Water- versus land-based exercise in elderly subjects: effects on physical performance and body composition

Effects of water aerobics on body composition in obesity and overweight people: a systematic review and meta-analysis

OBJECTIVES

Obesity and overweight significantly impact public health. The benefits of water aerobics (WAs) have been shown in obesity and overweight people, but the effects of WAs on body composition improvement are still unclear.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A systematic literature search was conducted on 16 November 2024, across the PubMed MEDLINE, Ovid MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Only randomised controlled trials (RCTs) were included, which were independently screened by two researchers. All RCTs on WAs that evaluated the anthropometric and body composition parameters of overweight and obesity subjects were included. Eligible studies were reported following the Reporting Items for Systematic Reviews and Meta-Analysis statement.

DATA EXTRACTION AND SYNTHESIS

All process were independently screened by two researchers (ZD, HZ). A fixed-effects or random-effects model was chosen based on the heterogeneity of the studies. The risk of bias in the included studies was assessed using the Risk of Bias V.2.0 tool, and sensitivity and subgroup analyses were conducted for outcome indicators. The quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

RESULTS

A total of 10 studies involving 286 participants were included. Sensitivity analyses were performed for percent body fat (PBF) with high heterogeneity, and the results were robust. WAs were able to reduce body weight (BW) (weighted mean differences (WMD)=-2.69, 95% CI -4.10 to -1.27, p<0.05, I2=0.0%) and waist circumference (WC) (WMD=-2.75, 95% CI -4.41 to -1.09, p<0.05, I2=27.0%), but the effect on other body indicators was not significant. The GRADE assessment revealed that the certainty of evidence was low for body mass index, lean mass, fat mass, waist-hip ratio and hip circumference and very low for PBF. In contrast, the certainty of evidence for BW and WC was moderate.

CONCLUSION

For the obesity and overweight people, WAs interventions over 10 weeks (ie, 12 weeks) reduced BW and WC, with more significant effects in women and greater improvements in body composition in middle-aged and older adults (average age ≥45 years). The moderate certainty of evidence for BW and WC, as assessed using the GRADE framework, indicates that these findings are robust.

PROSPERO REGISTRATION NUMBER

CRD42023466969.

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational aspect of geroscience. Thus, PA serves both as preventive medicine and therapeutic agent in pathological states. Sub-optimal PA levels correlate with increased disease prevalence in aging populations. Structured exercise prescriptions should therefore be customized and monitored like any other medical treatment, considering the dose-response relationships and specific adaptations necessary for intended outcomes. Current guidelines recommend a multifaceted exercise regimen that includes aerobic, resistance, balance, and flexibility training through structured and incidental (integrated lifestyle) activities. Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Particularly important are anabolic exercises, such as Progressive resistance training (PRT), which are indispensable for maintaining or improving functional capacity in older adults, particularly those with frailty, sarcopenia or osteoporosis, or those hospitalized or in residential aged care. Multicomponent exercise interventions that include cognitive tasks significantly enhance the hallmarks of frailty (low body mass, strength, mobility, PA level, and energy) and cognitive function, thus preventing falls and optimizing functional capacity during aging. Importantly, PA/exercise displays dose-response characteristics and varies between individuals, necessitating personalized modalities tailored to specific medical conditions. Precision in exercise prescriptions remains a significant area of further research, given the global impact of aging and broad effects of PA. Economic analyses underscore the cost benefits of exercise programs, justifying broader integration into health care for older adults. However, despite these benefits, exercise is far from fully integrated into medical practice for older people. Many healthcare professionals, including geriatricians, need more training to incorporate exercise directly into patient care, whether in settings including hospitals, outpatient clinics, or residential care. Education about the use of exercise as isolated or adjunctive treatment for geriatric syndromes and chronic diseases would do much to ease the problems of polypharmacy and widespread prescription of potentially inappropriate medications. This intersection of prescriptive practices and PA/exercise offers a promising approach to enhance the well-being of older adults. An integrated strategy that combines exercise prescriptions with pharmacotherapy would optimize the vitality and functional independence of older people whilst minimizing adverse drug reactions. This consensus provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults. Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided. The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine as it applies to exercise and geroscience, given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts. Overall, this consensus provides a foundation for applying and extending the current knowledge base of exercise as medicine for an aging population to optimize health span and quality of life.

Comparative Analysis of Physical Fitness in Aquatic and Terrestrial Environments Among Elderly Women

(1) Background: Aging is associated with a progressive decline in physical capacity, which is further exacerbated by conditions such as arthritis and chronic joint pain. This study aimed to compare the effects of aquatic and land-based exercise on the functional fitness of older adult women. (2) Methods: Sixty older women (mean age 66.9 ± 3.8 years) participated in this study, divided into two groups: aquatic exercise and land-based exercise. Both groups completed functional fitness tests, including flexibility (Back Scratch and Chair Sit-and-Reach Tests), lower body strength (Chair Stand Test), and dynamic balance (8-Foot Up-and-Go Test). Statistical analyses compared group performance. (3) Results: Improvements in flexibility were observed in the aquatic group, with trends toward significance for the Back Scratch Test (-0.2 ± 1.0 cm vs. -2.0 ± 0.0 cm, p = 0.08) and the Chair Sit-and-Reach Test (2.87 ± 2.0 cm vs. 0.27 ± 1.0 cm, p = 0.07). No statistically significant differences were observed between the groups in measures of lower body strength (Chair Stand Test: 19.1 ± 4.47 reps vs. 18.97 ± 3.77 reps, p = 0.9) or dynamic balance (8-Foot Up-and-Go Test: 6.28 ± 6.2 s vs. 6.03 ± 5.83 s, p = 0.07). (4) Conclusions: Aquatic exercise showed greater improvements in flexibility, particularly in the upper and lower body, although these differences did not reach statistical significance. Both training modalities were equally effective in maintaining lower body strength and dynamic balance in older adult women. These findings support the inclusion of tailored exercise programs in aging populations to address specific functional needs.

Identifying the benefits of recovery programs of aquatic gymnastics, aquatic ludotherapy and therapeutic swimming on human motor, kinetotherapeutic and mental capacity

Introduction

This study aimed to evaluate the motor, kinetotherapeutic, and psychological benefits of three aquatic therapeutic programs-aquagym recovery (AG), aquatic ludotherapy (ALT), and therapeutic swimming (TS)-for students specializing in balneo-physio-kinetotherapy.

Methods

The study group consisted of 101 students, out of which 43 students from the balneo-physiokinetotherapy study program (BFKT) and 67 master's degree students from physical therapy and functional rehabilitation (PTFR). The questionnaire was named Questionnaire regarding the benefits of therapeutic aquatic programs (QBTAP), and included 3 subscales according to the typology of the targeted objectives, namely: motor, kinetotherapeutic and psychological. The items of each subscale correspond to the objectives identified in the content of the 3 aquatic programs stipulated in the content of the courses corresponding to the disciplines in the education plans of academic study programs (BFK, TRFR). The motor subscale included 8 items, the kinetotherapeutic subscale included 16 items, and the psychological subscale included 10 items. The evaluation of the QBTAP questionnaire 5-point Likert scale. The three evaluated programs were: recovery aquagym (AG), aquatic ludotherapy (ALT) and therapeutic swimming (TS).

Results

The results and conclusion sections should highlight the main findings succinctly. For example: "The QBTAP showed high internal consistency (Cronbach's Alpha >0.9) across all subscales and programs, with significant differences identified between the three programs (p < 0.05).

