were included. Adherence to AHIIT was high, ranging from 84% to 100%. There was moderate certainty in evidence according to the Grading of Recommendations Assessment, Development and Evaluation system for a moderate beneficial effect on exercise capacity standardised mean differences (SMD) 0.78 (95% CI 0.48 to 1.08), p<0.00001) of AHIIT compared with a non-exercising control group. There was moderate certainty in evidence for no difference of effects on exercise capacity (SMD 0.28 (95% CI -0.04 to 0.60), p=0.08) of AHIIT compared with LBHIIT. There was moderate certainty in evidence for small effect on exercise capacity (SMD 0.45 (95% CI 0.10 to 0.80), p=0.01) of AHIIT compared with AMICT.

Conclusion

There are beneficial effects of AHIIT on exercise capacity in people with a range of chronic conditions. AHIIT has similar effects on exercise capacity as LBHIIT and may represent an alternative for people unable to perform LBHIIT.

PROSPERO registration number

CRD42022289001.

Aquatic Dual-Task Training and Its Relation to Motor Functions, Activities of Daily Living, and Quality of Life of Individuals With Parkinson's Disease: A Randomized Clinical Trial

Objectives

Parkinson's disease (PD) is a neurodegenerative disorder that impacts the dopaminergic neurons of the substantia nigra, leading to motor and non-motor symptoms, as well as changes in activities of daily living (ADL) and quality of life (QoL). Aquatic physical exercises and dual-task physical exercises have been used to manage PD symptoms. The aim of this study was to investigate the effects of a dual-task aquatic exercise program on the ADL, motor symptoms, and QoL of individuals with PD.

Methods

A randomized controlled trial with a parallel group design was employed, and participants were randomized into 2 groups: a control group and an experimental group. The intervention was a 10-week program consisting of twice-weekly 40-minute aquatic dual-task exercises. Pre-intervention evaluations of ADL, motor function, and QoL were conducted at baseline (AS1), immediately after the intervention (AS2), and 3 months post-intervention (follow-up-AS3). The Unified Parkinson's Disease Rating Scale (UPDRS) II and III sections and the Parkinson's Disease Questionnaire 39 (PDQ-39) were utilized for outcome measures.

Results

A total of 25 individuals completed the study. The experimental group showed significant improvements in both the UPDRS II (ADL) and III (motor function) sections (P's < .05), but there was no significant difference in PDQ-39 scores. Additionally, significant differences were observed in the experimental group between the AS2 and AS3 time periods (P < .05) for both UPDRS II and III scores (P < .05).

Conclusions

Aquatic dual-task training may be effective in improving both ADL and motor functions in individuals with PD. Furthermore, the combination of aquatic environment and dual-task exercises may represent a promising approach to maintaining and improving the functionality of individuals with PD.

Video-driven simulation of lower limb mechanical loading during aquatic exercises

Understanding the mechanical demands of an exercise on the musculoskeletal system is crucial to prescribe effective training or therapeutic interventions. Yet, that knowledge is currently limited in water, mostly because of the difficulty in evaluating external resistance. Here I reconcile recent advances in 3D markerless pose and mesh estimation, biomechanical simulations, and hydrodynamic modeling, to predict lower limb mechanical loading during aquatic exercises. Simulations are driven exclusively from a single video. Fluid forces were estimated within 12.5±4.1% of the peak forces determined through computational fluid dynamics analyses, at a speed three orders of magnitude greater. In silico hip and knee resultant joint forces agreed reasonably well with in vivo instrumented implant recordings (R²=0.74) downloaded from the OrthoLoad database, both in magnitude (RMSE =251±125 N) and direction (cosine similarity = 0.92±0.09). Hip flexors, glutes, adductors, and hamstrings were the main contributors to hip joint compressive forces (40.4±12.7%, 25.6±9.7%, 14.2±4.8%, 13.0±8.2%, respectively), while knee compressive forces were mostly produced by the gastrocnemius (39.1±15.9%) and vasti (29.4±13.7%). Unlike dry-land locomotion, non-hip- and non-knee-spanning muscles provided little to no offloading effect via dynamic coupling. This noninvasive method has the potential to standardize the reporting of exercise intensity, inform the design of rehabilitation protocols and improve their reproducibility.

Lower Limb Muscles' Activation during Ascending and Descending a Single Step-Up Movement: Comparison between In water and On land Exercise at Different Step Cadences in Young Injury-Free Adults

(1) Background: Forward step-up (FSU) simulates the stance phase in stair ascension. With the benefits of physical properties of water, aquatic FSU exercise may be more suitable for patients with lower limb weakness or pain. The purpose of this study is to investigate the effect of progressive steps per min on the surface electromyography (sEMG) of gluteus maximus (GM), biceps femoris (BF), rectus femoris (RF), and gastrocnemius (GA), when performing FSU exercise with different steps per min in water and on land. (2) Methods: Participants (N = 20) were instructed to perform FSU exercises at different steps per min (35, 60, and 95 bpm) in water and on land. The sEMG of the tested muscles were collected. The percentage maximum voluntary isometric contraction (%MVIC) of GM, RF, GA and BF at different environments and steps per min was compared. (3) Result: There was a statistically significant difference of %MVIC of RF at all steps per min comparisons regardless of the movement phases and environments (p < 0.01, except for descending phases of 35 bpm vs. 60 bpm). All tested muscles showed a statistically significant lower muscle activation in water (p < 0.05) (4) Conclusion: This study found that the %MVIC of the tested muscle in both investigated environments increase as steps per minute increases. It is also found that the movement pattern of FSU exercise activates RF the most among all the tested muscles. Muscle activation of all tested muscles is also found to be smaller in water due to buoyancy property of water. Aquatic FSU exercise might be applicable to patients with lower limb weakness or knee osteoarthritis to improve their lower limb strength.

