Health and functional benefits of aquatic exercise rehabilitation for children with disabilities: a systematic review of systematic reviews based on ICD-11 and ICF / 中国康复理论与实践

ObjectiveTo conduct a systematic review of systematic reviews on benefits of health and functioning for children with disabilities in aquatic exercise rehabilitation, in reference to the PRISMA guidelines, based on ICD-11 and ICF. MethodsSystematic reviews about aquatic exercise rehabilitation for children with disabilities were searched in PubMed, Web of Science, Embase and CNKI from January, 2014 to August, 2023. A systematic review was conducted. ResultsSeven English reviews were included from Iran, Brazil, Spain, Australia, USA and Poland, involving 69 randomised controlled trials with a total of 1 825 participants. They were mainly from the journals in the fields of pediatric physics and occupational therapy, physical therapy and rehabilitation, and children with disabilities, and the publication date was mainly from 2014 to 2023. The main types of diseases were intellectual and developmental disability (Down's syndrome, mild or high-functioning autism spectrum disorder, Asperger's syndrome), cerebral palsy (spastic cerebral palsy, spastic quadriplegia), developmental mental coordination disorder, attention deficit hyperactivity disorder, etc. The main impariment of functioning were consciousness function (b110), sleep function (b134), attention function (b140), memory function (b144), psychomotor function (b147), high-level cognitive function (b164), mobility (d4), interpersonal interactions and relationships (d7), community life (d910), recreation and leisure (d920). In the field of physical activity, the main barriers included insufficient participation in physical activity, less participation in aquatic exercise, low overall level of development, physical development as well as motor development and motor ability. The aquatic exercise rehabilitation program mainly included swimming exercises; water resistance and breathing training; water walking, running, jumping; shallow standing exercises; water aerobic activities, strength training and endurance exercises; as well as water games and spa programs. The intervention intensity of aquatic sports rehabilitation was low to moderate, and the frequency was 15 to 100 minutes a time, one to six times a week, lasting six to 40 weeks. The health and functional benefits of aquatic sports rehabilitation for children with disabilities were mainly reflected in improving cardiopulmonary function, enhancing respiratory muscle strength, improving core muscle strength, improving balance and coordination function, improving aerobic endurance, enhancing flexibility, and improving walking speed; reducing body mass, optimizing body mass index, reducing body fat percentage, waist circumference and waist-to-height ratio; improving cognitive and intellectual function, and improving sleep quality. For children with autism spectrum disorder, it could also promote communication activities, reduce repetitive stereotyped behaviors, improve swimming skills and abilities, and increase aquatic physical activity behaviors. ConclusionAquatic exercise rehabilitation can improve the body functions of children with disabilities, promote activity and participation, and enhance their overall health, quality of life and well-being.

A high-intensity interval training program in aquatic environment (hiitaq) for obese adolescents / Programa de treinamento intervalado de alta intensidade no ambiente aquático (hiitaq) em adolescentes obesos

ABSTRACT The increased prevalence of obesity has endangered the health of Brazilian adolescents. Regular physical activity and lifestyle changes are recommended as prevention and treatment. However, there is no consensus on the dose-response of training programs. This study aimed at assessing the effectiveness of a high-intensity interval training program in aquatic environment (HIITAQ) on physical fitness and cardiometabolic risk factors in obese teenagers. The sample consisted of 18 adolescents of both sexes, aged 12 to 17 years, diagnosed with obesity. Anthropometric variables, physical fitness, blood glucose, and lipid profile were evaluated before and after 12 weeks of training. The program consisted of two sets of 4-8 repetitions for 30 seconds (85%-95% of maximal heart rate) and 60 seconds of active rest interval. After applying the program, a reduction in body mass index was seen, that is, BMI z-score (p <0.01), as well as a reduction of Total Cholesterol, TC (p <0.01), and LDL (p <0.01). There was an increase in basal metabolic rate (p <0.01) and peak VO2 (p <0.01). No differences were seen after the training with regard to fat percentage, body mass index (BMI) waist/height ratio (WHtR), fasting blood glucose, insulin, and HDL-c (p>0.05). The high-intensity training program in aquatic environment was effective in reducing cardiometabolic risk factors.