Conclusion

The study concludes that aquagym most effectively improves motor capacity, aquatic ludotherapy enhances psychological function, and therapeutic swimming is most beneficial for recovery and rehabilitation.

Effects of shuttle balance exercises on gait speed, postural control, and quality of life in older males: A randomized controlled trial

BACKGROUND AND PURPOSE

Enhancing physical function and quality of life in older adults at higher risk of falls is challenging because of the lack of established interventions. This study examines the impact of a 6-week balance training program using the shuttle balance device on gait speed, postural control, and quality of life in older men.

METHODS

This single-blinded randomized controlled trial was conducted in a research laboratory. Thirty-two participants aged ≥60 years were randomly assigned to either an experimental group (EG; n = 16) or a control group (CG; n = 14). The EG participated in a 6-week shuttle balance exercise program, while the CG maintained regular physical activity routines. The main outcome measures included gait speed (assessed via the timed up and go test), postural control (assessed via center of pressure data on a force plate), and quality of life (evaluated using the SF-36 questionnaire).

RESULTS

Post-intervention, the EG showed significant improvements compared with the CG (p < 0.05). The 95% confidence intervals for the differences between groups were as follows: closed eyes (CE) mean velocity (-39.07, -0.13), CE sway area (-48.86, -0.18), SF-36 total score (9.01, 16.81), SF-36 physical functioning (7.00, 24.81), SF-36 physical role functioning (1.80, 27.57), SF-36 pain (15.01, 36.82), SF-36 general health state (7.48, 26.08), SF-36 vitality (5.60, 28.35), and SF-36 mental health (0.21, 21.12).

DISCUSSION

A 6-week shuttle balance training program significantly improves postural control and quality of life in older males. These findings suggest the potential effectiveness of shuttle balance exercises in enhancing physical function and well-being in this population. Further research is needed to validate these findings and explore the long-term effects with larger sample sizes.

Effects of aquatic and land high-intensity interval trainings on selected bio- and physiological variables among obese adolescents

Background

Obesity among adolescents have become a global public health problem. Exercises can effectively improve the bio-physiological factors of obese adolescents. High-intensive interval training (HIIT) has been applied to obese adolescents. Studies have reported that the Aquatic environment may bring the same or more positive exercise effects as the land environment. Therefore, the purpose of this study was to examine the effects of aquatic and land interventions on selected bio-and physiological variables among obese adolescences.

Methods

Twenty-eight obese adolescents who met the requirements participated in and completed this study. The participants were randomly assigned to Aquatic HIIT group (n=17) or Land HIIT group (n=11) for a four-week exercise intervention, 3 time/week. Each Intervention program was one-hour long, including 20 minutes of warm-up, 30 minutes of HIIT and 10 minutes of stretching and relaxation. Bio- and physiological variables including Anthropometry and body composition, Physical Function and blood pressure, and Lipid metabolism indexes were collected before and after the Aquatic and Land interventions.

Results

After four weeks of exercise interventions, the body mass, BMI, body fat rate, waist circumference, hip circumference and body water content were significantly reduced (p<0.05), and the lean body mass were significantly increased (p<0.05) in both groups. Both group exhibited significant effects in decreasing, systolic blood pressure (p<0.05), diastolic blood pressure (p<0.01), and increasing vital capacity and total energy consumption (p<0.05). The Aquatic HIIT group showed significant effects on reducing Rest heart rate (p<0.05), but no significant changes in Rest heart rate in Land HIIT group (p=0.364). The low-density lipoprotein cholesterol in both groups was significantly decreased (p<0.05). Moreover, the Aquatic HIIT group had significant better improvements (p<0.05) in lean body mass, waist circumference, waist-to-hip ratio, vital capacity and total energy consumption than Land HIIT group did.

Conclusions

The results of the present study demonstrated that in a short-term (4 weeks) both Aquatic and Land HIIT interventions may improve the body composition, physical function, blood pressure and low-density lipoprotein cholesterol (LDL-C) of overweight and obese adolescents. Furthermore, the Aquatic HIIT may be superior than the Land HIIT in weight control among the obese adolescents.

The Effectiveness of Water- versus Land-Based Exercise on Specific Measures of Physical Fitness in Healthy Older Adults: An Integrative Review

As the population ages, maintaining an active lifestyle becomes increasingly vital to promote overall health and well-being in older individuals. Water- and land-based exercises have emerged as popular options, each offering a distinct set of benefits tailored to the unique needs of this population group. An electronic database search, including PubMed, Scopus, MEDLINE, and Web of Science, was conducted until 15 September 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to investigate the effects of water-based compared to land-based exercise on selected fitness parameters in older healthy individuals. The eligibility criteria included studies with at least two groups of participants aged 60 and older, with physical fitness outcome measures. A total of ten studies met the inclusion criteria and were analyzed. While both exercise modalities may offer significant benefits, this review's findings emphasized the absence of conclusive evidence and consensus for recommending a single exercise category applicable to aquatic or land environments and providing more definite guidance to improve health-related physical fitness parameters in healthy older individuals. Finally, combining both training approaches may lead to a comprehensive array of health benefits for this age group population by also considering individual's needs, preferences, and fitness goals.

Sleep Duration and Sarcopenia: An Updated Systematic Review and Meta-Analysis

OBJECTIVES

In adults, short and long sleep duration has been associated with sarcopenia risk. Studies have shown that various factors, including biological and psychological factors, could be the underlying cause of the association between aberrant sleep duration and sarcopenia risk. In this study, we have qualitatively and quantitatively summarized previously published studies on sleep duration to assess the relationship between sleep duration and sarcopenia risk in adults. This would aid in enhancing our understanding of recent advancements in this field and the association between sleep duration and sarcopenia risk.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

In this review, we included studies evaluating the association between the duration of sleep and sarcopenia in adults in observational studies.

METHODS

Five electronic databases (PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Web of Science) were searched to April 20, 2023, to identify studies related to sarcopenia and sleep duration. Next, we calculated the odds ratios (ORs) for sarcopenia prevalence based on the adjusted data from individual studies. Statistical analyses were performed using Stata 11.0.

RESULTS

Sarcopenia prevalence was high (18%) in adults with long sleep duration. Our results showed a significant association between short duration of sleep and high sarcopenia prevalence in older adults (OR 1.2, 95% CI 1.02-1.41, I2 = 56.6%). Furthermore, a significant association was observed between all participants with long-duration sleep and high sarcopenia prevalence (OR 1.53, 95% CI 1.34-1.75, I2 = 56.8%). We also observed significant heterogeneity in the adjusted ORs.

CONCLUSIONS AND IMPLICATIONS

There was a correlation between sarcopenia and short or long sleep duration, especially in older adults. In adults with a long duration of sleep, sarcopenia prevalence was relatively high.

Sarcopenia prevalence and association with nutritional status in cohort of elderly patients affected by musculoskeletal concerns: a real-life analysis

Introduction

The progressive loss of skeletal muscle mass, strength, and function that frequently occurs as people get older is referred to as sarcopenia. Elderly musculoskeletal aging, sarcopenia, and obesity are all intimately connected. Our study's aim is to investigate the prevalence of sarcopenia in a real cohort of patients over 65 with musculoskeletal conditions referring to a Rehabilitation Unit. The secondary aim of our study is to investigate associations between sarcopenia and alterations in nutritional status and Body Mass Index (BMI). Finally, quality of life and global health has been investigated in our population.

