The effects of water temperature on cerebral blood flow during aquatic exercise.

PURPOSE: Recent studies suggest that episodic increases in cerebral blood flow (CBF) may contribute to the improvement in brain health associated with exercise training. Optimising CBF during exercise may enhance this benefit. Water immersion in ~ 30-32 °C augments CBF at rest and during exercise; however, the impact of water temperature on the CBF response has not been investigated. We hypothesised that cycle ergometry in water would increase CBF compared to land-based exercise, and that warm water would attenuate the CBF benefits. METHODS: Eleven young heathy participants (nine males; 23.8 ± 3.1 yrs) completed 30 min of resistance-matched cycle exercise in three separate conditions; non-immersion (Land), 32 °C and 38 °C water immersion up to the level of the waist. Middle cerebral artery velocity (MCAv), blood pressure, and respiratory measures were assessed throughout the exercise bouts. RESULTS: Core temperature was significantly higher in the 38 °C immersion than 32 °C (+ 0.84 ± 0.24 vs + 0.04 ± 0.16, P < 0.001), whilst mean arterial pressure was lower during 38 °C exercise compared to Land (84 ± 8 vs 100 ± 14 mmHg, P < 0.001) and 32 °C (92 ± 9, P = 0.03). MCAv was higher in 32 °C immersion compared to the Land and 38 °C conditions throughout the exercise bout (68 ± 10 vs 64 ± 11 vs 62 ± 12 cm/s, P = 0.03 and P = 0.02, respectively). CONCLUSION: Our findings suggest that cycle exercise in warm water attenuates the beneficial impact of water immersion on CBF velocity due to redistribution of blood flow to subserve thermoregulatory demand. Our findings suggest that, whilst water-based exercise can have beneficial effects on cerebrovascular function, water temperature is a key determinant of this benefit.

Impact of Land Versus Water Environments on Orthostatic Hypotension in Older Adults: A Randomized Crossover Study.

BACKGROUND/OBJECTIVES: Orthostatic hypotension (OH) is a common condition among older adults that increases the risk of falls. The study objectives are to determine the influence of distinct environments (water vs. land) on OH and the consequent effects of walking in these environments in older adults. Additionally, we aimed to assess the differences in response between two groups: older adults with OH and those without OH. METHODS: A randomized crossover design was utilized including one session involving water walking and the other session involving land walking, with a 1- to 3-day washout period. Orthostatic hemodynamic measurements were obtained before, immediately after, and 2 hr after a 15-min walking session. Two subgroups were formed for analysis: participants with OH (n = 14, 81 ± 7 years) and participants without OH (n = 11, 84 ± 7 years). RESULTS: Compared with the land environment, an 86% reduction in the frequency of OH episodes was noted when the older adults were immersed in water. This reduction was accompanied by greater mean arterial pressure, while participants without OH showed no such changes. The frequency of OH episodes was similar when assessed immediately after emerging from the pool following water-based walking or after land-based walking. All participants exhibited elevated mean arterial pressure immediately after water-based walking, but not after land-based walking. Two hours after walking, all participants demonstrated similar mean arterial pressure and frequency of OH episodes, regardless of the environment. CONCLUSIONS: Water immersion resulted in a substantial reduction in the frequency of OH episodes among older adults. Additionally, the frequency of OH episodes was not affected by prior walking exercise in either environment. Significance/Implication: These findings underscore the safety and potential advantages of water-based exercise for older adults dealing with OH.

Effects of aquatic high intensity interval training on parameters of functional autonomy, mental health, and oxidative dysfunction in elderly subjects with type 2 diabetes.