RESUMO A saúde de adolescentes brasileiros tem sido comprometida pelo aumento da prevalência da obesidade. A prática de exercício físico regular e modificações no estilo de vida são ações recomendadas como prevenção e tratamento. No entanto, não há consenso quanto à dose resposta dos programas de exercícios. O objetivo deste estudo foi verificar a efetividade de um programa de treinamento intervalado de alta intensidade no ambiente aquático (HIITAQ) na aptidão física e fatores de risco cardiometabólicos em adolescentes obesos. A amostra foi composta por 18 adolescentes de ambos os sexos, com idade entre 12 e 17 anos, com diagnóstico de obesidade. Foram avaliadas, variáveis antropométricas, aptidão física, glicemia e perfil lipídico, antes e após 12 semanas de treinamento. O programa foi composto por duas séries de 4 a 8 repetições com 30 segundos de duração (80-95% da frequência cardíaca máxima) por 60 segundos de recuperação ativa. Após o programa de exercícios verificou-se redução do índice de massa corporal escore z IMCz (p< 0,01), do Colesterol Total (p< 0,01) e LDL-c (p< 0,01). Houve aumento da taxa metabólica basal (p< 0,01) e do VO2 pico (p< 0,01). Não foram observadas diferenças após o treinamento no percentual de gordura, índice de massa corporal, IMC, relação cintura/estatura RCEst, glicemia em jejum, insulina e HDL-c (p>0,05). O programa de treinamento de alta intensidade no meio aquático foi efetivo na redução de fatores de risco cardiometabólicos.

Effects of Aquatic Exercise on Lower-limb Motor Function and Activities of Daily Living for Patients with Stroke: A Meta-analysis / 中国康复理论与实践

Objective:To evaluate the effects of aquatic exercise on lower-limb motor function and activities of daily living for patients with stroke. Methods:The randomized controlled trials (RCTs) about effects of aquatic therapeutic exercise on stroke patients were recalled from the databases of Cochrane Library, PEDro, PubMed, EMBASE, Web of Knowledge, Web of Science, OVID, EBSCO, CMCI, CNKI, Wanfang and VIP. The methodological quality of the included RCTs was evaluated. The data were extracted, and analysed with RevMan 5.3. Results:A total of 23 RCTs that represented 861 participants were evaluated. Compared with the control group, aquatic exercise significantly improved the performance of Berg Balance Scale (WMD = 2.69, 95%CI 1.21 to 4.16,P < 0.001), Timed Up and Go Test (WMD = -1.56, 95%CI -3.07 to -0.05,P < 0.05), Functional Reach Test (WMD = 2.69, 95%CI 1.21 to 4.16,P < 0.001), sway velocity of center of pressure (SVCOP) (left/right) (WMD = -1.38, 95%CI -2.72 to -0.05,P < 0.05), SVCOP (anteroposterior) (WMD = -1.64, 95%CI -3.10 to 　-0.18,P < 0.05), walking speed (SMD = 0.33, 95%CI 0.07 to 0.58,P < 0.05), Two Minute Walk Test (WMD = 12.75, 95%CI 4.17 to 21.34,P < 0.01), Functional Ambulation Category (WMD = 0.94, 95%CI 0.67 to 1.20,P < 0.001), muscle strength of knee extensor (WMD = 4.30, 95%CI 1.53 to 7.07,P < 0.01), muscle strength of knee flexor (WMD = 4.80, 95%CI 0.29 to 9.32,P < 0.05), and Functional Independence Measurement (WMD = 6.12, 95%CI 3.98 to 8.27,P < 0.001), but not significantly in the score of modified Barthel Index (WMD = 2.92, 95%CI -6.74 to 12.58,P = 0.55). Conclusion:Aquatic exercise can improve balance, walking and muscle strength of lower extremities of stroke patients, but do not for activities of daily living.

The beneficial effects of a water-based aerobic exercise session on the blood lipids of women with dyslipidemia are independent of their training status

OBJECTIVES: To evaluate the acute effects of a session of water-based aerobic exercise on the blood lipid levels of women with dyslipidemia and to compare these results according to their training status. METHOD: Fourteen premenopausal women with dyslipidemia, aged 40-50 years, participated in two water-based aerobic exercise sessions, the first when they were generally sedentary and the second after they were trained with a water-based aerobic training program for 12 weeks. Both experimental sessions were performed using the same protocol, lasted 45 min, and incorporated an interval method, alternating 3 min at a rating of perceived exertion (RPE) of 13 and 2 min at an RPE of 9. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and lipoprotein lipase enzyme (LPL) were obtained through venous blood collection before and immediately after each session. A generalized estimating equation method and Bonferroni tests were conducted (with time and training status as factors) for statistical analyses. RESULTS: At enrollment, the mean age of the participants was 46.57 years (95% confidence interval [CI] 44.81−48.34). The statistical analyses showed a significant time effect for all variables (TC: p=0.008; TG: p=0.012; HDL: p<0.001; LPL: p<0.001) except for LDL (p=0.307). However, the training status effect was not significant for any variable (TC: p=0.527; TG: p=0.899; HDL: p=0.938; LDL: p=0.522; LPL: p=0.737). These results indicate that the TC and TG levels reduced and the HDL and LPL concentrations increased from pre- to post-session in similar magnitudes in both sedentary and trained women. CONCLUSIONS: A single water-based aerobic exercise session is sufficient and effective to beneficially modify the lipid profile of women with dyslipidemia, regardless of their training status.

Does Aquatic Exercise Improve Quality Of Life In Obese Low-Back Pain Population?