Materials and methods

From January 2019 to January 2021, 247 patients over 65 years old with musculoskeletal concerns were enrolled and participated in an observational study. As outcome measures, the Mini Nutritional Assessment (MNA), the 12-Item Short Form Health Survey (SF-12), and the Cumulative Illness Rating Scale Severity Index (CIRS-SI) were used. Additionally, measurements of total skeletal muscle mass (SMM) and appendicular muscle mass (ASMM) using bioelectrical impedance analysis, as well as a hand grip strength test of the non-dominant hand were taken. The Mid Upper Arm Circumference (MUAC) and the Calf Circumference (CC) were measured and recorded as further indications of possible sarcopenia.

Results

A percentage of 46.1% of subjects with overt sarcopenia was found and 10.1% showed a severe sarcopenia. Patients with severe sarcopenia showed significantly lower values of BMI and MNA. Additionally, sarcopenic patients showed significantly lower values in MNA when compared to non-sarcopenic patients. Considering SF-12, only the physical score revealed slight significant differences. In particular, patients affected by probable or severe sarcopenia presented a lower value than non-sarcopenic patients. Concerning MUAC and CC, severe sarcopenic patients showed significant lower values for both the body parts.

Conclusion

Our study considers a cohort of real-life elderly subjects with musculoskeletal concerns and shows that these subjects are highly susceptible to sarcopenia. Therefore, rehabilitation for elderly patients with musculoskeletal concerns requires to be customized and multidisciplinary. Future research should further investigate these aspects in order to enable the early identification of sarcopenia and the formulation of customized rehabilitative programs. .

Effects of Exercise Training on Muscle Quality in Older Individuals: A Systematic Scoping Review with Meta-Analyses

BACKGROUND

The quantity and quality of skeletal muscle are important determinants of daily function and metabolic health. Various forms of physical exercise can improve muscle function, but this effect can be inconsistent and has not been systematically examined across the health-neurological disease continuum. The purpose of this systematic scoping review with meta-analyses was to determine the effects and potential moderators of exercise training on morphological and neuromuscular muscle quality (MMQ, NMQ) in healthy older individuals. In addition and in the form of a scoping review, we examined the effects of exercise training on NMQ and MMQ in individuals with neurological conditions.

METHODS

A systematic literature search was performed in the electronic databases Medline, Embase, and Web of Science. Randomized controlled trials were included that examined the effects of exercise training on muscle quality (MQ) in older individuals with and without neurological conditions. Risk of bias and study quality were assessed (Cochrane Risk of Bias Tool 2.0). We performed random-effects models using robust variance estimation and tested moderators using the approximate Hotelling-Zhang test.

RESULTS

Thirty studies (n = 1494, 34% females) in healthy older individuals and no studies in individuals with neurological conditions were eligible for inclusion. Exercise training had small effects on MMQ (g = 0.21, 95% confidence interval [CI]: 0.03-0.40, p = 0.029). Heterogeneity was low (median I2 = 16%). Training and demographic variables did not moderate the effects of exercise on MMQ. There was no association between changes in MMQ and changes in functional outcomes. Exercise training improved NMQ (g = 0.68, 95% CI 0.35-1.01, p < 0.000) across all studies, in particular in higher-functioning older individuals (g = 0.72, 95% CI 0.38-1.06, p < 0.001), in lower extremity muscles (g = 0.74, 95% CI 0.35-1.13, p = 0.001), and after resistance training (g = 0.91; 95% CI 0.42-1.41, p = 0.001). Heterogeneity was very high (median I2 = 79%). Of the training and demographic variables, only resistance training moderated the exercise-effects on NMQ. High- versus low-intensity exercise moderated the exercise-effects on NMQ, but these effects were considered unreliable due to a low number of studies at high intensity. There was no association between changes in NMQ and changes in functional outcomes.

CONCLUSION

Exercise training has small effects on MMQ and medium-large effects on NMQ in healthy older individuals. There was no association between improvements in MQ and increases in muscle strength, mobility, and balance. Information on dose-response relations following training is currently lacking. There is a critical gap in muscle quality data for older individuals with lower function and neurological conditions after exercise training. Health practitioners should use resistance training to improve muscle function in older individuals. Well-designed studies are needed to examine the relevance of exercise training-induced changes in MQ in daily function in older individuals, especially to those with lower function and neurological conditions.

The effects of water-based exercise on body composition: A systematic review and meta-analysis

AIMS

This study aimed to investigate the effects of water-based exercise (WBE) on body composition.

METHODS

Trials published up to October 28, 2022 were searched using the PubMed, EMBASE, Web of Science, Cochrane, Scopus, and Ovid databases. Randomized controlled trials of healthy adults published in English, comparing WBE and control groups, were included. Other studies with different research designs and participants with medical diagnoses were excluded. The main outcome measures were body weight (BW), body fat mass (BFM), body fat percentage (BFP), lean mass (LM), and skeletal muscle mass (SMM).

RESULTS

Overall, 17,458 potential studies were identified. After a closer inspection, 79 full-length articles were considered for further screening. Finally, 20 studies, involving 565 participants, were included in the meta-analysis. The WBE was beneficial in reducing BW, BFM, and BFP and increasing LM and SMM. Subgroup analyses were conducted based on different exercise intensities and times per week. Moderate- or moderate-vigorous-intensity exercise helped improve body composition, while lower-intensity WBE or aquatic high-intensity interval training (HIIT) seemed less helpful. Training for <120 min/week was insufficient to improve body composition. Training for >120 min/week was associated with improvements in body composition.

CONCLUSIONS

Moderate- or moderate-vigorous-intensity WBE helps improve body composition. Adults are encouraged to exercise for >120 min/week.

Catching and throwing exercises to improve reactive balance: A randomized controlled trial protocol for the comparison of aquatic and dry-land exercise environments

Reactive balance, a critical automatic movement pattern in response to a perturbation, is directly linked to fall prevention in older adults. Various exercise interventions have been broadly performed to improve reactive balance and thus prevent falls. Curiously, aquatic exercises have been suggested as an effective balance intervention and a safer alternative to exercises on dry land yet the efficacy of aquatic exercises on reactive balance has not been formally investigated. The present clinical trial aims to identify if skills acquired during aquatic exercise are more effectively transferred to a reactive balance task than land exercise. This study is designed as a double-blinded, randomized controlled clinical trial. Forty-four older adults aged 65 years or above who meet the eligibility criteria will be recruited and randomized into an aquatic exercise group or land exercise group. Each group will participate in the same single bout intervention that includes a ball throwing and catching task. A modified lean-and-release test will be implemented on land immediately before, after, and one week after the single bout intervention. The outcomes will include reaction time, rapid response accuracy, and mini-BESTest scores obtained from stepping and grasping reactions. All statistical analyses will be conducted using an intention-to-treat approach. Our conceptual hypothesis is that participants in the aquatic exercise group will demonstrate more improved outcome scores in the lean-and-release test when compared to those in the land exercise group. The results of the present study are expected to provide evidence to support the benefits of aquatic exercises for improving reactive balance in older adults. Further, participants may find aquatic exercises safer and more motivating, thus encouraging them to participate in further aquatic exercise programs.