Effects of Aquatic versus Land High-Intensity Interval Training on Acute Cardiometabolic and Perceptive Responses in Healthy Young Women

The effects of aquatic high-intensity interval training (AHIIT) on cardiometabolic and perceptive responses when compared to similar land-based exercise (LHIIT) remain unknown. Here, we aimed to (1) establish a matched intensity between mediums and (2) compare the acute cardiometabolic and perceptive responses to the two interventions in healthy young women. Twenty healthy young women performed a stationary running exercise at a matched exercise intensity. The incremental stages, in terms of percentage of heart rate (HR), maximal oxygen uptake (%VO₂max), percentage of oxygen uptake reserve (%VO₂R), percentage of heart rate reserve (%HRR), and rate of perceived exertion (RPE), were examined and acute cardiometabolic and perceptive responses were evaluated. The results showed that HR was significantly reduced (AHIIT: W 150 ± 19, R 140 ± 18, LHIIT: W 167 ± 16, R 158 ± 16 p < 0.01) and oxygen pulse (AHIIT: W 12 ± 2, R 10 ± 2, LHIIT: W 11 ± 2, R 9 ± 2 p < 0.05) was significantly increased with AHIIT compared to LHIIT. No significant group differences were observed for the perceptive responses. The comparable results demonstrated by the aquatic and land incremental tests allow precise AHIIT and LHIIT prescriptions. AHIIT had distinct differences in HR and oxygen pulse, despite having no distinct difference from LHIIT for some cardiometabolic and affective responses.

Measurements on the external load acting on aquatic resistance fins during flexion/extension movements using a robotic joint

Aquatic resistance training has been proven to be beneficial to many people, in particular those struggling with degenerative joint diseases or recovering from other musculoskeletal issues as the reaction forces acting on the joints become lower, but without compromising the cardiovascular and neuromuscular benefit of the movement. Little has been written on the load produced by or measurements of the devices used in aquatic resistance training. Therefore, uncertainties exist regarding details of how much load can be applied onto the foot when performing the movements and how to quantify progression. In this study, an instrumented robotic arm was designed, built, and used to measure the load acting on the three different types of fins during a simulated flexion/extension movement of a knee. The angular velocities of the knee ranged from 25°/s to 150°/s, which represent the physiological range of in vivo movements. The results demonstrated that the load followed a second-order polynomial with the angular velocities. The load is therefore a function of the angular velocity, the surface area of the fins, and the location of the fins away from the joint center rotation. We modeled the progression of speeds at maximal voluntary movements based on previous studies. The maximum loads measured between 11 kg and 13 kg in extension and 6 kg and 9 kg in flexion at 150°/s rotational velocity.

Effect of aquatic resistance interval training and dietary education program on physical and psychological health in older women: Randomized controlled trial

Due to demographic changes, the world’s population is progressively aging. The physiological deterioration of the older adult may lead to reduced balance capacity and increased risk of falls, among others, due to the prevalence of degenerative diseases. Physical exercise can be effective in reducing the risk of disease and slowing functional decline in older people. The aim of the research is to test the effects of aquatic resistance training and dietary education on health indicators, strength, balance, functional autonomy, perception of satisfaction with life. Thirty-four participants aged 69 ± 4 years were randomly assigned into two groups: experimental (aquatic resistance interval training) and control group (no intervention). The intervention consisted of resistance training in an aquatic environment carried out for 14 weeks (three sessions per week: 60 min each). All variables were analyzed twice; pre - post intervention. Aquatic resistance training has positive effects on strength (p &lt; 0.001), functional self-sufficiency (p &lt; 0.001) and aerobic capacity (p &lt; 0.001), however, no significant differences were observed in the perception of satisfaction with life and balance. Research results suggest that older women who engage in regular, scheduled aquatic resistance training have greater autonomy in performing activities of daily living, agility, gait control, and body composition variables (lower fat compartment and greater muscle mass).

What web-based information is available for people with Parkinson's disease interested in aquatic physiotherapy? A social listening study

Background

Aquatic physiotherapy is becoming a more frequently utilised treatment for people with Parkinson’s Disease (PD). Consumers are increasingly accessing information regarding health choices online, and it is not known what type or quality of information regarding aquatic physiotherapy is available.

Methods

Web-based platforms (Facebook™, Twitter™, YouTube™, Instagram™, blogs and the web) were searched using the Awario© social listening software. Webpages had to be in English, mention PD, aquatic physiotherapy and its effects. Quality of webpages was assessed using a modified DISCERN tool and content analysis summarised reported effects.

Results

Awario© identified 2992 entries, with 133 assessed using the modified DISCERN tool. A small number (n = 31, 24%) described the effects of aquatic physiotherapy for people with PD. Quality of webpages was low, with many lacking information regarding clear sources of information, contraindications to aquatic physiotherapy and descriptions of the therapeutic environment. Content analysis showed several themes; general physical, PD-specific and psychosocial effects. More than a third of webpages indicated that aquatic physiotherapy would improve strength, balance, pain and aid relaxation. A large number (n = 96, 72%) described at least one hydrodynamic or hydrostatic property of water, most commonly buoyancy (n-83, 62%).

Conclusions

Overall quality of information was poor, and it is recommended that webpages list all potential contraindications to aquatic physiotherapy and direct consumers to discuss potential participation with their healthcare professionals. Webpages also should include information regarding the therapeutic environment, disclose sources of information and focus on enablers to exercise to improve engagement of people with PD in aquatic physiotherapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02669-3.

The effect of aquatic High Intensity Interval Training on cardiometabolic and physical health markers in women: A systematic review and meta-analysis

BACKGROUND

We performed a meta-analysis of randomized controlled trials (RCTs) assessing the effect of Aquatic High Intensity Interval Training (AHIIT) on cardiometabolic and physical health markers in women.

METHODS

Systematic search used 7 databases (MEDLINE, PubMed, SPORTDiscus, Cochrane, Embase, CINAL complete, PsycINFO). The Physiotherapy Evidence Database (PEDro) score was used to evaluate the methodological quality of the studies. Clinical trials compared AHIIT with a control group that receive no exercise training. We integrated randomized controlled trials published in English, and participants were women aged ≥18 years. The outcome of interest was the change in cardiometabolic and physical health markers.

RESULTS

Among 242 articles screened, 18 articles (13 trials) were included in this meta-analysis comparing AHIIT (n = 261) with a control group (n = 215). The median PEDro score was 5.5 out of 10 (range, 4-8). AHIIT significantly improved peak oxygen uptake (Hedges' g 0.610; 95% CI 0.277-0.943; P < 0.001), reduced resting heart rate (Hedges' g -0.495; 95% CI -0.866 to -0.124; P < 0.05), as well as chair to stand test. (Hedges' g 0.548; 95% CI 0.019 to 1.077; P < 0.05).

CONCLUSION

AHIIT has a moderate effect in improving cardiometabolic and physical health markers in women.