The present study investigated the effects of aquatic exercise on parameters of functional autonomy, mental health, and oxidative dysfunction in elderly patients with DM2. A total of 130 elderly were included in the longitudinal clinical study and were attributed to the non-diabetic group (n = 27) and diabetes the group (n = 22). Both groups participated in 24 sessions of Hydro-HIIT, 48 h before and after Hydro-HIIT, the GDLAM index, depression, and anxiety scores and markers of oxidative dysfunction were quantified. After intervention, GI decreased in both groups (non-diabetes group = -24%; diabetes group = -22%) (p < 0.05), markers of depression (-46%), anxiety (-60%), DCFH-DA (-55%), SOD (+59%), TNF-α (-37%) and IL-1 (-48%) in diabetes group (p < 0.05). The intervention with Hydro-HIIT improves aspects related to functional autonomy, mental health, and exerts consequently, a modulating effect on oxidative stress and inflammatory response in elderly people diagnosed with DM2.

The effect of aquatic training and vitamin D3 supplementation on bone metabolism in postmenopausal obese women.

Purpose: Despite prevalence of studies indicating the positive effect of land-based exercise on bone metabolism, there are limited findings regarding the effect of aquatic exercise. The present study aimed to evaluate the effects of aquatic training and vitamin D3 supplementation on femur bone mineral density (BMD), serum 25(OH)D, and parathyroid hormone (PTH) in postmenopausal obese women with vitamin D insufficiency. Methods: 40 postmenopausal obese women were randomly divided into four groups of aquatic training + vitamin D3 intake group; (ATD), aquatic training with placebo intake group (AT), vitamin D3 intake group (D), and control group with placebo intake (CON). AT groups performed aerobic aquatic exercises for 8 weeks. Vitamin D3 supplementation groups consumed oral dose of 4000 IU/d for 8 weeks. Results: The femur BMD was significantly higher in the ATD than the AT and D and CON groups; in AT it was higher than the D and CON groups. Serum 25(OH)D level in the ATD was more than AT and CON, and in the D was more than the CON and AT. PTH in the ATD group was lower compared to AT, D, and CON groups. PTH was lower in the AT and D compared to the CON. Conclusion: In postmenopausal obese women with vitamin D insufficiency or deficiency, combining vitamin D supplementation and aquatic training was the most effective method for improving bone metabolism; Vitamin D supplementation (alone) was not sufficient to affect some of bone metabolism indices; Aquatic training could not improve serum vitamin D. By priority, ATD, AT, and D indicated better bone related metabolism indices.

The effect of aquatic and land exercise on the mental well-being of women following breast cancer surgery-comparative study.

PURPOSE: Women after surgical treatment of breast cancer are less likely to engage in physical activity and may exhibit depressive symptoms even for many years post-treatment. The aim of the study was to compare the impact of 6 months aquatic and land exercise on mental well-being of women after breast cancer surgery. METHODS: The study was based on a survey which involved a total of 90 women ≥ 50 years of age (including 60 subjects after treatment of breast cancer ≥ 2 years after surgery and 30 healthy control). The study participants were divided into three groups, i.e. women attending general exercise sessions in a gym (A, n = 30), participating in aquatic exercise (B, n = 30), as well as healthy female peers reporting no regular physical exercise for the period of 6 months (C, n = 30). The present data were acquired using standardized questionnaires designed to assess physical activity (IPAQ-SF), mental well-being (WHO-5) and level of anxiety, i.e., Generalized Anxiety Disorder Questionnaire (GAD-7). RESULTS: Both the aquatic and land exercise had positive effect on mental well-being of woman after breast cancer surgery and there were no significant differences between them. Analysis of the anxiety level (GAD-7) confirms that women after breast cancer treatment were more exposed to a feeling of generalised anxiety disorder, i.e. 8.67 vs. 6.73, 4.5 (p = 0.001). The results of WHO-5 index were significantly higher in the A and B groups comparing to healthy control, i.e. 13.27 vs. 14.18; 10.10 (p < 0.001), but the obtained results still indicate the low self-esteem of the study group. Women after breast cancer surgery who regularly participated in aquatic exercise were engaged in more vigorous physical activity compared to the other groups, i.e. 1049.33 vs. 521.33; 860.00 MET min/week (p = 0.001). CONCLUSION: Regardless of the type of physical activity, 6 months aquatic and land exercise contributed to improved mental well-being and ensured adequate levels of moderate physical activity of woman after BC surgery. Regular physical activity is crucial in the rehabilitation after mastectomy and can be an effective treatment to achieve beneficial mental outcomes.