An Intervention of 12 Weeks of Nordic Walking and Recreational Walking to Improve Cardiorespiratory Capacity and Fitness in Older Adult Women

(1) Background: The main aim of this study was to examine the effect of an intervention of 12 weeks in three groups on anthropometric measurement and heart rate (HR) variables, fitness index, and maximal oxygen consumption (VO2max) in older women. (2) Methods: In total, 166 Serbian adult women, aged 50 to 69 years old, participated in this study, comprising a control group (60 participants, μage = 57.8 + 6.6), Nordic-walking (NW) group (53 participants, μage = 57.5 + 6.8), and recreational-walking (RW) group (53 participants, μage = 57.8 + 6.6) in a physical fitness programme for 12 weeks. (3) Results: Anthropometric measurement variables were measured using a stadiometer and an electronic scale. The data showed differences in walking heart rate (bt/min) (p < 0.001; η2 = 0.088) between control, NW, and RW groups in the pretest analysis. Moreover, there were significant differences in walking heart rate (bt/min) (η2 = 0.155), heart rate at the end of the test (bt/min) (η2 = 0.093), total time of fitness index test (min) (η2 = 0.097), fitness index (η2 = 0.130), and VO2max (η2 = 0.111) (all, p < 0.001) between control, NW, and RW groups in the posttest analysis. (4) Conclusions: NW group training resulted in slightly greater benefits than RW group training. The present study demonstrated that both groups could act as modalities to improve the functionality and quality of life of people during the ageing process, reflected mainly in HR variables; UKK test measurements, and VO2max. It also contributes to the extant research on older women during exercise and opens interesting avenues for future research.

Systematic review of the effect of aquatic therapeutic exercise in breast cancer survivors

BACKGROUND

Aquatic therapeutic exercise can be equally effective or even superior to land-based exercise in improving several clinical variables. However, there is still a lack of knowledge on the effects compared to land-based interventions particularly in breast cancer (BC) patients.

OBJECTIVE

The objective of this study is to examine the effects of aquatic therapeutic exercise on pain, shoulder mobility, lymphedema, cardiorespiratory fitness, muscle strength, body composition, pulmonary function, cancer-related fatigue (CRF) and health-related quality of life (HRQoL) and which parameters are effective compared to similar land-based interventions.

METHODS

The databases used were PubMed, Scopus, Web of Science, Cochrane Library and CINAHL, retrieving 145 articles.

RESULTS

Eleven studies were included. Aquatic therapeutic exercise is feasible, safe, well tolerated and achieved high percentages of adherence. As for the assessed outcomes, moderate to large improvements were found compared to usual care or to land-based physical exercise interventions in pain, shoulder range of motion, pulmonary function, HRQoL, cardiorespiratory fitness and muscle strength. Inconclusive results were found for lymphedema, body composition and CRF.

CONCLUSIONS

Aquatic therapeutic exercise interventions using a combination of endurance, strength, mobility, stretching and breathing exercises resulted in improvements in common side effects of BC and its treatments. More studies on CRF, body composition and lymphedema need to be done to further evaluate the impact of the intervention on these outcomes.

The Inter-Rater and Intra-Rater Reliability of the Actual Aquatic Skills Test (AAST) for Assessing Young Children's Motor Competence in the Water

As children’s actual aquatic skills are important for the prevention of drowning as well as their engagement in lifelong aquatic physical activity, researchers and practitioners should be able to assess this vital concept accurately and reliably. Therefore, this study aimed to investigate the inter-rater and intra-rater reliability of the Actual Aquatic Skills Test (AAST), consisting of 17 different test items for the assessment of young children’s motor competence in the water. Six raters received a training and evaluation session on scoring the AAST, after which five of them assessed four test videos (of various children (n = 38) performing the test items) twice, with one to two weeks in between (i.e., test and re-test). Inter-rater and intra-rater reliability were determined per test video and for the different AAST test items across videos using Gwet’s Agreement Coefficient 2 (Gwet’s AC2). The Gwet’s AC2 for inter-rater reliability at the test varied from 0.414 to 1.000, indicating a moderate to perfect agreement between raters. For intra-rater reliability, it ranged from 0.628 to 1.000, demonstrating a good to perfect agreement between test and re-test scoring. In conclusion, the AAST is a promising tool to reliably assess young children’s actual aquatic skills in an indoor swimming pool.

Exercise effects on muscle quality in older adults: a systematic review and meta-analysis

To systematically review and analyse the effects of exercise on morphological and neuromuscular muscle quality (MQ) outcomes in older adults and assess a range of possible moderators that may affect the impact of exercise on MQ outcomes. Using PRISMA guidelines, randomised controlled trials were searched in CINAHL, EMBASE, LILACS, PubMed, SciELO, Web of Science, MedNar, OpenGrey and OpenThesis databases. Eligible trials examined the effects of exercise interventions on morphological and neuromuscular MQ in older adults (≥ 60 years). Twenty-one trials (n = 973 participants) were included. Exercise significantly improved morphological MQ (effect size (ES) = 0.32, 95% CI 0.13–0.51, P < 0.001) with significant results maintained for studies assessing muscle density and intermuscular adipose tissue (ES = 0.45–0.52, P < 0.05). For neuromuscular MQ, exercise provided significant positive effects (ES = 0.49, 95% CI 0.29–0.69, P < 0.001) but only maintained for physically healthy participants (ES = 0.43, P < 0.001), resistance exercise interventions (ES = 0.64, P < 0.001), or studies assessing 1-RM or knee extensor isokinetic muscle strength relative to leg lean mass (ES = 0.48–0.62, P = 0.001). Associations between exercise duration and changes in MQ measures were not observed (P > 0.05). Supervised exercise interventions significantly improved different measures of MQ regardless of exercise duration, although these effects were small-to-moderate and not supported across all population-, exercise-, and methods-related features.

Does a Multicomponent Exercise Program Improve Physical Fitness in Older Adults? Findings From a 5-Year Longitudinal Study

The objective was to assess the physical fitness of older adults participating in a 5-year multicomponent exercise program. The sample consisted of 138 older adults aged 60-93 years (70.4 ± 7.8 years) evaluated with the Senior Fitness Test (muscle strength, flexibility, balance, and cardiorespiratory fitness). The multicomponent program was carried out between the months of March and November of each year. Data were analyzed using generalized estimating equations (factor year: Year 1, Year 2, Year 3, Year 4, and Year 5; factor time: pretest and posttest) with Bonferroni's post hoc test. Participation in the multicomponent exercise program for 5 years (baseline pretest Year 1 and follow-up Year 5) improved lower and upper limb strength, lower limb flexibility, and balance and cardiorespiratory fitness, while upper limb flexibility was maintained. Year-by-year analysis revealed variable patterns for each fitness parameter. The results of this study show the potential benefits of implementing a long-term community-based exercise program.

A systematic review and meta-analysis comparing the effect of aquatic and land exercise on dynamic balance in older adults

BACKGROUND

Balance impairments are the leading causes of falls in older adults. Aquatic-based exercises have been broadly practiced as an alternative to land-based exercises; however, the effects on dynamic balance have not been comprehensively reviewed and compared to land exercises. Thus, the purpose of this systematic review and meta-analysis was to compare the effectiveness of aquatic exercises (AE) to land exercises (LE) on dynamic balance in older adults.

METHODS

Electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, psycINFO), from inception to November 2019, were searched. Studies met the following eligibility criteria: Randomized controlled trials, English language, older adults aged 65 years or older, a minimum of one AE and LE group, at least one assessment for dynamic balance. For the meta-analysis, the effect sizes of dynamic balance outcomes were calculated using a standardized mean difference (SMD) and a 95% confidence interval (CI).