Background: Low-back pain is one of the most common reasons for work stress, poor health, sickness, and reducing the quality of life. While obesity is a growing public health concern, it was proved that obesity is a risk factor for low back pain. Whereas obese low-back pain people cannot avoid weight load on the spine in any exercise, but they can easily carry out the exercise in water. This study aimed to know the effect of aquatic exercise on quality of life among obese low-back pain people. Methods: A total of 39 women with BMI≥27 kg.m-2 who had non-specific chronic low-back pain were purposively selected for this study. They randomly assigned in two groups; exercising (N=19, 37.85±5.83 years with 32.97±4.84kg.m-2) and control group (N=20, 40.8±5.25 years with 31.87±4.79 kg.m-2). The exercising group carried out the aquatic exercise, twice per week, 60 minutes per session, for 12 weeks. Quality of life was measured using the SF-36v2 questionnaire with eight domains; physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Results: The findings showed a significant (p≤0.001) improvement in the quality of life in the exercising group after 12 weeks. The significant improvement was found on seven domains of the SF-36v2 in the exercising group after the aquatic exercise intervention program while there was no significant effect on mental health (p=0.051). In the control group, a negative change in mean difference (-3.02) was observed in the mental health domain, while it was changed (15.32) for the exercising group. There was no significant change in BMI in both groups, also. Conclusion: In conclusion, a 12-week aquatic exercise is an appropriate intervention program to improve the overall quality of life among obese women who are suffering from non-significant chronic low- back pain.

Aquatic Exercise at Thermoneutral Water Temperature Enhances Antitumor Immune Responses

Despite the broad rehabilitative potential of aquatic exercises, the relationship between aquatic exercise and the immune system has not been fully elucidated to date. In particular, there are few specific and delicate immunological approaches to the effect of water temperature on immunity. Thus, we examined the effect of water temperature on immunity during aquatic exercise. The animal tumor model was adopted to examine the impact of aquatic exercise at thermoneutral temperature (TT; 29°C) on immunity compared with aquatic exercise at body temperature (BT; 36°C). Tumor-bearing mice were made to swim in TT water or in BT water for 3 wk and immune cells and their functional activity were analyzed using FACS. Tumor growth was significantly suppressed in mice that exercised in TT than in BT water. The tumor control correlated with the increased number of NK (2-fold), γδT cells (2.5-fold), NKT (2.5-fold), and cytotoxic CD8⁺ T cells (1.6-fold), which play a critical role in anti-tumor immune responses. Furthermore, the functional activity was dramatically improved in the TT group, showing enhanced production of IFNγ in CD8⁺ T cells compared with the BT group. This study demonstrates that aquatic exercise in TT water may improve protective immune responses more effectively than in BT water. Although the effects of water temperature on immune function need further verification in humans, this study suggests that water temperature in human hydrotherapy may be important for improving immune function.

Application of Mobile Assessment in Aquatic Rehabilitation Assessment for Patients with Spinal Cord Injury / 中国康复理论与实践

Objective:To explore the application of mobile medical technology in aquatic rehabilitation assessment for patients with spinal cord injury. Methods:From November, 2017 to April, 2018, 72 patients with spinal cord injury accepted aquatic exercise were randomly divided into control group (n = 36) and experimental group (n = 36). All the patients were assessed with Water Orientation Assessment of Alyn (WOTA), using paper scale for the control group, mobile scale for the experimental group, twice. The time for assessment and for recall was recorded. The accuracy of results and variety between assessment was compared. Results:The time for assessment and for recall was less in the experimental group than in the control group (t > 10.492, P < 0.001), with more accuracy of standard total score, the variety of total score and standard total score (χ2 > 4.545, P < 0.05). Conclusion:Compared with the paper-based assessment, the assessment based on mobile technology may improve work efficiency.

Effects of aquatic exercise on mental health, functional autonomy and oxidative stress in depressed elderly individuals: A randomized clinical trial

OBJECTIVES: The aim of this study was to investigate the effects of aquatic exercise on mental health, functional autonomy and oxidative stress parameters in depressed elderly individuals. METHODS: Initially, ninety-two elderly individuals were included in the study and were allocated into the depression group (n=16) and nondepression group (n=14). Both groups engaged in the aquatic exercise program for 12 weeks, including two weekly sessions (45 min/session) at a low intensity (between 50% and 60% of maximal heart rate or Borg scale scores of 13 to 14) throughout the intervention. All outcomes were evaluated at baseline and 12 weeks later. RESULTS: The patients were 63.5±8.8 years old. The following scores were decreased after training in the depressed group: depression (53%), anxiety (48%), and Timed Up & Go (33%). The following scores increased: Berg Balance Scale (9%) and flexibility (44%). Regarding the blood-based parameters, there were decreases in protein carbonylation (46%) and nitric oxide (60%) and increases in glutathione (170%) and superoxide dismutase (160%) in the depression group (p<0.005). CONCLUSIONS: The aquatic exercise program reduces depression and anxiety, improves functional autonomy and decreases oxidative stress in depressed elderly individuals.