Effects of exercise during water immersion on arterial function in humans.

Flow-mediated dilation (FMD) provides a valid bioassay of vascular function in humans. Although water immersion induces hemodynamic effects that modify brachial artery shear stress, it is unclear whether water-based exercise modifies FMD. We hypothesized that exercise in 32°C water would decrease brachial artery shear and FMD relative to land-based exercise, whereas exercise in 38°C would increase brachial shear and FMD. Ten healthy participants (8 males; 23.9 ± 3.3 yr) completed 30 min of resistance-matched cycle exercise in three separate conditions: on land and in 32°C and 38°C water. Brachial artery shear rate area under the curve (SRAUC) was measured throughout each condition, with FMD measured pre- and postexercise. Brachial SRAUC increased during exercise in all conditions and was highest across the 38°C condition compared with Land and 32°C conditions (38°C: 27,507 ± 8,350 vs. Land: 9,908 ± 4,738 vs. 32°C: 13,840 ± 5,861 1/s, P < 0.001). Retrograde diastolic shear was greater during 32°C than both Land and 38°C conditions (32°C:-3,869 ± 2,198 vs. Land:-1,602 ± 1,334 vs. 32°C:-1,036 ± 1,754, P < 0.01). FMD increased as a result of 38°C (6.2 ± 1.9 vs. 8.5 ± 2.7%, P = 0.03), with no change in the Land exercise (6.3 ± 2.4 vs. 7.7 ± 2.4%, P = 0.10) or 32°C condition (6.4 ± 3.2 vs. 6.7 ± 3.2%, P = 0.99). Our findings indicate that cycle exercise in hot water attenuates retrograde shear, increases antegrade shear, and FMD. Exercise in 32°C water induces central hemodynamic changes relative to land-based exercise, but these do not translate to increases in FMD in either condition, likely due to the impact of increased retrograde shear. Our findings indicate that modification of shear has direct acute impacts on endothelial function in humans.

The Effectiveness of Aquatic Therapy on Motor and Social Skill as Well as Executive Function in Children With Neurodevelopmental Disorder: A Systematic Review and Meta-analysis.

OBJECTIVE: To summarize the evidence on the efficacy of aquatic therapy on motor and social skill as well as executive function compared with land-based exercises in children with neurodevelopmental disorders. DATA SOURCES: The following 6 databases were searched: Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, Google scholar (advance), and Web of Science from 1990 to June 2022. STUDY SELECTION: The search included only clinical trials. Two reviewers independently assessed the full text and conducted manuscript selection, data extraction, and quality assessment. DATA EXTRACTION: Using standardized forms, data were extracted and all points of disagreement were discussed between authors. DATA SYNTHESIS: Data synthesis was applied to summarize information from the included trials. The quantitative analysis incorporated fixed-effect models. Of the 150 studies identified in the initial search, 16 trials (248 children) met the eligibility criteria. Aquatic therapy improved factors related to the Humphries' Assessment of Aquatic Readiness (HAAR) checklist such as mental adjustment (standardized mean difference [SMD], 0.69; 95% confidence interval [CI], 0.20-1.19; I2=10%) compared with land-based exercises (control), water environment (SMD, 0.99; 95% CI, 0.43-1.54; I2=83%), Rotation (SMD, 0.63; 95% CI, 0.14-1.12; I2=0%), balance and control (SMD, 2.09; 95% CI, 1.47-2.72; I2=36%) and independent movement (eg, walking, moving upper body, standing, transferring) in water (SMD, 0.87; 95% CI, 0.37-1.38; I2=0%) compared with the control group in the 4 trails. The HAAR tool is based on the Halliwick method and aims to assess the appropriateness for an individual with disability to engage in aquatic therapy. The study protocol was also registered with PROSPERO number CRD42022341898. CONCLUSION: Aquatic therapy demonstrated a more robust positive effect on factors related to the HAAR checklist than land-based exercises. Further research is needed to further elucidate the clinical utility of aquatic therapy for children with neurodevelopmental disorder at long-term follow-up.