RESULTS

A total of 11 trials met the inclusion criteria, and 10 studies were eligible for the meta-analysis. The meta-analysis presented that older adults in AE groups demonstrated comparable enhancements in dynamic steady-state balance (SMD = - 0.24; 95% CI, -.81 to .34), proactive balance (SMD = - 0.21; 95% CI, -.59 to .17), and balance test batteries (SMD = - 0.24; 95% CI, -.50 to .03) compared with those in LE groups.

CONCLUSIONS

AE and LE have comparable impacts on dynamic balance in older adults aged 65 years or older. Thus, this review provides evidence that AE can be utilized as a reasonable alternative to LE to improve dynamic balance and possibly reduce the risk of falls.

Randomized Clinical Trial of Water-Based Aerobic Training in Older Women (WATER Study): Functional Capacity and Quality of Life Outcomes

BACKGROUND

The purpose of this study was to investigate the effects of 2 water-based aerobic training programs on functional capacity and quality of life (QoL) of older women.

DESIGN

Randomized clinical trial.

METHODS

A total of 41 women (64.3 [3.1] y) were randomized into a continuous (CTG) and an interval (ITG) water-based aerobic training group. Training programs were performed with exercise intensity based on rating of perceived exertion throughout 12 weeks (twice a week). Functional tests with and without dual-task and QoL questionnaire were applied pretraining and posttraining. Per protocol and intention to treat analysis were conducted using generalized estimating equations, with Bonferroni post hoc test (α = .05).

RESULTS

The per protocol analysis showed an increase in the 30-second chair stand (6% [12%] vs 18% [13%]), 6-minute walk (4% [7%] vs 2% [8%]), and 5-m habitual gait velocity (6% [11%] vs 4% [7%]) tests after CTG and ITG training groups. In addition, the intention to treat analysis revealed an increase in the 30-second chair stand test (7% [13%] vs 12% [13%]) and physical domain of QoL (8% [26%] vs 14% [22%]) after CTG and ITG training groups, as well as an increase in the gait velocity with verbal task after CTG (6% [11%]).

CONCLUSIONS

Both water-based aerobic training programs induced similar improvements in the functional capacity and maintained the QoL perception in older women.

Comparative effects of water- and land-based combined exercise training in hypertensive older adults

OBJECTIVES

A randomized controlled trial was designed to compare water- and land-based combined (aerobic and resistance) exercise training programs on cardiometabolic parameters, functional fitness, and quality-of-life (QoL) in hypertensive older adults.

METHODS

Fifty-three participants were divided into three groups: 1) land-based exercise group (LET, n=17), 2) water-based exercise group (WET, n=16), and 3) control group (CON, n=20). All programs comprised of a 12-week supervised training program (three 1-hr sessions per week), followed by a 12-week self-supervised training program. Blood pressure (BP), glutathione peroxidase (GPx), total nitrite/nitrate (NOx-), malondialdehyde (MDA), high-sensitive C-reactive protein (hs-CRP), blood lipids, functional fitness, and QoL were assessed before and after each period.

RESULTS

Following the supervised period, systolic BP, rate-pressure product, GPx, NOx-, MDA, hs-CRP concentrations, physical and psychological domains, and overall QoL significantly improved in both training groups. Only the WET improved LDL-C and lipoprotein combine index. Meanwhile, the 30s chair-stand test and 2-min step test improved only in the LET. Succeeding the self-supervised period, systolic BP and NOx- concentration significantly improved in both training groups. Notwithstanding, the 30s chair-standing and arm curl tests improved only in the LET.

CONCLUSIONS

Both training programs rendered ameliorated systolic BP, antioxidant capacity and inflammation, muscular strength, aerobic endurance and QoL with a higher progression in the LET. Nevertheless, metabolic variables were greater improved in the WET. Additionally, due to greater exercise participation, the WET program may be a useful tool in motivating hypertensive older adults to continuously exercise on their own.

Muscle Activation and Distribution during Four Test/Functional Tasks: A Comparison between Dry-Land and Aquatic Environments for Healthy Older and Young Adults

BACKGROUND

The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water.

AIM

To compare muscle activity between two groups (healthy young adults (HYA) and healthy older adults (HOA)) in two different environments (dry land and aquatic) using surface electromyography during the execution of four different test/functional movements.

METHODS

Analytical cross-sectional study. HYA and HOA carried out four functional tasks (Step Up and Down, Sit To Stand test, Gait Initiation and Turns During Gait) in two different environments (dry land and aquatic). Absolute and relative muscle activation was compared between each group and between each environment. In addition, the stability of the measured was calculated through a test-retest (ICC 2:1).

RESULTS

Within the same environment there were significant differences between young and older adults in three of the four functional tasks. In contrast, in the gait initiation, hardly any significant differences were found between the two groups analysed, except for the soleus and the anterior tibial. Measurement stability ranged from good to excellent.

CONCLUSIONS

Level of the musculature involvement presents an entirely different distribution when the test/functional task is performed on dry land or in water. There are differences both in the relative activation of the musculature and in the distribution of the partition of the muscles comparing older and young adults within the same environment.

Effect of water exercise in blood pressure and sleep quality of hypertensive adults

BACKGROUND

Together with ageing there is an increase in blood pressure levels. However, physical activity is one of the most recommended strategies for preventing the increase of blood pressure. Water exercise involves numerous advantages, one of which is the comfort proportioned by water temperature. The aim of this study was to evaluate the effects of a water exercise program on blood pressure, physical fitness, quality of sleep and the likelihood of having sleep apnea (SA) in hypertensive adults.

METHODS

We evaluated 21 sedentary hypertensive subjects of both sexes. The water exercise was conducted over 13 weeks, three times/week, 50 min/day. Resting blood pressure, height, body weight, waist and hip circumference, functional capability, as well as sleep quality and the likelihood of having sleep apnea were evaluated before and after the experimental period.

RESULTS

There was a significant decrease in systolic and mean blood pressure. Significant increases in strength, muscular and aerobic endurance, coordination, agility, dynamic balance and flexibility were also seen. In addition, a reduction in the likelihood of sleep apnea was identified, despite a deterioration in sleep quality.

CONCLUSIONS

Water exercise was effective in reducing systolic blood pressure, in improving functional capacity variables, and in reducing probability of sleep apnea in hypertensive subjects, however it promoted worsening of sleep quality.

Balance as an Additional Effect of Strength and Flexibility Aquatic Training in Sedentary Lifestyle Elderly Women

Objective

To evaluate the additional effects of on balance an aquatic muscle strengthening and flexibility training program in healthy sedentary lifestyle elderly women.

Method

This controlled clinical trial included 56 healthy sedentary women, aged from 65 to 70 years, divided into two groups. The aquatic group (AG) underwent aquatic training (45 minutes/session, 32 sessions), and the control group (CG) received no intervention. Data were collected pre- and post-intervention, during a one-week period. Lower limb muscle strength was measured by a force sensor (myometer). Flexibility was measured by biophotogrammetry. Functional balance was evaluated by the Performance Oriented Mobility Assessment (POMA) and the Berg Balance Scale (BBS).

Results

Muscle strength, flexibility, and balance improved in AG (p < 0.001), but not in CG.

Conclusion

The aquatic exercises program, which was originally developed to promote muscle strength and flexibility, also improved functional balance. Aquatic training is an option for physical health promotion for sedentary lifestyle elderly women.