Water Orientation Test of Alyn 2 (Chinese) and Its Reliability and Validity in Patients with Spinal Cord Injury / 中国康复理论与实践

@#Objective To translate the Water Orientation Test of Alyn 2 (WOTA2) into Chinese, and to study its reliability and validity for patients with spinal cord injury. Methods After authorizing, the English version WOTA2 scale and its training package were translated into Chinese. From January to September, 2018, 137 patients with spinal cord injury were evaluated with the Chinese version WOTA2 by two evaluators independently, and evaluated again three days later by one of the evaluators. The Cronbach's α, Spearman-Brown coefficient, intra-group correlation coefficient (ICC) and Kappa coefficient were calculated to evaluate the reliability. Content Validity Index (CVI) of items (I-CVI) and scale (S-CVI) were used to evaluate the content validity, and factors analysis was used to evaluate the structure validity. Results The Cronbach's α was 0.947 in all items of the scale, 0.890 in mental adjustment items and 0.954 in aquatic skills items. Pearson correlation coefficient of the half scales separated by odd and even items was 0.948, and the Spearman-Brown coefficient was 0.973. The ICC of test-retest was 0.965 in total score, 0.965 in centesimal system total score, 0.847 in mental adjustment score and 0.970 in aquatic skills score. The ICC of inter-testers was 0.964 in total score, 0.965 in centesimal system total score, 0.847 in mental adjustment score and 0.970 in aquatic skills score. The Kappa coefficient was 0.528 to 0.927 in test-retest and 0.528 to 0.927 in inter-testers. The I-CVI was 0.8 to 1.0 and S-CVI was 0.63. Factors analysis extracted four factors, which met the theory, and contributed 67% of cumulative variance. Conclusion The Chinese version WOTA2 is good in reliability and validity for patients with spinal cord injury, and can be used in the clinical practice of aquatic therapeutic exercise in China.

Effects of Aquatic Taiji Quan on Balance Function of Patients with Incomplete Spinal Cord Injury / 中国康复理论与实践

Objective To investigate the effects of aquatic Taiji Quan on balance function of patients with incomplete spinal cord injury. Methods From March to December, 2015, 30 patients with incomplete spinal cord injury received aquatic Taiji Quan exercise based on rou-tine rehabilitation, 30 minutes every day, five times a week for five weeks. They were assessed with Berg Balance Scale (BBS) before and after exercise. Dynamic balance function and static balance function were also assessed with Active Balancer assessment. Results The BBS score significantly improved after exercise (t=-9.652, P3.528, Z>-2.590, P0.05). The dynamic stability limit range enlarged (t=-4.516, P<0.01), and the time to target significantly shortened (t=4.530, P<0.001). Conclusion Aquatic Taiji Quan can improve the balance function of patients with incomplete spinal cord injury.

Effects of a deep-water running program on muscle function and functionality in elderly women community dwelling

AIMS: The aim of the study was to determine the effects of deep-water running on muscle function and functionality in community dwelling old women. METHODS: Older women (n=19) were randomly assigned to one of the two groups: deep-water running (DWR: n=09, 64.33±4.24 years, 75.15±12.53 kg, 160.45±7.52 cm; or control group CG: n=10, 64.40±4.22 years, 74.46±12.39 kg, 158.88±5.48 cm). The DWR group carried out 18 weeks of deep-water running, twice/week 50 min sessions. Dynamic isokinetic strength for the lower limb and functionality was assessed before and after intervention. RESULTS: DWR group increased peak torque, total work and average power of the knee and hip flexors and extensors. Additionally showed better performance on gait speed, timed up and go test, five-times-sit-to-stand-test repetitions from a chair as well as the six-minute walk test. CONCLUSION: The deep-water running program was effective to improve muscle function and functionality.(AU)

Composición Corporal y Somatotipo de Mujeres de Entre 16 a 18 Años: Efecto de un Programa Acuático-Aeróbico en el Mejoramiento de la Fuerza Muscular / Body Composition and Somatotype in Women between 16 and 18 Years of Age: Effect of an Aquatic-Aerobics Program on the Improvement of Muscular Strength