Efficacy and safety of aquatic exercise in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To examine the efficacy and safety of aquatic exercise for people with knee osteoarthritis. DATA SOURCES: PubMed, Web of Science, Embase, CENTRAL, CNKI and WanFang databases were searched from 1966 to September 2022. REVIEW METHODS: Randomized controlled trials evaluating aquatic exercise for people with knee osteoarthritis compared with no exercise and land-based exercise were included. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the certainty of evidence. RESULTS: Twenty-two studies with 1394 participants were included. Compared with no exercise (13 trials with 746 participants), low-to high-certainty evidence revealed that aquatic exercise yielded significant improvements in patient-reported pain (SMD -0.58, 95% CI -0.82 to -0.33), stiffness (SMD -0.57, 95% CI -1.03 to -0.11) and physical function (SMD -0.35, 95% CI -0.52 to -0.18) immediately postintervention. A sustained effect was observed only for pain at three months postintervention (SMD -0.48, 95% CI -0.91 to -0.06). The confidence intervals demonstrated that the pooled results do not exclude the minimal clinically important differences. There were no significant differences between the effects of aquatic exercise and land-based exercise (13 trials with 648 participants) on pain (SMD -0.12, 95% CI -0.29 to 0.04), stiffness (SMD -0.17, 95% CI -0.49 to 0.16) or physical function (SMD -0.13, 95% CI -0.28 to 0.02). No study reported a serious adverse event in relation to aquatic exercise. CONCLUSION: Aquatic exercise provides a short-term clinical benefit that is sustained for at least three months postintervention in terms of pain in people with knee osteoarthritis.

Effects of aquatic exercise on appetitive responses in adolescents with obesity: An exploratory study.

Aquatic exercise has been suggested as a beneficial modality to improve weight loss, cardiorespiratory fitness and quality of life in adolescents with obesity; however, its impact on appetite control in youth remains unknown. The aim of this preliminary study was to examine the effect of an acute aquatic exercise session on energy intake (EI), appetite feelings and food reward in adolescents with obesity. Twelve adolescents with obesity (12-16 years, Tanner stage 3-5, 9 males) randomly completed two conditions: i) control (CON); ii) aquatic exercise session (AQUA). One hour before lunch, the adolescents stayed at rest outside the water in a quiet room for 45 min on CON while they performed a 45-min aquatic exercise session on AQUA. Ad libitum EI and macronutrients were assessed at lunch and dinner, subjective appetite feelings taken at regular intervals, and food reward measured before and after lunch. Paired T-test showed that EI was not different between CON and AQUA at lunch (1333 ± 484 kcal vs 1409 ± 593 kcal; p = 0.162) and dinner (528 ± 218 kcal vs 513 ± 204 kcal; p = 0.206). Total daily ad libitum EI was significantly higher on AQUA (1922 ± 649 kcal) compared with CON (1861 ± 685 kcal; p = 0.044) but accounting for the exercise-induced energy expenditure, relative energy intake did not differ (2263 ± 732 kcal vs 2117 ± 744 kcal, p = 0.304). None of the appetite feelings (hunger, fullness, prospective food consumption and desire to eat) and food reward dimensions were significantly different between conditions. These preliminary and exploratory results suggest that an acute aquatic-exercise session might not induce energy compensatory responses in adolescents with obesity.