Water-based continuous and interval training in older women: Cardiorespiratory and neuromuscular outcomes (WATER study)

The purpose of this study was to investigate the effects of two water-based aerobic programs on cardiorespiratory and neuromuscular outcomes in older women. Forty-one women (60 to 75 years old) volunteered to participate in the study. Participants were randomized into a water-based continuous (CTG; n = 21; 63.9 ± 2.5 years) or an interval (ITG; n = 20; 64.8 ± 3.6 years) aerobic training group. Both training programs were performed for 12 weeks (45-min sessions twice a week), with exercise intensity based on rating of perceived exertion (Borg's RPE 6-20 Scale). Pre and post training assessments of cardiorespiratory and neuromuscular outcomes were performed. Data analyses were conducted using Generalized Estimating Equations and Bonferroni post-hoc test (α = 0.05). After the intervention, the CTG and the ITG displayed similar improvements in time to exhaustion (8% vs. 11%), peak oxygen uptake (9% vs. 7%), maximal dynamic knee extension strength (5% vs. 6%), dynamic muscular endurance of knee extensors (10% vs. 11%), maximal vastus lateralis electromyographic signal amplitude (13% vs. 35%), as well as an increase in muscle thickness (5% vs. 6%) and decrease in muscle echo intensity (-2% vs. -3%) of the quadriceps femoris. In conclusion, older women benefited from water-based exercise training prescribed based on participants' RPE, with both the interval and the continuous training programs resulting in similar increases in the cardiorespiratory and neuromuscular parameters.

Five Weeks of Aquatic-Calisthenic High Intensity Interval Training Improves Cardiorespiratory Fitness and Body Composition in Sedentary Young Adults

Aquatic exercise may be better tolerated by sedentary, overweight individuals than land-based exercise. The purpose of the present study was to determine the effects of five weeks of aquatic high-intensity interval training (AHIIT) using standard calisthenic pool exercises, on cardiorespiratory fitness and body composition in sedentary young adults. Eleven college-age participants (9 women, 2 men) completed 15 exercise sessions that included three sessions per week for five weeks. Each session consisted of a five-minute warm-up period, 25 minutes of exercise, and a five-minute cool down. A training progression based upon standard progression principals from a pilot study was implemented. The exercises consisted of 25 exercise intervals lasting 10-30 seconds in duration, utilizing combinations of 8-12 different exercises. Twenty-two standard aquatic upper body, lower body, and full body aerobic exercises, most of which utilized aquatic dumbbells or hand paddles, were performed in an AHIIT protocol during each exercise session. Reductions in body composition (32.6 to 30.6% fat), submaximal (169 to 165 b·min^-1) and peak heart rate (199 to 192 b·min^-1), submaximal VO₂ (21.7 to 19.3 ml·kg^-1·min^-1 and peak VO₂ (30.5 to 31.95 ml·kg^-1·min^-1) occurred from pre- to post-program. This is the first study to determine the effectiveness of standard aquatic calisthenic exercises used in an AHIIT protocol. Improvements in cardiorespiratory fitness and exercise economy as well as body composition were observed in these sedentary individuals.

Evaluation of aquafitness exercise on the physical and mental health of older women: a pilot study

Physical activity is a priority to improve health. However, a sedentary lifestyle is increasingly becoming the norm. For example, in Mexico, sedentarism has increased, especially among older women. This study evaluated the effects of aquafitness on the health of older women in Mexico. Healthy older women performed aquafitness exercise and were compared to a control group of comparable women. Outcome assessments performed at baseline and after 17-weeks included psychological and physical/anthropometric measures. Participants in aquafitness became more optimistic, lost more weight, body fat, and a subsequent decrease in BMI, compared to controls. The results suggest important avenues for future research.

Vertical Ground Reaction Force During a Water-Based Exercise Performed by Elderly Women: Equipment Use Effects

Purpose: The present study aimed to compare the vertical ground reaction force responses during the performance of the stationary running water-based exercise with and without equipment at different cadences by elderly women. Method: Nineteen elderly women (age: 68.6 ± 5.0 years; body mass: 69.0 ± 9.5 kg; height: 154.9 ± 5.6 cm) completed one session consisting of the performance of the water-based stationary running with elbow flexion and extension immersed to the xiphoid process depth. The exercise was performed in three conditions, without equipment, with water-floating and with water-resistance equipment, at three cadences (80 b·min^-1, 100 b·min^-1 and maximal) in a randomized order. Peak and impulse of vertical ground reaction force were collected during the exercise using an underwater force plate. Repeated measures two-way ANOVA was used (α = 0.05). Results: Peak vertical ground reaction force (p < .001) and impulse (p ≤ 0.002) resulted in lower values for the water-floating use (0.42-0.48 BW and 0.07-0.13 N.s/BW) in comparison to the water-resistance equipment use (0.46-0.60 BW and 0.09-0.16 N.s/BW) and to the non-use of equipment (0.45-0.60 BW and 0.07-0.17 N.s/BW), except for the impulse at the maximal cadence. In addition, peak vertical ground reaction force at 80 b·min^-1 (p = .002) and impulse at the maximal cadence (p < .001) showed lower values compared to the other cadences. Conclusion: The use of water-floating equipment minimizes the vertical ground reaction force during the stationary running water-based exercise performed by elderly women regardless of the cadence.

Fitness-related benefits: land-based versus aqua-base

BACKGROUND

It is well documented that individuals participating in land-based aerobic activities receive several fitness-related benefits. Given its virtual weightlessness, thermoregulatory comfort, and ease of movements, aqua-based aerobic activities are commonly perceived as a simpler form of exercise, therefore, lacking the fitness-related benefits equivalent to that of land-based aerobic activities. The purpose of this study was to compare fitness-related benefits between land-based (LAND) versus aqua-based (AQUA) aerobic activity classes within a 15-week period.

METHODS

One hundred and fifty-four volunteers participating in LAND (N.=76) and AQUA (N.=78) exercise groups were required to exercise 2 days per week, 50 minutes per day, for 15 weeks. Pre- and post-fitness assessments obtained were body composition, muscular endurance, muscular strength, cardiorespiratory endurance, and flexibility.

RESULTS

Mixed ANOVA showed a main effect and interaction for body composition in which, overall, participants decreased more body fat percentage in the land group. A main effect for both muscular strength and muscular endurance was revealed, but no interactions. There were no significant main effects or interactions for neither cardiorespiratory endurance nor flexibility.

CONCLUSIONS

Individuals participating in land-based aerobic activities displayed greater decreases in percent body fat when compared to aqua-based aerobic activities, whereas both land- and aqua-based displayed improvements in muscular strength and muscular endurance. There were no changes in cardiorespiratory endurance and flexibility within both groups.

Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review

BACKGROUND

According to the World Health Organization, the elderly are at the highest risk of injury or death from a fall. Age-related changes in strength, balance and flexibility are degenerative factors that may increase the risk of falling, and an aquatic training may offer a favourable environment to improve these modifiable risk factors.

METHODS

A systematic review was conducted to assess the potential preventative role of aquatic exercise for reducing the risk of falls in the elderly by improving predisposing risk factors. Electronic databases and reference lists of pertinent articles published between 2005 and 2018 were searched. Randomized controlled trials (RCTs) that directly or indirectly addressed the effect of aquatic exercise for the prevention of falls in healthy participants were included within the synthesis. Studies were included if they were reported between January 2005 and May 2018 within a population aged between 60 and 90 years old that were without exercise-effecting comorbidities. Data related to participant demographics, study design, methodology, interventions and outcomes was extracted by one reviewer. Methodological quality assessment was independently performed by two reviewers using the PEDro (Physiotherapy Evidence Database) scale.

RESULTS

Fourteen trials met the inclusion criteria. Exercise intervention duration and frequency varied from 2 to 24 weeks, from 2 to 3 times per week, from 40 to 90 min per session. Fall rate was not reported in any of the studies analysed. However, aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling.