Las actividades acuáticas son una clara alternativa a los programas de reforzamiento muscular terrestre. El objetivo de este trabajo fue determinar el efecto de un programa de ejercicios acuáticos-aeróbicos sobre pliegues y diámetros corporales y en el mejoramiento de la fuerza muscular de mujeres jóvenes. Doce mujeres de entre 16 a 18 años, sedentarias, seleccionadas intencionalmente fueron sometidas a un programa de ejercicios acuáticos de 18 sesiones, desarrollados en la Piscina Olímpica Municipal de la ciudad de Arica, Chile. Los resultados muestran que las jóvenes presentan un IMC de sobrepeso, con un somatotipo predominantemente endomórfico. Los pliegues corporales de muslo anterior y pantorrilla disminuyen significativamente al final de la aplicación del programa, igual comportamiento expresa la sumatoria de ellos (7: de 167,06±8,71 mm a 145,23±8,9 mm en pre-test). La fuerza muscular se incrementa significativamente en los músculos pectoral mayor, latísimo del dorso y bíceps braquial. Sin embargo este incremento es más significativo (p<0,001) en la sumatoria de los músculos evaluados (7: de 137,72±5,27 kg a 158,67±6,48 kg al finalizar el programa). Se concluye que el programa de ejercicios acuáticos-aeróbicos aplicado a las jóvenes, tiene un efecto positivo, con aumento significativo en la fuerza muscular y una disminución significativa en pliegues cutáneos. La aplicación de este tipo de programas, otorga múltiples beneficios para la salud y la mejora de la calidad de vida.

Aquatic activities are a clear alternative to programs of terrestrial muscle strengthening. The aim of this study was to determine the effect of aquatic-aerobics exercises on folds and body diameters and improving muscle strength in young women. Twelve women between 16­18 years old, sedentary, intentionally selected were subjected to an aquatic-aerobics exercises program of 18 sessions, developed at the Olympic Swimming Pool in Arica-Chile. The results show that young women have an overweight BMI, with a predominantly endomorph somatotype. The body folds of anterior thigh and calf decreased significantly at the end of program implementation, similar behavior expressed in the sum of these (7: of 167.06±8.71 mm to 145.23±8.9 mm in pretest). Muscle strength was significantly increased in the pectoralis major, latissimus dorsi and brachial biceps muscles. However, this increase is more significant (p<0.001) in the sum of muscles evaluated (?7: of 137.72±5.27 kg to 158.67±6.48 kg after the program). It is concluded that aquatic-aerobics exercise programs applied to young women, have a positive effect, with significant increases in muscle strength and a significant decrease in skin folds. The implementation of these programs provides multiple benefits for health and improved quality of life.

19-3 Long-term effects of repeated hot spring aquatic exercise combined with physical therapy on muscle strength and endurance of patients / 日本温泉気候物理医学会雑誌

Objective: While electromyographic data on healthy individuals during aquatic exercise have been reported, few studies have examined long-term changes in patients’ muscle strength after 30-day intervention. This study aims to study the long-term effects of repeated hot spring aquatic exercise combined with physical therapy on patients’ muscle strength and endurance. Methods: A total of 12 patients (mean age: 71.9±13.1; FIM score: 117±7.5; the number of patients with cerebrovascular disease: 5; and the number of patients with orthopedic disease: 7) who suffer decreased muscle strength and endurance in addition to sensory and balance dysfunction due to paralysis or fracture, were studied. Each hot spring aquatic exercise session consisted of walking forward and backward, hip abduction, flexion, and extension, lunge, and squat, which lasted approximately 15 minutes. The loading level was set at a pulse of 77±11.2 → 84±13.5/minute, with a perceived exertion rate (modified Borg Scale) of 0.7±1.0 → 2.4±2.3. During the intervention period, conventional physical therapy was also performed on the patients in parallel. Measurement was performed 4 times, immediately, 10, 20, and 30 days after the initiation of intervention. Measurement items were the 6-minute walking distance (6MD) for an index of endurance, CS-30 score for an index of muscle strength, and hip flexor, extensor, and abductor, knee flexor and extensor, and ankle plantar and dorsiflexor strength using a hand-held dynamometer (HHD). Results: The 6MD and CS-30 scores improved 20 days after, and the hip flexor and extensor, knee flexor, and ankle plantar and dorsiflexor strength improved 30 days after the initiation of intervention. Those patients with higher ADL levels showed improvements markedly in 6MD score. Measurements conducted on some patients 60 days after the initiation showed improvements in the 6MD and CS-30 scores. Discussion: While it has been reported by other studies that the muscle activity level in the aquatic exercise is lower compared to that in the ordinary physical therapy, the results of CS-30, 6MD and HHD scores after the 30-day intervention in this study show the improvements at the muscle strength and endurance of each joint. This may be because the buoyancy and viscosity of water have contributed to the adjustment of the suitable exercise intensity level, which depends on each patient’s disability, the endurance and strength of the muscles involved in standing up and walking are improved. Based on these results, it is said that the intervention combining hot spring aquatic exercise and physical therapy should be continued for more than 20 days to improve the CS-30 score and 6MD, and more than 30 days to promote the muscle strength of each joint.