Effects of Bathing in a Tub on Physical and Psychological Symptoms of End-of-Life Cancer Patients: An Observational, Controlled Study

This observational, controlled study explored the effects of bathing on the physical and psychological aspects of terminal cancer patients on a palliative care ward. With nurses' assistance, the patients evaluated and recorded the severity of their symptoms at 10:00 am, 30 minutes after initial bathing, and at 5:00 pm. The bathing care was provided as routine care according to the patients' wishes. Twelve symptoms were measured using 9 items (numbers 1-9) from the Edmonton Symptom Assessment System-Revised Japanese version and 3 items from the Cancer Fatigue Scale. Outcomes were compared between bathing days and nonbathing days (control) and between before and after bathing. Of the 57 bathers, data were available for both bathing days and nonbathing days for 42 bathers. In the comparison between bathing and nonbathing days, tiredness was significantly improved (effect size [ES], 0.35; P = .02). On the basis of the pre-post bathing comparison, 6 symptoms, namely, tiredness (ES, 0.40; P < .01), lack of appetite (ES, 0.36; P = .01), decreased well-being (ES, 0.33; P = .01), anxiety (ES, 0.36; P = .01), pain (ES, 0.31; P = .02), and depression (ES, 0.30; P = .02), were significantly improved. Bathing in a tub effectively improves tiredness and might be effective for distressing symptoms in end-of-life cancer patients.

Accelerometer-based prediction of ground reaction force in head-out water exercise with different exercise intensity countermovement jump

Background

Water jumping exercise is an alternative method to achieve maintenance of bone health and reduce exercise injuries. Clarifying the ground reaction force (GRF) of moderate and high cardiopulmonary exercise intensities for jumping movements can help quantify the impact force during different exercise intensities. Accelerometers have been explored for measuring skeletal mechanical loading by estimating the GRFs. Predictive regression equations for GRF using ACC on land have already been developed and performed outside laboratory settings, whereas a predictive regression equation for GRF in water exercises is not yet established. The purpose of this study was to determine the best accelerometer wear-position for three exercise intensities and develop and validate the ground reaction force (GRF) prediction equation.

Methods

Twelve healthy women (23.6 ± 1.83 years, 158.2 ± 5.33 cm, 53.1 ± 7.50 kg) were recruited as participants. Triaxial accelerometers were affixed 3 cm above the medial malleolus of the tibia, fifth lumbar vertebra, and seventh cervical vertebra (C7). The countermovement jump (CMJ) cadence started at 80 beats/min and increased by 5 beats per 20 s to reach 50%, 65%, and 80% heart rate reserves, and then participants jumped five more times. One-way repeated analysis of variance was used to determine acceleration differences among wear-positions and exercise intensities. Pearson’s correlation was used to determine the correlation between the acceleration and GRF per body weight on land (GRF_VL_BW). Backward regression analysis was used to generate GRF_VL_BW prediction equations from full models with C7 acceleration (C7 ACC), age, percentage of water deep divided by body height (PWDH), and bodyweight as predictors. Paired t-test was used to determine GRF_VL_BW differences between values from the prediction equation and force plate measurement during validation. Lin’s CCC and Bland–Altman plots were used to determine the agreement between the predicted and force plate-measured GRF_VL_BW.

Results

The raw full profile data for the resultant acceleration showed that the acceleration curve of C7 was similar to that of GRFv. The predicted formula was − 1.712 + 0.658 * C7ACC + 0.016 * PWDH + 0.008 * age + 0.003*weight. Lin’s CCC score was 0.7453, with bias of 0.369%.

Conclusion

The resultant acceleration measured at C7 was identified as the valid estimated GRF_VL_BW during CMJ in water.

Combination Therapy of Physical Activity and Dexamethasone for Cancer-Related Fatigue: A Phase II Randomized Double-Blind Controlled Trial

BACKGROUND

Despite the high frequency of cancer-related fatigue (CRF) and its debilitating effects on the quality of life of patients with advanced cancer, there are limited treatment options available. Treatments including physical activity (PA) or dexamethasone (Dex) improve CRF; however, they have lower adherence rates (PA) or long-term adverse effects (Dex). The aim of this study was to determine the feasibility of and preliminary results for the combination of PA and Dex in improving CRF.

METHODS

In this phase II randomized controlled trial, patients with advanced cancer and CRF scores of ≥4/10 on the Edmonton Symptom Assessment Scale were eligible. Patients were randomized to standardized PA for 4 weeks with either 4 mg of Dex (LoDex arm) or 8 mg of Dex (HiDex arm) twice a day for 7 days. Feasibility and change in the Functional Assessment of Cancer Illness Therapy-Fatigue subscale (FACIT-F) from baseline to day 8 and day 29 (primary outcome) were assessed. Secondary outcomes included changes in fatigue dimensions (FACIT-General, Patient-Reported Outcomes Measurement Information System [PROMIS]-Fatigue).

RESULTS

A total of 60 of 67 (90%) patients were evaluable. All patients were adherent to study medication. We found that 84% and 65% of patients in the LoDex arm and 96% and 68% of patients in the HiDex arm were adherent to aerobic and resistance exercise, respectively. The FACIT-F effect size in the LoDex arm was 0.90 (P<.001) and 0.92 (P<.001) and the effect size in the HiDex arm was 0.86 and 1.03 (P<.001 for both) at days 8 and 29, respectively. We found significant improvements in the Functional Assessment of Cancer Therapy-Physical (P≤.013) and the PROMIS-Fatigue (P≤.003) at days 8 and 29 in both arms. Mixed-model analysis showed a significant improvement in the FACIT-F scores at day 8 (P<.001), day 15 (P<.001), and day 29 (P=.002). Changes in the FACIT-F scores were not significantly different between patients in the 2 arms (P=.86).

CONCLUSIONS

Our study found that the combination therapy of PA with Dex was feasible and resulted in the improvement of CRF. The improvement was seen for up to 3 weeks after the discontinuation of Dex. Further larger studies are justified.

CLINICALTRIALS

gov identifier: NCT02491632.