CONCLUSIONS

There is limited, low-quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling. Although the evidence is limited, and many interventions are not well described, these results should be considered by health and exercise professionals when making evidence-based, clinical decisions regarding training programmes to reduce the risk of falling.

Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies

The prevalence of obesity in combination with sarcopenia (the age-related loss of muscle mass and strength or physical function) is increasing in adults aged 65 years and older. A major subset of adults over the age of 65 is now classified as having sarcopenic obesity, a high-risk geriatric syndrome predominantly observed in an ageing population that is at risk of synergistic complications from both sarcopenia and obesity. This Review discusses pathways and mechanisms leading to muscle impairment in older adults with obesity. We explore sex-specific hormonal changes, inflammatory pathways and myocellular mechanisms leading to the development of sarcopenic obesity. We discuss the evolution, controversies and challenges in defining sarcopenic obesity and present current body composition modalities used to assess this condition. Epidemiological surveys form the basis of defining its prevalence and consequences beyond comorbidity and mortality. Current treatment strategies, and the evidence supporting them, are outlined, with a focus on calorie restriction, protein supplementation and aerobic and resistance exercises. We also describe weight loss-induced complications in patients with sarcopenic obesity that are relevant to clinical management. Finally, we review novel and potential future therapies including testosterone, selective androgen receptor modulators, myostatin inhibitors, ghrelin analogues, vitamin K and mesenchymal stem cell therapy.

Water-based aerobic training improves strength parameters and cardiorespiratory outcomes in elderly women

The aim of the present study was to compare the effects of water-based aerobic training and water-based resistance training on muscular strength and cardiorespiratory fitness in older women. Sixty-nine individuals were randomized into the following three groups: the water-based aerobic training (WA, n = 23) group, the water-based resistance training (WR, n = 23) group, and the control group (CG, n = 23). Participants were trained two times per week for 10 weeks. The trainings presented a linear periodization with an increase in the volume-intensity relation. Maximal dynamic muscular strength and the cardiorespiratory fitness were evaluated before the start of training and after 10 weeks of training. Only the WA group showed an increase in maximal oxygen consumption (13.8%) and oxygen consumption at the second ventilatory threshold (16.4%). Maximal dynamic strength of knee extensors improved in 10.6% of WA, 8.0% of WR, and 4.7% of CG participants, without any difference between the groups. Maximal dynamic strength of knee flexors was increased in 14.1% of WA and in 17.7% of WR participants; however, it remains unchanged in CG participants. No differences were observed in resting heart rate, peak heart rate, heart rate at the second ventilatory threshold and maximal dynamic strength of shoulder horizontal flexors. It was concluded that WA seems to be more efficient for improvement in cardiorespiratory responses, and both WA and WR were efficient for development of maximal dynamic strength of knee flexion and extension.

Effects of a short-term aquatic exercise intervention on symptoms and exercise capacity in individuals with chronic fatigue syndrome/myalgic encephalomyelitis: a pilot study

PURPOSE

This pilot pre-and post-intervention study investigated the effects of a short-term aquatic exercise programme on physiological outcomes, symptoms and exercise capacity in women with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

METHODS

Eleven women (54.8 ± 12.4 year) volunteered for the 5-week program; an initial 20-min aquatic exercise session then two self-paced 20-min sessions per week for 4 weeks. Pre- and post-intervention outcomes were physiological measures, 6 min Walk Test (6MWT), perceived exertion (RPE), hand grip strength, Sit-to-Stand, Sit-Reach test, Apley's shoulder test, FACIT questionnaire, and 24-h post-test tiredness and pain scores (0-10 visual analogue scale). Heart rates, RPE, 24- and 48-h post-session tiredness/pain scores were recorded each session.

RESULTS

6MWT distance increased by 60.8 m (p = 0.006), left hand grip strength by 6 kg (p = 0.038), Sit-Reach test by 4.0 cm (p = 0.017), right shoulder flexibility by 2.9 cm (p = 0.026), FACIT scores by 8.2 (p = 0.041); 24-h post-test tiredness and pain decreased by 1.5 and 1.6, respectively (p = 0.002). There were significant post-intervention increases in exercising heart rates (6MWT 4- and 6-min time points), oxygen saturation at 2-min, and reduced RPE at 4-min. Weekly resting and exercising heart rates increased significantly during the study but RPE decreased; immediately post- and 24-h post-session tiredness decreased significantly. There were no reports of symptom exacerbation.

CONCLUSIONS

Five weeks of low-moderate intensity aquatic exercise significantly improved exercise capacity, RPE and fatigue. This exercise mode exercise may potentially be a manageable and safe physical activity for CFS/ME patients.

The effect of 12 weeks of water-aerobics on health status and physical fitness: An ecological approach

The main purpose of the present study was to verify the effects of a 12-week water aerobics program in a real-life context on health indicators and physical fitness in adults and older adults. Fifteen volunteers (58.80 ± 14.32 years old) were part of an experimental group (Exercise), and eight volunteers (59.00 ± 12.26 years old) were part of the control group (Control). The Exercise performed 45 min of water aerobics twice a week for 12 weeks; no physical exercise was permitted for the Control during the same period. The evaluations were performed the week before (pre-training) and after the training program (post-training). The primary outcomes were the strength and cardiorespiratory fitness variables and the secondary outcomes included body anthropometry, lipid profile and blood pressure. Adjusted analysis for age and baseline values showed no differences between Exercise and Control in post-training moment. However, there was a moderated tendency for increased explosive strength of the upper limbs (ηp2 = 0.17), reduced body fat (ηp2 = 0.17), reduced systolic blood pressure (ηp2 = 0.14) and triglycerides (ηp2 = 0.19) in Exercise. Within groups changes showed that the training program caused an increase mainly in explosive strength in the upper limbs (0.26 m, 95% CI, 0.03, 0.49; ES = 0.63) In addition, there was a significant decrease in fat mass (-0.89%, 95% CI, -1.74, -0.03; ES = 0.61) and in the systolic blood pressure (-0.83 mmHg, -1.46, -0.19; ES = 0.71). Nonetheless, no significant changes were observed for the lipid profile. These results suggest that 12 weeks of water aerobics performed twice a week in a real-life context seem to benefit the explosive strength, body composition, and blood pressure of adults and older adults but is insufficient to alter cardiorespiratory fitness and lipid profiles.

Community Capacity Building Exercise Maintenance Program for Frail Elderly Women

PURPOSE

The purpose of this study was to examine the effects of community capacity building exercise maintenance program for frail elderly women.

METHODS

A quasiexperimental pretest-posttest design was used with nonequivalent control group. The experimental group (n = 22) received community capacity building exercise maintenance program, whereas the control group (n = 23) received health physical exercise program for 16 sessions over 8 weeks. The data of physical fitness, body compositions, self-efficacy, and health-related quality of life were collected three times for both group: before the intervention, immediately after the intervention, and 8 weeks after the intervention. Analyses were conducted using χ² test, t test, Fisher's exact test, and repeated measures analysis of variance.

RESULTS

Compared to the control group, muscular strength (p = .002), static balance (p = .013), muscular endurance (p = .003), self-efficacy (p < .001), and health-related quality of life (p = .030) were significantly improved in the experimental group. In addition, body fat percentage (p = .005) in this group was significantly decreased after the community capacity building exercise maintenance program.

CONCLUSION

Theses results indicated that a community capacity building exercise maintenance program is feasible, and associated with exercise maintenance among frail elderly women.