19-3Long-term effects of repeated hot spring aquatic exercise combined with physical therapy on muscle strength and endurance of patients / 日本温泉気候物理医学会雑誌

<b>Objective: </b> While electromyographic data on healthy individuals during aquatic exercise have been reported, few studies have examined long-term changes in patients’ muscle strength after 30-day intervention. This study aims to study the long-term effects of repeated hot spring aquatic exercise combined with physical therapy on patients’ muscle strength and endurance. <BR><b>Methods: </b>A total of 12 patients (mean age: 71.9±13.1; FIM score: 117±7.5; the number of patients with cerebrovascular disease: 5; and the number of patients with orthopedic disease: 7) who suffer decreased muscle strength and endurance in addition to sensory and balance dysfunction due to paralysis or fracture, were studied. Each hot spring aquatic exercise session consisted of walking forward and backward, hip abduction, flexion, and extension, lunge, and squat, which lasted approximately 15 minutes. The loading level was set at a pulse of 77±11.2 → 84±13.5/minute, with a perceived exertion rate (modified Borg Scale) of 0.7±1.0 → 2.4±2.3. During the intervention period, conventional physical therapy was also performed on the patients in parallel. Measurement was performed 4 times, immediately, 10, 20, and 30 days after the initiation of intervention. Measurement items were the 6-minute walking distance (6MD) for an index of endurance, CS-30 score for an index of muscle strength, and hip flexor, extensor, and abductor, knee flexor and extensor, and ankle plantar and dorsiflexor strength using a hand-held dynamometer (HHD). <BR><b>Results: </b>The 6MD and CS-30 scores improved 20 days after, and the hip flexor and extensor, knee flexor, and ankle plantar and dorsiflexor strength improved 30 days after the initiation of intervention. Those patients with higher ADL levels showed improvements markedly in 6MD score. Measurements conducted on some patients 60 days after the initiation showed improvements in the 6MD and CS-30 scores.<BR><b>Discussion: </b>While it has been reported by other studies that the muscle activity level in the aquatic exercise is lower compared to that in the ordinary physical therapy, the results of CS-30, 6MD and HHD scores after the 30-day intervention in this study show the improvements at the muscle strength and endurance of each joint. This may be because the buoyancy and viscosity of water have contributed to the adjustment of the suitable exercise intensity level, which depends on each patient’s disability, the endurance and strength of the muscles involved in standing up and walking are improved. Based on these results, it is said that the intervention combining hot spring aquatic exercise and physical therapy should be continued for more than 20 days to improve the CS-30 score and 6MD, and more than 30 days to promote the muscle strength of each joint.

Comportamento da frequência cardíaca em imersão nas situações de repouso e durante exercícios de hidroginástica / Heart rate behavior in immersion in cases of rest and during water exercises

INTRODUÇÃO: A frequência cardíaca é um parâmetro de fácil utilização para prescrição e controle da intensidade do exercício. Ao realizar um exercício no meio aquático ocorrem alterações fisiológicas significativas que devem ser compreendidas para a prescrição de exercícios, ocasionando assim os efeitos adaptativos adequados. OBJETIVO: Realizar uma revisão sistemática da literatura sobre o comportamento da frequência cardíaca em imersão nas situações de repouso e durante exercícios de hidroginástica e sobre os fatores que a influenciam. RESULTADOS: Os estudos envidenciam que a frequência cardíaca pode ser influenciada pela profundidade devido ao gradiente de pressão hidrostática exercido sobre o corpo, bem como à termorregulação diferenciada. Em repouso, a frequência cardíaca pode variar de acordo com as diferentes temperaturas da água, posições corporais e profundidades. No entanto, a magnitude do efeito de cada um desses fatores sobre a frequência cardíaca ainda não é bem definido. CONCLUSÃO: Durante a realização de exercícios de hidroginástica, essa variável é proporcional à velocidade de execução do exercício, à utilização de equipamento resistivo, à área projetada e ao grupo muscular envolvido e inversamente proporcional à profundidade.

INTRODUCTION: Heart rate is an easy parameter to control and prescribe exercise intensity. When performing an exercise in aquatic environment significant physiological changes occur; these changes must be understood to prescribe exercise, causing to appropriate adaptive effects. OBJECTIVE: To conduct a systematic review of literature on the behavior of heart rate by immersion in rest situations and during aquatics exercises, as well as understanding the factors that influence it. RESULTS: The results showed that heart rate may be influenced by the immersion due to the gradient of hydrostatic pressure exerted on the body and to different thermoregulation. At rest, the heart rate can change according to different water temperatures, body positions and depths of immersion. However, the magnitude of the effect of each factor on the heart rate has not been well defined. CONCLUSION: During aquatic exercise, this variable is proportional to the speed of execution, use of resistive equipment, projected area and the muscle group involved and inversely proportional to the depth of immersion.