Improving functional and motor capacity through means/resources and methods specific to acvatic activities

Introduction. Exercise programs in the aquatic environment have as their main objective the improvement and maintenance of physical capacity/ capability, these being in continuous development and diversification. Water exercise amplifies the effects of general physical exercise, by allowing a more precise control over the movement of each body segment and of the body as a whole. The aquatic environment offers a number of beneficial effects compared to ones offered by the terrestrial environment. The benefits obtained through the aquatic activities are fundamental and are reflected throughout the entire body including both motor, functional and aesthetic level. Material and method. The objective of this study is represented by the identification of new forms of physical exercise that will increase the motor’s capacity. In order to achieve this goal, several methodological requirements were met, such as: successive engagement of the joints and muscle groups in effort (starting with the neck’s muscles, shoulders, arms, torso and legs, simultaneously with scapular-humeral joints, spine and coxo-femoral joints and legs), the gradually usage of exercises, starting with the most basic and then increasing the complexity of the exercises, the usage of the accessible exercises in the beginning of the training, executed with high amplitude and reduced speed, focusing on the correctness of the execution, the selection and the adequate/ appropriately usage of the initial positions according to the subject’s particularities and the shape/form of the exercise, the optimal control of the effort, achieved through a number of iterations, optimal execution time and breaks, the sets of general physical exercises will consist of sets of 8-12 exercises/reps, the principle of symmetry in the execution of the exercises has to be respected, the continuity of practicing a set of exercises for 6 to 8 consecutive lessons, the recommended work method is fragmented-imitative, efficiently combining the explication with the demonstration, the number of repetitions and the movement’s correction. Results and discussions. Analyzing results obtained after the evaluation, we have noticed significant growth in the functional and motor capacities. Conclusions. The systematization of water activities on objective criteria effectively contributes to their knowledge, while allowing them to be included in the spectrum of recreational, sporting, relaxing or therapeutic activities. Keywords: acvatic activities, physical exercise, evaluations,

The Effectiveness of Aquatic Plyometric Training in Improving Strength, Jumping, and Sprinting: A Systematic Review

CONTEXT

Aquatic plyometric training may provide benefits due to reduced joint loading compared with land plyometric training; however, the reduced loading may also limit performance gains.

OBJECTIVE

To systematically review the effect of aquatic plyometric training on strength, performance outcomes, soreness, and adverse events in healthy individuals.

EVIDENCE ACQUISITION

Five databases were searched from inception to June 2020. Quality assessment and data extraction were independently completed by 2 investigators. When similar outcome measures were used, standardized mean differences were calculated.

EVIDENCE SYNTHESIS

A total of 19 randomized controlled trials with 633 participants (mean age, range 14-30 y) were included. Aquatic plyometric training was most commonly performed in waist to chest deep water (12/19 studies), 2 to 3 times per week for 6 to 12 weeks (18/19 studies), with final program foot contacts ranging from 120 to 550. Meta-analyses were not completed due to the clinical and statistical heterogeneity between studies. Compared with land plyometric training, aquatic plyometric training exercises and dosage were replicated (15/16 studies) and showed typically similar performance gains (3/4 knee extensor strength measures, 2/4 leg extensor strength measures, 3/4 knee flexor strength measures, 7/10 vertical jump measures, 3/3 sprint measures). In total, 2 of 3 studies monitoring muscle soreness reported significantly less soreness following training in water compared with on land. Compared with no active training (no exercise control group or passive stretching), most effect sizes demonstrated a mean improvement favoring aquatic plyometric training (23/32 measures). However, these were not significant for the majority of studies measuring isokinetic knee strength, vertical jump, and sprinting. The effect sizes for both studies assessing leg press strength indicated that aquatic plyometric training is significantly more effective than no training.

CONCLUSION

Aquatic plyometric training appears similarly effective to land plyometric exercise for improving strength, jumping, and sprinting and may be indicated when joint impact loading needs to be minimized. However, the low quality of studies limits the strength of the conclusions.

Systematic review of aquatic physical exercise programs on functional fitness in older adults

The practice of physical exercise is recommended in the prevention of the deterioration of neuromuscular functions in aging. The objectives of this systematic review were to describe the protocols used and the functional fitness indicators evaluated in aquatic exercise programs in adults aged 50 to 80 years. The Pubmed database was used. The keywords were: 1) Physical exercise program or protocols or duration or type of exercise or aquatic exercise, frequency or intensity or indicators; 2) Adults or older adults; 3) Training or indicators, functional fitness, physical fitness. The search strategy considered the components of the Population, Interventions, Comparators, Outcomes, and Study design (PICOS) tool. Nine experimental studies were identified. These studies developed protocols to improve functional fitness in adults aged 50 to 80 years. They were based on sessions of 2 to 5 per week, the work time per session was 30 to 60min, intensities varied between 50 to 95% and totaled between 4 to 24 weeks of intervention. The activities were based on aquatic gymnastic exercises aimed at muscular strengthening of the upper and lower extremities, as well as coordination, balance, agility, cycling and walking exercises submerged in water. The protocols developed to improve functional fitness in adults aged 50 to 80 years were based on general physical exercise prescription guidelines (frequency, duration, intensity and type of activity). The application of aquatic exercises based on gymnastic exercises can provoke positive responses on functional fitness if worked at least 2 to 5 times per week, 30 to 60min/day and at intensities of 50 to 95%. These systematized indicators can be used by professionals working with adults to create and promote aquatic programs to improve functional fitness.

Effect of Aquatic Exercise on Sleep Efficiency of Adults With Chronic Musculoskeletal Pain

BACKGROUND

Aerobic exercise improves sleep for people who have difficulty in sleeping soundly, but most research to date has focused on land-based exercise. There has been only very limited research into the effect of aquatic exercise on people with chronic musculoskeletal (MSK) pain. The purpose of this study is to examine the effect of a 6-week aquatic exercise program on sleep efficiency among adults with chronic MSK pain.

METHODS

A total of 30 adults with chronic MSK pain were recruited by convenience sampling and assigned into intervention and control groups by a trained research assistant. Their sleep efficiency, sleep quality, activity level, stress level, and pain level were measured with ActiGraph GT3X accelerometer before and after the intervention group completed a 6-week, biweekly program of aquatic exercise.

RESULTS

Following intervention, the intervention group had significantly longer total true sleep time (by 27.6 min, P = .006); greater sleep efficiency (+3.01%, P = .005); and less pain (-1.33/10, P = .026). The control group had significantly shorter total true sleep time by 5.8 minutes (P = .036) while changes in the other outcomes were not significant.