MUSCLE STRENGTH, GH AND IGF-1 IN OLDER WOMEN SUBMITTED TO LAND AND AQUATIC RESISTANCE TRAINING

ABSTRACT Introduction: Aging leads to decline in multiple organ systems associated to hormone alterations and loss of muscle mass and strength. Objective: To evaluate the effects of land and water resistance training on muscle strength, basal serum levels of GH, IGF-1, and IGFBP3 in elderly women. Methods: Subjects were distributed in three groups: land resistance training (LRT; n=10; age: 66.10±2.77 years), water resistance training (WRT; n=10; age: 67.10±3.54 years) and control (CG; n=10; age: 68.80±5.41 years). Muscle strength was assessed with the 1-RM test in bench press (BP) and leg press (LP) exercises. Serum levels of GH, IGF-1, and IGFBP3 were analyzed by chemiluminescence. Results: Repeated measures ANOVA showed elevated muscle strength in the BP only in LRT (D%=60.2%; p=0.0001) when compared to the CG (D%=46.73%, p=0.0001) and WRT (D%=32.49%, p=0.004). LRT and WRT increased muscle strength in LP (D%LRT=57.14%; p=0.004; D%WRT=42.3%; p=0.033). There was an increase in LRT and WRT in the LP when compared to CG (D%=45.59%, p=0.019; D%=43.97%, p=0.026, respectively). IGF-1 was elevated only in LRT (D%=49.72%, p=0.004) from pre- to post-test and when compared to WRT (D%=56.76%, p=0.002) and CG (D%=74.63%, p=0.0001). IGFBP3 levels showed that only WRT increased (D%=26.79%, p=0.044) from pre- to post-test. The IGF-1/IGFBP3 ratio demonstrated that LRT reached intragroup elevation (D%=52.66%, p=0.002) and when compared to WRT (D%=94.11%, p=0.0001) and CG (D%=73.45%, p=0.0001). There was no significant difference in GH. Conclusion: Land resistance training may provide better anabolic effects in elderly women.

The Relative Efficacy of Land-Based and Water-Based Exercise Training on Macro- and Microvascular Functions in Older Patients With Type 2 Diabetes

Microvascular and macrovascular dysfunction plays an important role in the pathogenesis of diabetic vascular disease. Twenty-nine older patients with type 2 diabetes were randomly assigned into the land-based (LB; n = 14) or water-based (WB; n = 15) groups. Both groups completed supervised aerobic cycling exercises three times per week for 12 weeks. The WB group performed cycling exercise training in warm water (36 °C) immersed to the hip level. After 12 weeks, blood glucose concentration and insulin resistance did not change but hemoglobin A1c levels decreased (P < .05) in both groups. Plasma nitric oxide concentrations increased (P < .05) in both groups. Flow-mediated dilation in the popliteal artery increased and arterial stiffness decreased (P < .05) in both exercise groups. Indices of microvascular reactivity improved (P < .05) only in the WB group. The benefits of warm water-based training were similar in general, and superior in some measures, to the more established land-based cycling exercise.

Horizontal ground reaction forces to stationary running performed in the water and on dry land at different physiological intensities

The aim of the present study was to compare the peak anterior-posterior (Fy) and medio-lateral (Fx) ground reaction forces (GRFs) of women performing stationary running at different intensities in aquatic and dry land environments. Fourteen young women performed the stationary running exercise at three cadences (first ventilatory threshold, second ventilatory threshold and maximum effort, as determined during exercise in water) in aquatic and dry land environments. Two-way repeated measures ANOVA was used to analyse the data (α = .05). As a result, significantly lower peak Fy anterior, Fy posterior, Fx medial and Fx lateral values were observed for the aquatic environment, except for the Fy posterior at the first ventilatory threshold. Significant differences were observed between cadences in the peak Fy anterior, Fy posterior, Fx medial and Fx lateral values, with higher values for the cadence corresponding to maximum effort compared to the first ventilatory threshold, except for the Fy posterior and Fx medial in the aquatic environment. The results indicate that the horizontal GRFs are reduced in the aquatic environment and depend on the intensity of stationary running exercise performance.

Effects of water-based exercise on bone health of middle-aged and older adults: a systematic review and meta-analysis

BACKGROUND

Age-related bone loss is a major health concern. Only exercises associated with high-impact and mechanical loading have been linked to a positive effect on bone turnover; however, these types of exercises may not always be appropriate for middle-aged and older adults due to physical decline or chronic disorders such as osteoarthritis. Water-based exercise (WBE) has been shown to affect different components of physical fitness, has lower risks of traumatic fracture, and applies less stress to joints. However, the effects of WBE on bone health are unclear.

OBJECTIVE

This study aimed to explore whether WBE is effective in preventing age-related bone deterioration in middle-aged and older adults.

METHODS

A search of relevant databases and the references of identified studies was performed. Critical narrative synthesis and meta-analyses were conducted.

RESULTS

Eleven studies, involving 629 participants, met all inclusion criteria. All participants were postmenopausal women. Eight studies compared WBE to a sedentary control group, and four studies had land-based exercise (LBE) participants as a comparison group. Meta-analyses revealed significant differences between WBE and control group in favor of WBE for changes in bone mineral density (BMD) at the lumbar spine (mean difference [MD] 0.03 g/cm²; 95% confidence interval [CI]: 0.01 to 0.05) and femoral neck (MD 0.04 g/cm²; 95% CI: 0.02 to 0.07). Significant differences were also revealed between WBE and LBE in favor of LBE for changes in lumbar spine BMD (MD -0.04 g/cm²; 95% CI: -0.06 to -0.02). However, there was no significant difference between WBE and LBE for changes in femoral neck BMD (MD -0.03 g/cm²; 95% CI: -0.08 to 0.01).

CONCLUSION

WBE may have benefits with respect to maintaining or improving bone health in postmenopausal women but less benefit when compared to LBE. Further research is required on this topic.

The effect of aquatic exercise on physical functioning in the older adult: a systematic review with meta-analysis

BACKGROUND

ageing and sedentary behaviour cause negative changes in the neuromuscular systems of healthy older adults resulting in a decrease in physical functioning. Exercising in water (aquatic exercise, AE) has been shown to be effective at improving physical functioning in this population; however, no systematic review with meta-analysis has been published.

PURPOSE

to investigate the effect of AE on physical functioning in healthy older adults compared to control or land-based exercise (LE) through a systematic review with meta-analysis of randomised controlled trials.

DATA SOURCES

Medline, Embase, Cinahl, PEDro, SPORTDiscus, Web of Science, Cochrane Library, published before 31st December 2015.

STUDY SELECTION

in total, 28 studies met the inclusion criteria and were included in the systematic review; 24 studies with 1,456 subjects (89% female) and with mean age 66.4 years were included in the meta-analysis.

DATA EXTRACTION

data were extracted and checked for accuracy by three independent reviewers.

DATA SYNTHESIS

size of treatment effect was measured using the standardised mean difference with 95% confidence intervals (CIs).

RESULTS

compared to control interventions, AE had a moderate positive effect on physical functioning 0.70 [95% CI 0.48 to 0.92]. Compared to LE, AE had a small positive effect on physical functioning 0.39 [0.12 to 0.66].

LIMITATIONS

there is a high risk of bias and low methodological quality in the studies particularly when comparing AE to LE with possible over estimation of the benefit of AE.

CONCLUSIONS

AE may improve physical functioning in healthy older people and is at least as effective as LE.