Comparison between the Effect of Aquatic Exercise Program and Land Exercise Program in Spastic Cerebral Palsy on Motor Function and Balance / 대한스포츠의학회지

The purpose of this study was to evaluate the efficacy of a aquatic exercise program (AEP) compared with a land exercise program (LEP) in children with spastic cerebral palsy on motor function and balance. Thirty children with spastic cerebral palsy receiving edgewise treatment were randomly assigned to two groups, a AEP and a LEP. AEP and LEP were applied to two groups of children with spastic cerebral palsy for 30 minutes, three times a week for 8 weeks. Range of motion (ROM) of ankle dorsi flexion, Modified Ashworth Scale (MAS) while ankle dorsi flexed, Pediatric Berg's Balance Scale (PBS), and Gross Motor Function Measure (GMFM) were used for pre and post comparison. There were significant differences of ROM while ankle dorsi flexed, PBS and GMFM between pre and post treatment in all the two groups (p<0.05). But as a measure of MAS while ankle dorsi flexed did not show a significant differences. And the was significant difference in the amount of change of the ROM while ankle dorsi flexion between the two groups (p<0.05). The results would suggest that both of the exercise program are equally effective.

THE EFFECT OF ACUTE EXERCISE IN WATER ON ARTERIAL STIFFNESS.-THE DIFFERENCE FROM THAT OF EXERCISE ON LAND- / 体力科学

<b>Objective:</b> Aerobic exercise on land decreases arterial stiffness, however, the effect of exercise in water on arterial stiffness has not been clear. This study investigated the effect of a 15-min cycling exercise on land and that in water on pulse wave velocity (PWV) as an index of arterial stiffness. <b>Methods:</b> Nine healthy young men were randomly performed exercise on land and exercise in water equivalent to 50% of each maximum oxygen uptake on separate days. The PWV from carotid to femoral artery (aortic PWV) and femoral to posterior tibial artery (leg PWV) were measured at baseline and 15, 30, 60 min after exercise. <b>Results:</b> The heart rate in water was significantly lower during exercise than that on land. In addition, the carbon dioxide output and respiratory exchange ratio during exercise were significantly greater in water. Body temperature increased after the exercise on land but decreased after the exercise in water. Although the aortic PWV and leg PWV decreased concomitantly with decrease in SBP and DBP after the exercise on land, there were no significant changes after the exercise in water. <b>Conclusion:</b> Although acute exercise on land decreased arterial stiffness after exercise, acute exercise in water of the same exercise load did not. The differences in body temperature and blood pressure after exercise may result in diverse arterial stiffness after exercise.

Comparação das respostas cardiorrespiratórias de um exercício de hidroginástica com e sem deslocamento horizontal nos meios terrestre e aquático / Comparisons of cardiorrespiratory responses in a hydrogymnastics exercise with and without horizontal movement on land and in aquatic environment

O objetivo do estudo foi comparar as respostas cardiorrespiratórias de um exercício de hidroginástica (corrida estacionária) realizado com e sem deslocamento horizontal no meio terrestre (MT), em piscina funda (PF) e em piscina rasa (PR). Seis mulheres jovens realizaram os exercícios durante 4 min numa cadência de 80 bpm. O exercício consistia em flexão e extensão de quadril com os braços simulando um movimento de corrida. A frequência cardíaca (FC) e o consumo de oxigênio (VO2 ) foram coletados no último minuto de exercício e a percepção de esforço (PE) foi coletada ao término do exercício. Para a comparação das variáveis utilizou-se ANOVA two-way para medidas repetidas com fatores meio e forma de execução (p < 0,05). Para todas as variáveis analisadas foram encontrados valores menores no exercício em PR comparado ao exercício no MT. Porém, nenhuma diferença foi observada entre o exercício no MT e em PF, exceto para a FC, que foi menor no exercício em PF. Em relação à forma de execução, para a FC, foram encontrados valores maiores no exercício com deslocamento quando comparado ao exercício sem deslocamento somente na PF. Estes achados sugerem a possibilidade de executar o exercício analisado em PF com gasto energético (GE) similar e FC menor quando comparado ao mesmo exercício no MT. Fato de grande relevância para populações que querem obter um GE semelhante ao exercício no MT, mas que necessitam de uma menor sobrecarga cardiovascular.

The aim of the study was to compare the cardiorespiratory responses during an hydrogymnastics exercise performed with and without horizontal movement on land environment (LE) and in a deep (DS) and in a shallow swimming pool (SS). Six YOUNG women performed the exercise during four minutes in each environment (LE, DS and SS) and situation (with and without horizontal movement) in a cadence of 80 bpm. The exercise consisted in a hip flexion/extension while the arms simulating a running movement. The heart rate (HR) and oxygen uptake (VO2 ) were veriefied during the last minute in each exercise and the rate of perceived exertion (RPE) was collected in the ending of the exercise. To variables comparisons was used ANOVA two-way for repeated measures with factors environment and situation (p < 0,05). For all cardiorespiratory variables analyzed, SS exercise were lower than that found on LE. Although, no difference was observed in the exercise performed on LE or in DS, except for the HR, that was lower during DS. Acording to the different situations, higher HR value was found during the exercise with horizontal movement when compared with the exercise without horizontal movement in the DS. These findings suggest the possibility to perform the exercise analyzed with similar energy expenditure and lower FC in DS when compared with exercise in LE. It is very important for people that need similar energy expenditure and lower cardiovascular overload during aquatic exercise.