CONCLUSIONS

Six weeks of moderate-intensity aquatic exercise may improve sleep efficiency and reduce pain for persons suffering chronic MSK pain.

Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

We sought to synthesize the evidence about aerobic exercise intervention during pulmonary rehabilitation, and to further explore the difference in rehabilitation effects between water and land-based aerobic exercise. This review's purpose is to provide a basis by which practitioners and therapists can select and create appropriate therapeutic programs.

METHODS

Data of randomized and quasi-randomized controlled trials comparing training group (TG, aerobic exercise in water or land) and control group (CG, usual care) in chronic obstructive pulmonary disease (COPD) patients (January 1, 2000-December 28, 2019) were obtained from the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases. Two researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. Review Manager software (Rev Man 5.3; Cochrane, London, UK) was used for meta-analysis. The rehabilitation effect of water- or land based aerobic exercise was evaluated by subgroup analysis. The proposed systematic review details were registered in PROSPERO (CRD 42020168331).

RESULTS

Eighteen studies (1311 cases of COPD) were included. Meta-analysis results show that compared with the control group, the dyspnea level and functional and endurance exercise capacity in COPD patients were significantly improved after aerobic exercise (P < .05), but there was no significant change in lung function (P > .05). Compared with land-based aerobic exercise, water-based aerobic exercise significantly improved the endurance exercise capacity in COPD patients (mean difference [MD]: 270.18, 95% CI: 74.61-465.75).

CONCLUSION

Medium to high-quality evidence shows that aerobic exercise can effectively improve dyspnea and exercise capacity in COPD patients. Compared with land-based aerobic exercise, water-based aerobic exercise had a significant additional effect in improving the endurance exercise capacity of COPD patients.

Is Aquatic Therapy Optimally Prescribed for Parkinson's Disease? A Systematic Review and Meta-Analysis

BACKGROUND

Aquatic therapy offers an alternative physiotherapy approach to managing the motor and non-motor symptoms associated with Parkinson's disease (PD).

OBJECTIVE

This review examined exercise prescription for aquatic therapy in PD and evaluated if aquatic therapy is as effective as land-based physiotherapy for improving movement, disability and wellbeing in people living with PD.

METHODS

A systematic search of eight databases was conducted to identify suitable randomized controlled trials from inception until August 2019. Aquatic therapy prescription data and outcomes of interest included gait, balance, motor disability, mobility, falls, mood, cognitive function and health related quality of life data was extracted and synthesised. A meta-analysis was performed where appropriate.

RESULTS

Fourteen studies involving 472 participants (Hoehn & Yahr scale I-IV) met the inclusion criteria. Eight were of modest quality, scoring 70-80% on the PEDro scale. Seven studies were included in the meta-analysis. Exercise prescription was highly variable and often insufficiently dosed. Similar gains were shown for aquatic therapy and land exercises for balance, motor disability or quality of life. A statistically significant difference was found for mobility as measured using the TUG (-1.5 s, 95 % CI -2.68 to -0.32; p = 0.01, I2 = 13%), in favor of aquatic therapy.

CONCLUSION

Aquatic therapy had positive outcomes for gait, balance and mobility that were comparable to land-based physiotherapy in the early stages of PD. The optimal dosage, content and duration of aquatic interventions for PD could not be confirmed in this meta-analysis. Many trials appeared to be under-dosed and therapy duration was low, ranging from 3-11 weeks.

Improving functional and motor capacity through means/resources and methods specific to acvatic activities

Introduction. Exercise programs in the aquatic environment have as their main objective the improvement and maintenance of physical capacity/ capability, these being in continuous development and diversification. Water exercise amplifies the effects of general physical exercise, by allowing a more precise control over the movement of each body segment and of the body as a whole. The aquatic environment offers a number of beneficial effects compared to ones offered by the terrestrial environment. The benefits obtained through the aquatic activities are fundamental and are reflected throughout the entire body including both motor, functional and aesthetic level. Material and method. The objective of this study is represented by the identification of new forms of physical exercise that will increase the effort’s capacity. In order to achieve this goal, several methodological requirements were met, such as: successive engagement of the joints and muscle groups in effort (starting with the neck’s muscles, shoulders, arms, torso and legs, simultaneously with scapular-humeral joints, spine and coxo-femoral joints and legs), the gradually usage of exercises, starting with the most basic and then increasing the complexity of the exercises, the usage of the accessible exercises in the beginning of the training, executed with high amplitude and reduced speed, focusing on the correctness of the execution, the selection and the adequate/ appropriately usage of the initial positions according to the subject’s particularities and the shape/form of the exercise, the optimal control of the effort, achieved through a number of iterations, optimal execution time and breaks, the sets of general physical exercises will consist of sets of 8-12 exercises/reps, the principle of symmetry in the execution of the exercises has to be respected, the continuity of practicing a set of exercises for 6 to 8 consecutive lessons, the recommended work method is fragmented-imitative, efficiently combining the explication with the demonstration, the number of repetitions and the movement’s correction. Results and discussions. Analyzing results obtained after the evaluation, we have noticed significant growth in the functional and motor capacities. Conclusions. The systematization of water activities on objective criteria effectively contributes to their knowledge, while allowing them to be included in the spectrum of recreational, sporting, relaxing or therapeutic activities. Keywords: acvatic activities, physical exercise, evaluations,

Validation of the functional component of the Halliwick-ICF assessment scale

Introduction: Aquatic rehabilitation therapy can improve strength and functional ability. Previous studies measured outcomes on land but did not measure underwater functional ability.Purpose: This study aimed to validate the functional component of the Halliwick-ICF assessment scale, and to compare the scale between underwater and on-land activities.Methods: Rehabilitation and medical charts of individuals with brain lesions and/or spine injuries who underwent aquatic therapy were retrospectively reviewed. Twenty-one functional components of the Halliwick-ICF assessment scale items were categorized through exploratory factor analysis: center of gravity alteration, basic functional activity, and progressive basic functional activity. Confirmatory factor analysis was performed to evaluate the validity of the functional components of the Halliwick-ICF assessment scale. Spearman's correlation analyses were conducted using Medical Research Council sum and modified Barthel index scores.Results: Ninety-five participants (mean age: 53.4 years, range: 27-73 years) were included in the analysis. Convergence and discrimination validity for all three factors were established. Total scores of the scale showed correlations with the modified Barthel index (r = 0.636, p < .001) and Medical Research Council sum (r = 0.298, p = .01) scores.Conclusion: The functional components of the Halliwick-ICF assessment scale demonstrated validity with physical function on land, suggesting its usefulness in aquatic therapy.