Aqua-Plyometric Exercises-Induced Changes in Muscle Strength, Bone Mineral Properties, and Physical Fitness in Patients With Juvenile Idiopathic Arthritis: A 12-Week, Randomized Controlled Trial.

PURPOSE: To determine whether a 12-week, lower body-targeted aqua-plyometric (AquaPlyo) exercise program could improve muscle strength, bone mineral properties, and physical fitness in patients with juvenile idiopathic arthritis. METHODS: A randomized controlled trial was adopted and included 48 patients with polyarticular juvenile idiopathic arthritis (age: 12-18 y). Patients were assigned to undergo either AquaPlyo exercises (AquaPlyo group, n = 24) or standard exercises (control group, n = 24). The outcome measures were assessed pretreatment and posttreatment and included concentric quadriceps peak torque, bone mineral properties (areal bone mineral density [BMD], volumetric BMD, bone mineral content, and BMD Z score), and physical fitness. RESULTS: A significant posttreatment increase in the concentric quadriceps peak torque was detected in the AquaPlyo group compared with the control group (either at an angular velocity of 90°/s [right side: P = .016, left side: P = .025] or 180°/s [right side: P = .007, left side: P = .029]). Besides, a considerably greater improvement in the areal BMD (P = .0006), volumetric BMD (P = .027), bone mineral content (P = .002), and BMD Z score (P = .0004) was observed in the AquaPlyo group. Moreover, a remarkably greater rise in the physical fitness (P < .001) was revealed in the AquaPlyo group. CONCLUSION: AquaPlyo training can efficiently enhance muscle strength, improve bone mineral properties, and boost physical fitness in patients with juvenile idiopathic arthritis.

Effectiveness of Water-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that, due to dyspnea, decreases patients' physical function and quality of life. The aim of the research was to evaluate the effectiveness of water-based exercise (WE) in improving functional capacity and respiratory muscle strength in patients with COPD. It consisted of a systematic review and meta-analysis of eight randomized clinical trials (RCTs) from the last 10 years, found in PubMed, PEDro, Scopus and Web of Science databases. Methodological quality was analyzed using the PEDro scale and the Cochrane Collaboration Risk of Bias Tool. Regarding the evaluation of functional capacity, mainly assessed were lung function, respiratory muscle strength, and maximal or aerobic exercise. The results showed that WE improves functional capacity compared to a non-exercising control group (SMD: 73.42; IC 95%: 40.40 to 106.45; I2: 0%). There are no statistically significant differences between a WE treatment and a land exercise (LE) treatment (p = 0.24) in functional capacity, nor with respect to respiratory muscle strength (p = 0.97). These data should be interpreted with caution, as more RCTs with aquatic intervention in COPD patients are needed to elucidate whether there are differences between WE or LE according to patient characteristics and comorbidities.

Quantifying physiological and biomechanical responses of shallow water walking: a systematic review and meta-analysis.

Detecting the physiological and biomechanical alterations in shallow water walking (SWW) due to water depth and speed is important for health professionals to perform accurate exercise prescription. This systematic review with meta-analysis aimed to investigate the acute physiological and biomechanical responses of SWW at different immersion depths in comparison to dry land walking. The main result (initial search: 1960 studies; systematic review: 42 studies; meta-analysis: 22 studies) indicated that metabolic power was higher in the immersion depth levels of xiphoid process (standardized mean differences (SMD) = 0.90; 95% confidence intervals (CI): 0.26 to 1.54) and waist (SMD = 3.35; 95% CI: -0.18 to 6.87) in comparison to dry land. SWW at xiphoid and waist depths seems to be an adequate exercise if the objective is to increase the energy expenditure and cardiovascular demand while the lower limb impact forces are reduced in comparison to dry land walking. PROSPERO registration: CRD42018113040.

Quality of life responses after combined and aerobic water-based training programs in older women: a randomized clinical trial (ACTIVE Study).