THE EFFECTS OF AQUATIC EXERCISE TRAINING ON TRUNK MUSCLES FUNCTION AND ACTIVITIES OF DAILY LIVING IN OBESE WOMEN / 体力科学

The purpose of this study was to examine the effects of aquatic exercise training on the trunk muscles function and activities of daily living in abdominal obese women. Nineteen abdominal obese (abdominal circumference: 90 cm or more) and fifteen age-matched non-obese women were recruited as participants in this study. The aquatic exercise training (60 min/day, three days/week for 8 weeks) based on abdominal twists for activating the trunk muscle function. Physical parameters, biochemical characteristics, arteriosclerotic parameters and activities of daily living scores were assessed before and after the training period. In both groups showed abdominal circumference, percent of body fat, blood pressure and lower extremity muscle strength increased significantly after aquatic exercising training. In particular, endurance capacity of abdominal and back muscles increased significantly and activities of daily living scores were significantly improved in the obese group. Moreover, the improvement in the strength of lower extremities and improvement in the activities of daily living scores, such as climbing and descending stairs, in the obese group tended to be higher than non-obese women. Additionally, in abdominal obese group, the amount of the reduction of abdominal circumference was significantly associated with that of the increase in the strength of lower extremities. Taken together, these findings suggest the possibilities that the present aquatic exercise training based on trunk muscle exercise improving the function of trunk and lower extremity muscles with reduction in the abdominal obesity, contributing to improve activities of daily living in abdominal obese women.

Avaliação do equilíbrio estático e dinâmico de idosas praticantes de hidroginástica e ginástica / Evaluation of static and dynamic balance in elderly women performing aquatic exercise and gymnastics

Este estudo avaliou o equilíbrio estático e dinâmico e valências motoras relacionadas em idosas praticantes de ginástica e hidroginástica. Participaram 31 mulheres na modalidade hidroginástica (GH, 69,32 ± 6,57 anos) e 28 na ginástica (GG; 65,57 ± 7,67 anos), com no mínimo seis meses de prática e frequência mínina de três vezes na semana. Foram realizadas medidas de estatura (cm), peso (kg) e circunferências de cintura, quadril e abdome (cm) e cálculos do índice de massa corporal (IMC) e relação cintura-quadril (RCQ). As habilidades físicas foram medidas pelos testes de ?sentar e levantar em 30 segundos? (resistência de membros inferiores) e ?8-feet Up-and-go? (equilíbrio dinâmico), ambos propostos por Rikli e Jones (1999), ?sentar e alcançar? (flexibilidade) e teste de equilíbrio estático de Caromano (1998). A análise estatística empregou o teste t de Student e correlação de Pearson com nível de significância de 0,05. Em relação às medidas antropométricas (IMC e RCQ), não foi observada diferença estatística entre os grupos. Nos testes de aptidão física, foi encontrada diferença estatística apenas nos testes ?8-feet Up-and-Go? e ?sentar e levantar?, com melhores resultados para o grupo GG. Não foram observadas correlações intra e inter grupos, entre equilíbrios estático e dinâmico e as valências motoras estudadas. Conclui-se que não houve superioridade entre as modalidades, mas foi possível observar uma tendência de superioridade do grupo GG em parâmetros como agilidade, equilíbrio e flexibilidade.

This study evaluated static and dynamic balance and related motor valences in elderly women who had been undergone gymnastics or aquatic exercise training for at least 6 months, three times a week. Thirty-one women performed water gymnastics (mean age: 69.32 ± 6.57 years) and 28 gymnastics (65.57 ± 7.67 years). Height (cm), weight (kg) and waist, hip and abdominal circumference (cm) were measured and the body mass index (BMI) and waist-hip ratio (WHR) were calculated. Physical fitness was measured using the ?sit and get up in 30 seconds? test (leg endurance) and ?8-foot up-and-go? test (dynamic balance), both proposed by Rikli and Jones (1999), and the ?sit and reach? (flexibility) and static balance tests described by Caromano (1998). Statistical analysis was performed using the Student t-test and Pearson?s correlation, with a level of significance of 0.05. No significant difference in the anthropometric measures (BMI and WHR) was observed between groups. In the physical fitness tests, significant differences were only found in the ?8-foot up-and-go? and ?sit and get up? tests, with the gymnastics group presenting better results. No correlations within or between groups were observed regarding static and dynamic balance or motor valences. In conclusion, neither type of exercise was superior but the gymnastics group tended to show better results in terms of parameters such as agility, balance and flexibility.