Impact or no impact for women with mild knee osteoarthritis? A Bayesian meta-analysis of two RCT's with contrasting interventions

OBJECTIVE

We aim to predict the probability of a benefit from two contrasting exercise programs for a woman with a new diagnosis of mild knee osteoarthritis (OA). The short and long-term effects of aquatic resistance training (ART) and high-impact aerobic land training (HLT) compared with the control will be estimated.

METHODS

Original data sets from two previously conducted randomised controlled trials (RCT) were combined and used in a Bayesian meta-analysis. Group differences in multiple response variables were estimated. Variables included cardiorespiratory fitness, dynamic maximum leg muscle power, maximal isometric knee extension and flexion force, pain, other symptoms and quality of life. The statistical model included a latent commitment variable for each female participant.

RESULTS

ART has 55% - 71% probability of benefits in the outcome variables and as the main effect, the intervention outperforms the control in cardiorespiratory fitness with a probability of 71% immediately after the intervention period. HLT has 46% - 63% probability of benefits after intervention with the outcome variables, but differently from ART, the positive effects of physical performance fade away during the follow-up period. Overall, the differences between groups were small and the variation in the predictions between individuals was high.

CONCLUSIONS

Both interventions had benefits but ART has a slightly higher probability of long-term benefits on physical performance. Because of high individual variation and no clear advantage of one training method over the other, personal preferences should be considered in the selection of the exercise program to ensure highest commitment to training.

Randomized controlled trial of aquatic exercise for treatment of knee osteoarthritis in elderly people

Aim

The aim of this study is to assess the efficacy of aquatic exercise on pain, gait, and balance among elderly patients with knee osteoarthritis.

Methods

We performed a randomized controlled trial at a university hospital. Overall, 32 men with knee osteoarthritis, aged ≥ 60 years, were included. Pain, balance, and gait were evaluated before and 2 months after interventions. The group control used acetaminophen and followed lifestyle recommendations. The intervention group performed the aquatic exercise three sessions per week for 8 weeks.

Results

At the end of the study, mean pain scores were significantly different between the groups (p = 0.010). Within-group analyses showed that group intervention experienced significant pain relief (p = 0.019), whereas group control did not show the significant change (p = 0.493). There was significant improvement in favor of aquatic exercise with regard to static (p = 0.001) and dynamic (p = 0.001) balance, step length (p = 0.038), stride length (p < 0.001), and cadence (p < 0.001). However, we did not find a significant difference in step time and width between the two groups.

Conclusions

Aquatic exercise would be beneficial in decreasing subjective pain of osteoarthritis. There are some recognizable improvements in patients’ gait and balance as well.

Recovery of motor function after traumatic spinal cord injury by using plasma-synthesized polypyrrole/iodine application in combination with a mixed rehabilitation scheme

Traumatic spinal cord injury (TSCI) can cause paralysis and permanent disability. Rehabilitation (RB) is currently the only accepted treatment, although its beneficial effect is limited. The development of biomaterials has provided therapeutic possibilities for TSCI, where our research group previously showed that the plasma-synthesized polypyrrole/iodine (PPy/I), a biopolymer with different physicochemical characteristics than those of the PPy synthesized by conventional methods, promotes recovery of motor function after TSCI. The present study evaluated if the plasma-synthesized PPy/I applied in combination with RB could increase its beneficial effects and the mechanisms involved. Adult rats with TSCI were divided into no treatment (control); biopolymer (PPy/I); mixed RB by swimming and enriched environment (SW/EE); and combined treatment (PPy/I + SW/EE) groups. Eight weeks after TSCI, the general health of the animals that received any of the treatments was better than the control animals. Functional recovery evaluated by two scales was better and was achieved in less time with the PPy/I + SW/EE combination. All treatments significantly increased βIII-tubulin (nerve plasticity) expression, but only PPy/I increased GAP-43 (nerve regeneration) and MBP (myelination) expression when were analyzed by immunohistochemistry. The expression of GFAP (glial scar) decreased in treated groups when determined by histochemistry, while morphometric analysis showed that tissue was better preserved when PPy/I and PPy/I + SW/EE were administered. The application of PPy/I + SW/EE, promotes the preservation of nervous tissue, and the expression of molecules related to plasticity as βIII-tubulin, reduces the glial scar, improves general health and allows the recovery of motor function after TSCI. The implant of the biomaterial polypyrrole/iodine (PPy/I) synthesized by plasma (an unconventional synthesis method), in combination with a mixed rehabilitation scheme with swimming and enriched environment applied after a traumatic spinal cord injury, promotes expression of GAP-43 and βIII-tubulin (molecules related to plasticity and nerve regeneration) and reduces the expression of GFAP (molecule related to the formation of the glial scar). Both effects together allow the formation of nerve fibers, the reconnection of the spinal cord in the area of injury and the recovery of lost motor function. The figure shows the colocalization (yellow) of βIII-tubilin (red) and GAP-43 (green) in fibers crossing the epicenter of the injury (arrowheads) that reconnect the rostral and caudal ends of the injured spinal cord and allowed recovery of motor function.

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

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

The Effect of Exercise on Quality of Life, Fatigue, Physical Function, and Safety in Advanced Solid Tumor Cancers: A Meta-analysis of Randomized Control Trials

BACKGROUND

People with metastatic cancers experience poor quality of life (QoL), fatigue, and decreased physical function. Exercise improves these symptoms in the curative setting, but the efficacy and safety of exercise in the metastatic setting is uncertain.

METHODS

Prospective, randomized trials of moderate/high-intensity aerobic exercise or resistance training vs. control in patients with advanced/metastatic solid cancers were identified from prior reviews and updated using a search of PubMed. The mean and SD for validated outcome measures (QoL, physical function, and fatigue) were extracted for intervention and control groups at baseline and postintervention. The Mann-Whitney test was used to evaluate the effect of exercise on the pooled change between baseline and postintervention. Safety was evaluated qualitatively.