BACKGROUND: Quality of life (QoL) is an important health index for older adults. AIM: The aim of this study was to compare the effects of 16 weeks of aerobic training to 8 weeks of aerobic followed by 8 weeks of combined (i.e., resistance and aerobic exercises) training, as well as to a control group on the QoL of older women exercising in the aquatic environment. METHODS: 52 older women were first randomized to either aerobic training (n = 35) or a control group (n = 17). After 8 weeks of intervention, participants initially assigned to the aerobic training group were again randomized to either 8 additional weeks of aerobic (n = 17) or combined training (n = 18). Aerobic training was performed at the heart rate percentage associated with the anaerobic threshold, while resistance training sets were performed at maximal effort. The control group performed low-intensity water-based therapeutic exercises. QoL was assessed before (week 0) and after the intervention (week 17) using the WHOQOL-BREEF and WHOQOL-OLD questionnaires. Generalized Estimating Equations (GEE) and Bonferroni post hoc tests (α = 0.05) were used to compare time points and groups. RESULTS: QoL improved significantly only in the training groups after the 16-week training intervention, whereas it remained unchanged in the control group. In addition, autonomy, environment, and present, past and future activities domains were more impacted after combined training. CONCLUSION: QoL improved only in the water-based training groups, and the addition of resistance exercises to the training program resulted in additional benefits to autonomy, environment, and past, present, and future activities domains. TRIAL REGISTRATION: Clinical Trials NCT03892278.

Can spa rehabilitative interventions play a role for patients suffering from neurodegenerative disorders at the early stages? A scoping review.

The global burden of neurodegenerative disorders is significantly increasing as life expectancy rises but currently there is no cure for these conditions. An extensive search on MEDLINE (PubMed) and PEDro databases was conducted selecting clinical trials, Randomized Controlled Trials, and longitudinal studies published in the last 20 years in order to highlight what evidence there is for a role of spa rehabilitative interventions for patients with neurodegenerative diseases, in terms of motor function, symptoms, and quality of life (QoL) improvement and cost-effectiveness. A total of 225 publications were analyzed. Only three manuscripts were selected for review because they matched the inclusion criteria. These studies demonstrated statistically significant differences in the outcomes evaluated among patients affected by Parkinson's disease after thermal rehabilitative treatments: motor function, balance, QoL, and psychological well-being statistically improved. In addition, rehabilitation in the spa setting seemed to be cost-effective for these patients. However, further studies are needed to define the role of spa rehabilitative interventions for these patients as the literature is still limited.

Prescribing and Self-Regulating Heated Water-Based Exercise by Rating of Perceived Exertion in Older Individuals With Hypertension.

We aimed to analyze the usefulness of the 6-20 rating of perceived exertion (RPE) scale for prescribing and self-regulating high-intensity interval (HIIE) and moderate-intensity continuous (MICE) aerobic exercise performed in a heated swimming pool (32 °C). Fifteen older individuals (65 ± 3 years) treated for hypertension underwent a symptom-limited maximal graded exercise test to determine their heart rate at anaerobic threshold, and respiratory compensation point. On different days, participants were randomized to HIIE (walking/jogging between 11 and 17 of RPE; 25 min) and MICE (walking at 11-13 of RPE; 30 min). Heart rate during the low-intensity intervals of HIIE and MICE remained below the graded exercise test's heart rate at anaerobic threshold (-7 ± 18 bpm/-16 ± 15 bpm) and respiratory compensation point (-18 ± 18 bpm/-30 ± 16 bpm), respectively, and maintained in the aerobic training zone during the high-intensity intervals of HIIE (+8 ± 18 bpm/-4 ± 19 bpm). The RPE scale at 15-17 is a useful tool for prescribing and self-regulating heated water-based HIIE and may have important implications for water-based exercise in older individuals with hypertension.

Effects of aquatic high-intensity interval training and moderate-intensity continuous training on central hemodynamic parameters, endothelial function and aerobic fitness in inactive adults.

