Wearable technologies for monitoring aquatic exercises: A systematic review

Objective

To review methods for aquatic exercise monitoring using wearables.

Data sources

Database search of PubMed, IEEEXplore, Scopus and Web of Science based on keywords, considering articles from the year 2000. The last search was performed on 26 October 2022.

Review methods

Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol, eligible articles on water exercises were selected and summarized. Further screening process concentrated on studies exploiting wearable devices, organized according to demographics, purpose, protocols, outcomes and methods. A custom critical appraisal questionnaire was applied.

Results

Out of the 1062 articles identified, 572 were considered eligible and subjected to preliminary synthesis. The final review focused on 27 articles featuring wearable devices applied to aquatic exercises. Four studies were disregarded as they applied wearable devices to determine daily physical activity or for sleep monitoring after training. Summary tables of 23 studies exploiting wearable devices for underwater motion analysis are provided, specifying the investigated parameters, major outcomes and study quality. This review identified four research gaps: (a) the absence of clinical protocols for underwater motion studies, (b) a deficit of whole-body studies, (c) the lack of longitudinal studies monitored via wearable devices and (d) the reliance of underwater studies on measurement and assessment methods developed for land-based investigations.

Conclusions

This review emphasizes the need for both technological and methodological improvements for underwater motion analysis studies using wearables. We advocate for longitudinal clinical investigations with wearables to substantiate water exercise as an addition or replacement for land-based physical activity.

Exercise as a multi-modal disease-modifying medicine in systemic sclerosis: An introduction by The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis (G-FoRSS)

Systemic sclerosis (SSc) is a heterogeneous multisystem autoimmune disease whereby its main pathological drivers of disability and damage are vascular injury, inflammatory cell infiltration, and fibrosis. These mechanisms result in diffuse and diverse impairments arising from ischemic circulatory dysfunction leading to painful skin ulceration and calcinosis, neurovascular aberrations hindering gastrointestinal (GI) motility, progressive painful, incapacitating or immobilizing effects of inflammatory and fibrotic effects on the lungs, skin, articular and periarticular structures, and muscle. SSc-related impairments impede routine activities of daily living (ADLs) and disrupt three critical life areas: work, family, social/leisure, and also impact on psychological well-being. Physical activity and exercise are globally recommended; however, for connective tissue diseases, this guidance carries greater impact on inflammatory disease manifestations, recovery, and cardiovascular health. Exercise, through myogenic and vascular phenomena, naturally targets key pathogenic drivers by downregulating multiple inflammatory and fibrotic pathways in serum and tissue, while increasing circulation and vascular repair. G-FoRSS, The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis recognizes the scientific basis of and advocates for education and research of exercise as a systemic and targeted SSc disease-modifying treatment. An overview of biophysiological mechanisms of physical activity and exercise are herein imparted for patients, clinicians, and researchers, and applied to SSc disease mechanisms, manifestations, and impairment. A preliminary guidance on exercise in SSc, a research agenda, and the current state of research and outcome measures are set forth.

Effect of an Aquatic Balance-Training Program in Patients with Chronic Stroke: A Single-Group Experimental Pilot Study

Background and Objectives: Stroke survivors face severe problems affecting their mobility, such as balance impairments and an increased risk of falls. The principal aim of this study was to quantify the effects of 12 sessions of Halliwick aquatic therapy for the treatment of balance in patients with chronic stroke. Materials and Methods: Twenty-nine people with stroke participated in this single-group experimental pilot study. Sessions were performed three times a week for a total of 12 sessions. A stabilometric assessment was conducted using a computerized platform. The evaluations were performed at baseline, at four weeks, and one month after completing the aquatic program. Results: The results obtained revealed significant differences for postural stability values (p < 0.001) and single-leg stabilometry. However, in the case of values within the limits of stability, such as forward (F = 0.339, p = 0.676), backward (F = 0.449, p = 0.644), forward right oscillations (F = 1.637, p = 0.21), and the anterior/posterior instability index (F = 0.614, p = 0.55), no significant differences were found. Conclusions: These findings suggest that Halliwick therapy may potentially improve stroke balance impairments. The main limitations of the study were the sample size, the lack of a control group, and the study not being blind.

Effect of changing water depth on muscle activity and motion kinematics during sit-to-stand motion

BACKGROUND

Sit-to-stand (STS) movement is a fundamental activity in daily life. Studies have examined the effect of water depth during aquatic exercise; however, no investigation has examined the effect of water depth on STS movements.

RESEARCH QUESTION

This study examined whether changing water depth affected muscle activity and motion kinematics during the STS movement.

METHODS

Eleven participants performed the STS movement on the ground (land) and at different water depths (1.0-m [deep] and 0.6-m [shallow]) at a self-determined pace. Lower extremity and trunk muscle activity, lower extremity joint angle, and trunk segment inclination angle were measured. Mean muscle activity during STS movement, initial and final postures, and range of motion of each angle was evaluated. Correlations of a normalised time-series pattern of electromyography and motion kinematics measures between land and shallow (land-shallow) and between land and deep (land-deep) were investigated.

RESULTS

The rectus femoris was more active in shallow than in deep water STS movement but less than that in land STS. Other muscles showed no significant differences between shallow and land STS movement. Correlation of the time series pattern in the tibialis anterior, rectus femoris, and erector spinae muscles was higher in the land-shallow than the land-deep STS. The trunk showed more forward inclination in the shallow STS than the land but less than the deep. Correlation of the time series pattern in the hip joint and trunk inclination angles was higher in the land-shallow STS than in the land-deep STS.

SIGNIFICANCE

STS exercise in the shallow water depth reduced muscle load for the knee extensor but not for other muscles. The muscle activity pattern showed a higher correlation between the land STS and shallow water than deep. Sitting posture becomes upright when the water depth decreases, but a similar motion pattern could be attained regardless of water depth.