RESULTS

Sixteen trials were analyzed. Among patients with scores at the mean or 2SD above, exercise was not associated with significant or clinical difference in QoL or fatigue. In patients with baseline scores 2SD below mean, exercise was associated with nonsignificant difference meeting minimal clinical important difference in QoL (-2.8 vs. 4.6, P = 0.28). For function, patients at the mean had nonstatistically significant, but clinically meaningful difference in the six-minute walk test (6-MWT) (14.7 vs. 29.0 m, P = 0.44). In patients 2 SD below the mean, there was a clinically meaningful difference in two patient-reported functional subscales (0.1 vs. 5.3, P = 0.076 and 0.44 vs. 8.5, P = 0.465) and a clinically meaningful improvement in the 6-MWT (-7.5 vs. 27.0 m, P = 0.34), although none of these associations met statistical significance. There were no differences in falls, fractures, or pain.

DISCUSSION

Exercise is associated with clinically meaningful improvements in QoL, function, and 6-MWT in some patients with metastatic cancer. Despite poor reporting of safety, there was no signal of increased harm from exercise in this setting.

Prediction of ground reaction forces while walking in water

Despite being a key concept in rehabilitation, controlling weight-bearing load while walking, following lower limb injury is very hard to achieve. Walking in water provides an opportunity to prescribe load for people who have pain, weakness or weight bearing restrictions related to stages of healing. The aim of this experimental study was to evaluate and validate regression models for predicting ground reaction forces while walking in water. One hundred and thirty seven individuals (24±5 years, 1.71±0.08 m and 68.7±12.5 kg) were randomly assigned to a regression group (n = 113) and a validation group (n = 24). Trials were performed at a randomly assigned water depth (0.75 to 1.35 m), and at a self-selected speed. Independent variables were: immersion ratio, velocity, body mass, and waist, thigh and leg circumferences. Stepwise regression was used for the prediction of ground reaction forces and validation included agreement and consistency statistical analyses. Data from a force plate were compared with predicted data from the created model in the validation group. Body mass, immersion ratio, and velocity independently predicted 95% of the vertical and resultant ground reaction force variability, while, together, velocity and thigh circumference explained 81% of antero-posterior ground reaction force variability. When tested against the data measured in validation samples, the models output resulted in statistically similar values, intraclass correlation coefficients ranging from 0.88 to 0.90 and standard errors of measurement, 11.8 to 42.3 N. The models introduced in this study showed good predictive performance in our evaluation procedures and may be considered valid in the prediction of vertical, antero-posterior and resultant ground reaction forces while walking in water. All predictive variables can be easily determined in clinical practice. Future studies should focus on the validation of these models in specific populations.

Impact of water therapy on pain management in patients with fibromyalgia: current perspectives

Exercise-related interventions have been recommended as one of the main components in the management of fibromyalgia syndrome (FMS). Water therapy, which combines water's physical properties and exercise benefits, has proven effective in improving the clinical symptoms of FMS, especially pain, considered the hallmark of this syndrome. However, to our knowledge, the mechanisms underlying water therapy effects on pain are still scarcely explored in the literature. Therefore, this narrative review aimed to present the current perspectives on water therapy and the physiological basis for the mechanisms supporting its use for pain management in patients with FMS. Furthermore, the effects of water therapy on the musculoskeletal, neuromuscular, cardiovascular, respiratory, and neuroendocrine systems and inflammation are also addressed. Taking into account the aspects reviewed herein, water therapy is recommended as a nonpharmacologic therapeutic approach in the management of FMS patients, improving pain, fatigue, and quality of life. Future studies should focus on clarifying whether mechanisms and long-lasting effects are superior to other types of nonpharmacological interventions, as well as the economic and societal impacts that this intervention may present.

Effects of land vs water jump exercise: Implications for exercise design targeting bone health

PURPOSE

To quantify ground reaction force (GRF), osteogenic index (OI), muscle activity, and blood lactate levels during continuous jumping performed in water and on land.

METHODS

Thirteen post-menopausal women (59.5 ± 6.8 years) performed two bouts of jumping, on land (LND) and in water at a depth of 1 m (WEX). Each 10-minute, 40-second bout consisted of 2 consecutive sets of squat, lunge, jumping jax, countermovement, and single legged jumps as intervals: 10 seconds maximal effort and 60 seconds recovery at 50% of heart rate reserve (HRR). Pre- and post-exercise lower extremity rate of perceived exertion (RPE) was recorded, and 10-µL earlobe blood samples were collected to assess lactate concentration. During exercise, data were collected for electromyography, GRF, and heart rate. Total GRF (TGRF) and total muscular activity (TMA) during each 10 seconds of jumping were measured. OI for one bout of continued jumps was determined by averaging GRF·ln (number of jumps + 1).

RESULTS

There were no differences between WEX and LND for percent HRR and RPE. TGRF, OI, TMA, and lactate concentration on LND jumps were significantly higher than WEX.

CONCLUSION

At similar cardiorespiratory and RPE levels, the lower impact loading of 10 minutes 40 seconds of interval continuous jumping exercise in 1-m depth was less osteogenic than on land. However, one daily bout of water jumping, 5 days per week resulted in a similar OI as 3 days of jumping on land. WEX might substitute or provide an adjunct to LND exercise to promote bone health.

Force during functional exercises on land and in water in older adults with and without knee osteoarthritis: Implications for rehabilitation

BACKGROUND

Closed kinetic chain and plyometric exercises are commonly used in aquatic rehabilitation because they are believed to reduce joint loading whilst replicating functional tasks. However, the forces and relationship to land-based functional movement is unknown. This study aims to compare vertical ground reaction force during squats, calf raises and jumping in older adults with and without knee osteoarthritis on land and in water.

METHODS

Forty one participants (Healthy n = 21; Knee osteoarthritis n = 20; Age 68.5 (4.4) years) completed squats and calf raises at slow, medium and maximal speeds and jumping at maximal speed on land and in waist and chest depth water. Vertical ground reaction force and pain rating was measured in each environment.

RESULTS

Force in all exercises was significantly greater on land than in chest depth water (p < 0.005). Peak force was significantly greater at maximal speed compared to slow speed (p < 0.001). The pattern of force in squats at slow speed in water was different to on land, with force highest at the start and end of the exercise and decreasing in the central phase. Pain ratings were significantly lower (p < 0.001) in water compared to on land in squats.