Objective: The effects of land-based high-intensity interval training (HIIT) on the cardiovascular system have already been demonstrated. However, the water environment is different from that on land. Therefore, we investigated the effects of 6-week aquatic HIIT and moderate-intensity continuous training (MICT) on central hemodynamic parameters, endothelial function, and aerobic fitness in inactive adults. Methods: Thirty-one inactive adults were randomly assigned to HIIT or MICT group. HIIT group performed twelve 30-s swimming exercise bouts with the intensity of 95% HRmax and 15-18/20 RPE with a 60-s rest period between each bout. MICT group performed a 30-min uninterrupted swimming exercise with the intensity of 70%-75% HRmax and 12-14/20 RPE. Training frequency for both groups was three times a week. The pulse wave analysis and flow-mediated dilation (FMD) were measured by non-invasive equipments. Results: The aerobic fitness significantly increased after HIIT, but no change was seen after MICT. Augmentation pressure (AP) and augmentation index normalized at 75 bpm (AIx@HR75) significantly decreased after HIIT but not MICT, whereas MICT rather than HIIT improved subendocardial viability ratio (SEVR), central and peripheral blood pressure, and resting HR. Only HIIT significantly increased brachial endothelial function. Conclusion: A six-week aquatic HIIT and MICT had no differences in hemodynamic parameters, endothelial function, and aerobic fitness, however 6 weeks of aquatic HIIT reduced arterial stiffness, increased endothelial function and aerobic fitness, while 6 weeks of aquatic MICT reduced arterial blood pressure and resting HR and increased the coronary blood flow reserve.

Aquatic exercise in patients with haemophilia: Electromyographic and functional results from a prospective cohort study.

INTRODUCTION: Recurrent joint bleeds in haemophilia patients often cause musculoskeletal changes leading to functional capacity impairment. AIM: In this study, we assessed the effects of aquatic activities performed to improve functional capacity in these patients. METHODS: The interventional protocol consisted of 24 hydrotherapy sessions during three months, in comparison with 24 swimming sessions. The pre- and post-intervention assessment consisted of Functional Independence Score, haemophilia joint health score (HJHS), Pediatric Haemophilia Activities List (PedHAL), surface electromyography (SEMG) of thigh muscles to assess muscle electric activity, and load cell on extensor and flexor thigh muscles to evaluate muscular strength. RESULTS: Forty-seven haemophilia patients were enrolled in this study, and 32 (23 severe haemophilia A, one moderate haemophilia A and 8 severe haemophilia B), median age 12y (6 to 40y), concluded the aquatic intervention. We observed a statistically significant increase with substantial improvement in functional capacity in the pre- and post-intervention evaluation of hydrotherapy in comparison with the swimming protocol, with HJHS (p = .006 and p = .001 respectively), PedHAL (Sum score) (p = .022 and p = .001) and score FISH (p = .021). The swimming group revealed significant improvements in muscular strength, in all muscles tested (p = .005 and p = .001). SEMG signal amplitude reached significantly higher levels in all muscles evaluated after both interventions except for the vastus medialis (right) in the hydrotherapy group. CONCLUSION: Our results concluded that both swimming and hydrotherapy were associated with physical improvement in haemophilia patients; however, only hydrotherapy lead to a more significant improvement in functional capacity.

The effects of different types of aquatic exercise training interventions on a high-fructose diet-fed mice.