CONCLUSIONS

Closed kinetic chain exercises offer inherently different loading in an aquatic environment. Body weight squats and calf raises in water could be defined as either neuromotor or low load, high velocity training. Maximal speed exercise in water produces higher relative load compared to slow speed and minimal pain providing an opportunity for clinicians to use greater speed to address power deficits.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

AQE is comparable to LBE for treating knee OA.

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

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

Land-based and aquatic trunk exercise program improve trunk control, balance and activities of daily living ability in stroke: a randomized clinical trial

BACKGROUND

There are many land-based or aquatic exercise programs for improving trunk control, balance, and activities of daily living in stroke patients. However, no study has reported the effects of an exercise program that combines land-based and aquatic trunk exercises in stroke patients.

AIM

To investigate the effects of a land-based and aquatic trunk exercise (LATE) program on trunk control, balance, and activities of daily living in chronic stroke patients.

DESIGN

This study was designed as a single-blind randomized controlled trial.

SETTING

Inpatient rehabilitation ward, Goyang, Republic of Korea.

POPULATION

Twenty-nine patients participated in this study.

METHODS

Participants were randomly allocated to the LATE group (N.=14) and control group (N.=15). The LATE program consisted of land-based and aquatic trunk exercises, performed for 30 minutes per day, 5 days per week, for 4 weeks as an adjunct to 30 minutes of conventional physical therapy. The control group underwent only conventional physical therapy for 30 minutes each time, twice per day, 5 days per week, for 4 weeks. The participants were tested before and after the intervention using the Korean Trunk Impairment Scale (K-TIS) and the 5-item, 3-level Postural Assessment Scale for Stroke (PASS-3L) to assess trunk control; the 7-item, 3-level Berg Balance Scale (BBS-3L) and the Functional Reach Test (FRT) to evaluate balance; and the Modified Barthel Index (MBI) to assess activities of daily living.

RESULTS

The LATE group exhibited improvements in K-TIS, PASS-3L, BBS-3L, and MBI scores and FRT distance compared with the control group (P<0.05).

CONCLUSIONS

The results of this study suggest that the LATE program can help improve trunk control, balance, and activities of daily living in chronic stroke patients and may be used as a practical adjunct to conventional physical therapy.

CLINICAL REHABILITATION IMPACT

The LATE program can improve postural control in stroke patients and improve independence in daily activities.

The effect of aquatic high-intensity interval training on aerobic performance, strength and body composition in a non-athletic population: systematic review and meta-analysis

Objective:

In a non-athletic population, to (1) investigate the effectiveness of high-intensity interval training in an aquatic environment (A-HIIT) on aerobic performance, strength, and body composition and (2) report on safety of this approach.

Method:

A systematic search was undertaken of six databases until May 2018. Trials were eligible for inclusion if they compared the effect of A-HIIT in a non-athletic population with a control group that received no exercise training. Data were extracted independently by two reviewers and meta-analyses were undertaken using a random effects model to produce standardized mean difference (SMD) and 95% confidence intervals (CIs). Risk of bias was assessed using Cochrane’s risk of bias tool. All studies were graded using Physiotherapy Evidence Database (PEDro) and Consensus for Exercise Reporting Template (CERT) scales to determine quality of reporting.

Results:

Eight studies reported over 13 papers met study criteria ( n = 377). Compared with a control group, those who completed a program of A-HIIT demonstrated greater aerobic performance (SMD 0.69 (95% CI 0.39–0.98); I2 = 0%; n = 191) and lower limb muscle strength (SMD 0.30 (95% CI 0.04–0.56); I2 = 0%; n = 237). No differences were seen in measures of body composition or the number of adverse events. All studies were at risk of performance bias. The (mean ± SD) PEDro and CERT scores were 4.9 ± 1.5 and 15.1 ± 2.1, respectively.

Conclusion:

In a non-athletic population, A-HIIT was safe and may have improved aerobic performance and lower limb strength. The exercise interventions were well described and monitoring and reporting of exercise intensity in water was feasible.

[Research progress of rehabilitation after autologous chondrocyte implantation on knee]

Objective

To summarize the research progress of rehabilitation after autologous chondrocyte implantation (ACI).

Methods

The literature related to basic science and clinical practice about rehabilitation after ACI in recent years was searched, selected, and analyzed.

Results

Based on the included literature, the progress of the graft maturation consists of proliferation phase (0-6 weeks), transition phase (6-12 weeks), remodeling phase (12-26 weeks), and maturation phase (26 weeks-2 years). To achieve early protection, stimulate the maturation, and promote the graft-bone integrity, rehabilitation protocol ought to be based on the biomechanical properties at different phases. Weight-bearing program, range of motion (ROM), and options or facilities of exercise are importance when considering a rehabilitation program.

Conclusion

It has been proved that the patients need a program with an increasingly progressive weight-bearing and ROM in principles of rehabilitation after ACI. Specific facilities can be taken at a certain phase. Evidences extracted in the present work are rather low and the high-quality and controlled trials still need to improve the rehabilitation protocol.

Training with an Electric Exercise Bike versus a Conventional Exercise Bike during Hemodialysis for Patients with End-stage Renal Disease: A Randomized Clinical Trial

Objective

Hemodialysis (HD) patients have lower fitness levels than healthy subjects because of various structural, metabolic, and functional abnormalities secondary to uremic changes in skeletal muscles. Aerobic and resistance exercises are beneficial in improving not only physical function, including maximal oxygen uptake and muscle strength, but also anthropometrics, nutritional status, and hematologic indices. The use of electric ergometers that place light loads on patients has been implemented at many dialysis facilities in Japan. However, reports comparing the effects on body function of electric and variable-load ergometers are few. This study aimed to compare electric ergometers and variable-load ergometers in terms of exercise outcomes in HD patients.

Methods

A total of 15 ambulatory HD patients were randomly divided into two groups: the variable-load ergometer group (n=8) and the electric ergometer group (n=7). HD patients exercised at a level based on their physical function three times a week for 12 weeks.

Results

After the 12-week intervention period, only the variable-load ergometer group experienced significant increases in lower extremity muscle strength and exercise tolerance.

Conclusion

This study confirmed that conventional aerobic training and electric bike exercise during HD were efficacious and safe without causing sudden hypotension or any other side effects. However, exercise using a variable-load ergometer may be more effective than exercise using an electric bike in improving the physical function of HD patients. Exercise using a variable-load ergometer elicited specific whole-body and local effects.