Gradual weight gain in modern people and a lowering onset age of metabolic disease are highly correlated with the intake of sugary drinks and sweets. Long-term excessive fructose consumption can lead to hyperglycemia, hyperlipidemia and accumulation of visceral fat. Abdominal obesity is more severe in females than in males. In this study, we used a high-fructose-diet-induced model of obesity in female mice. We investigated the effects of aquatic exercise training on body weight and body composition. After 1 week of acclimatization, female ICR mice were randomly divided into two groups: a normal group (n=8) fed standard diet (control), and a high-fructose diet (HFD) group (n=24) fed a HFD. After 4 weeks of induction followed by 4 weeks of aquatic exercise training, the 24 obese mice were divided into 3 groups (n=8 per group): HFD with sedentary control (HFD), HFD with aquatic strength exercise training (HFD+SE), and HFD with aquatic aerobic exercise training (HFD+AE). We conducted serum biochemical profile analysis, weighed the white adipose tissue, and performed organ histopathology. After 4 weeks of induction and 4 weeks of aquatic exercise training, there was no significant difference in body weight among the HFD, HFD+SE and HFD+AE groups. Serum triglyceride (TG), AST, ALT, and uric acid level were significantly lower in the HFD+SE and HFD+AE groups than in the HFD group. The weight of the perirenal fat pad was significantly lower in the HFD+AE group than in the HFD group. Hepatic TG and total cholesterol (TC) were significantly lower in the HFD+AE group than in the other groups. Long-term intake of a high-fructose diet can lead to obesity and increase the risk of metabolic disease. Based on our findings, we speculate that aquatic exercise training can effectively promote health and fitness. However, aquatic aerobic exercise training appears to have greater benefits than aquatic strength exercise training.

Aquatic high intensity interval training to improve aerobic capacity is feasible in adolescents with cerebral palsy: pilot randomised controlled trial.

OBJECTIVE: To investigate feasibility of aquatic high intensity interval training for adolescents with cerebral palsy, who can ambulate independently but may choose a mobility aid in some circumstances. DESIGN: Pilot randomised controlled trial. METHOD: Following baseline assessments, participants were randomised to usual care or ten weeks of twice weekly aquatic high intensity interval training. Each class comprised 10 one-minute exercise intervals separated by one-minute rest. High intensity exercise was defined as the attainment of ⩾80% of peak heart rate measured by telemetry. SETTING: Tertiary paediatric hospital. MAIN MEASURES: Primary outcomes related to the feasibility of the protocol to progress to a definitive trial. Consumer feedback was obtained. RESULTS: Of 119 potential participants, 46 appeared eligible and 17 consented, resulting in a recruitment fraction of 37% (95% CI 23-52). Twelve completed baseline assessments and were randomised (5 males; 14 years 7 months SD 2 years 0 months). In the intervention group, of the 1190 exercise stations (across all participants and sessions), heart rate data were available for 1180 stations and high intensity exercise was achieved during 1111 stations (93%, 95% CI 92-95). All randomised participants completed the study and reported that the intervention was fun and provided friendship opportunities. There were no major adverse events or exacerbation of pain. CONCLUSIONS: Aquatic high intensity interval training in ambulant adolescents with cerebral palsy is feasible, while maintaining adherence and fidelity. Uncertainty remains on the efficacy of the intervention, highlighting the need for a large definitive trial.

Acute Blood Pressure Effects in Older Adults with Hypertension After Different Modalities of Exercise: An Experimental Study.

This study investigated the acute blood pressure (BP) effects of different exercise modalities in older adults with hypertension. Sixty volunteers were randomly assigned (n = 15/group) into different exercise protocols: resistance, bike, water-based exercise (WE), and a control session-all for ∼45 min. Clinic BP measurements were taken before, immediately after, and 15 and 30 min after protocols. The data were analyzed by one-way analysis of variance; generalized estimating equations, following Bonferroni post hoc (p < .05). Immediately after exercise, the systolic BP (SBP) increased in all exercise protocols (resistance exercise = Δ10.3, bike exercise = Δ5.8, WE = Δ9.5 mmHg; p < .001), while the diastolic BP was not altered. Afterward, the SBP reached the value observed before exercise. In Minute 30, only WE presented a significant reduction for SBP (WE = Δ-4.6 mmHg; p < .05). This study has important clinical implications in hemodynamic safety for acute BP increases immediately after exercises, as well as, in the SBP, reduction benefits for older adults with hypertension.