Effects of Aquatic Exercise on Muscle Strength in Young and Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Trials.

ABSTRACT: Prado, AKG, Reichert, T, Conceição, MO, Delevatti, RS, Kanitz, AC, and Kruel, LFM. Effects of aquatic exercise on muscle strength in young and elderly adults: a systematic review and meta-analysis of randomized trials. J Strength Cond Res 36(5): 1468-1483, 2022-The effects of training in an aquatic environment on muscular strength are still contradictory in the literature. The aim was to conduct a systematic review and meta-analysis of randomized studies about muscle strength responses after a program of aquatic exercise. A systematic review followed the Cochrane and PRISMA recommendations. The search was performed between December 2015 and January 2016. There were no language restrictions, and PubMed, SCOPUS, Scielo, Cochrane, and PEDro databases were consulted. An analysis of eligibility of the studies was performed by 2 independent authors. The data extraction followed standard criteria, and an evaluation of methodological quality was performed. The statistical analysis was conducted in the Review Manager 5.1 software. The statistical heterogeneity was assessed by means of Cochran's Q test and by the inconsistency test (I2). The search found 2,563 articles, 27 were included, totaling a total n of 1,006 subjects. The analysis of the risk of bias demonstrated a lack of clarity of the randomization process, allocation concealment, blinding assessment, intention to treat analysis, and calculation of the sample in 70% or more of the studies analyzed. Meta-analysis demonstrated a significant increase in handgrip strength, in isometric peak torque (PT) of knee unilateral extension and flexion, and isokinetic PT (60°·s-1) of knee unilateral extension. Sensitivity analyses demonstrated that the positive effects of training in an aquatic environment may be dependent on factors such as age, velocity of movement, and use of device. Land-based and aquatic exercises seem to lead to similar muscle strength gains. Aquatic exercise should be recommended as a strategy to improve muscle strength, but new studies with better methodological quality should be conducted.

Clustering of Physical Activity and Sedentary Behavior Associated With Body Composition in Brazilian Older Adults.

This study described the clustering patterns of moderate to vigorous physical activity and sedentary time (ST) according to handgrip strength and investigated the association between identified clusters of fat and lean mass in older adults from southern Brazil. Objective measures were used for moderate to vigorous physical activity, ST, and body composition outcomes. Two-step cluster and linear regression analyses were conducted according to handgrip strength. Three clusters were identified: all-day sitters, sitters, and active sitters. The prevalence of clusters in the low-strength group was 58.2%, 22.8%, and 19.0%, respectively, while the prevalence of clusters in the high-strength group was 42.1%, 34.8%, and 23.1%, respectively. All-day sitters had 2.6% more fat mass than active sitters with low strength. High levels of ST characterized all cluster profiles; low strength, lack of moderate to vigorous physical activity, and high ST levels among older adults may indicate a subpopulation at a greater risk of overweight and obesity-related diseases.

Acute effect of bodyweight-based strength training on blood pressure of hypertensive older adults: A randomized crossover clinical trial.

Background: Strength Training (ST) reduces the cardiovascular risk of hypertensive elderly people; however, there is a need for efficient and low-cost ST programs that aim to reduce blood pressure (BP) in elderly people with adherence and affectivity in this population. Objective: Evaluate the acute effect on BP and satisfaction with the practice of bodyweight-based strength training (BWST) in hypertensive older adults. Methods: Participants performed a BWST session and a control session (CS). The BWST consisted of six exercises, with three sets of 30 seconds. In the CS, no activity was performed. BP was measured before and at 0, 10, 20, and 30 minutes post-session. Participants' satisfaction was assessed. Results: Eleven older adults (65.8 ± 4.6 years; 7 men) participated in the study. There was an increase (p = .028) in systolic BP immediately after BWST, returning to baseline values in the intervals 10, 20, and 30 post-section. In the CS there was an increase (p = .009) 30 minutes post-session compared to 20 minutes. Between sessions, a lower systolic BP was found in BWST (-6.54 ± 3.31; p = .048) 30 minutes post-sessions. For satisfaction, 82% of participants were "totally satisfied" with BWST. Conclusion: The SBP is lower 30 minutes after BWST session than control session, and BWST promoted a pleasant affective response in hypertensive older adults.

Effects of three water-based resistance trainings on maximal strength, rapid strength and muscular endurance of sedentary and trained older women / Efectos de tres entrenamientos de fuerza en el medio acuático en la fuerza máxima, fuerza rápida y la resistencia muscular de mujeres mayores sedentarias y entrenadas

Water-based resistance training (WRT ) increases strength in sedentary elderly. However, it is not known if this modality pro-motes strength gains in the trained elderly. In addition, as all the existing studies compared the WRT group with the control group, it is not yet known what the best WRT strategy to promote strength gains in the elderly. Therefore, the aim of this study was to compare the effects of three WRT on the maximal strength, rapid strength and muscular endurance of sedentary and trained elderly women. Twenty-six women were allocated in groups: simple set of 30 seconds (1x30s, 66±1 years), multiple sets of 10 seconds (3x10s, 67±2 years) and simple set of 10 seconds (1x10s, 65±1 years). Training lasted for 20 weeks (two weekly sessions). Assessments were performed after 12 and 20 weeks of training to assess sedentary and trained women, respectively. Maximal strength was assessed by the 1RM test in knee extension, knee flexion and elbow flexion exercises. In these same exercises, the muscular endurance was evaluated, for this, the individual should perform the maximal of repeti-tions with the load corresponding to 60% of 1RM. Finally, rapid force was assessed by the rate of force development during knee extension. After 12 weeks of training, all groups significantly increased the maximal strength, muscular endurance and rapid strength. However, the groups showed no increase in strength from week 12 to week 20. In conclusion, the three WRT promoted an improvement in strength of sedentary older women, however, they were not efficient in promoting adaptations in trained women

El entrenamiento de fuerza en el medio acuático (WRT ) aumenta la fuerza de mayores sedentarios. Sin embargo, no se sabe si esta modalidad promueve ganancias de fuerza en mayores entrenados. Además, como todos los estudios existentes compararon el grupo WRT con el grupo control, aún no se sabe cuál es la mejor estrategia WRT para promover ganancias de fuerza en los ancianos. Por lo tanto, el objetivo del presente estudio fue comparar los efectos de tres WRT en la fuerza máxima, fuerza rápida y resistencia muscular en mujeres mayores sedentarias y entrenadas. Veintiséis mujeres fueron distribuidas en los grupos: serie simple de 30 segundos (1x30s, 66±1 años), series múltiples de 10 segundos (3x10s, 67±2 años) y serie simple de 10 segundos (1x10s, 65±1 años). Los entrenamientos tuvieron una duración de 20 semanas (dos sesiones semanales). Las evaluaciones fueron realizadas después de 12 y 20 semanas de entrenamiento para evaluar mujeres sedentarias y entrenadas, respectivamente. La fuerza máxima se evaluó mediante la prueba de 1RM en ejercicios de extensión de rodilla, flexión de rodilla y flexión de codo. En estos mismos ejercicios, se evaluó la resistencia muscular, para ello, el individuo debe realizar el máximo de repeticiones con la carga correspondiente al 60% de 1RM. Finalmente, la fuerza rápida se evaluó por la tasa de desarrollo de la fuerza durante la extensión de la rodilla. Después de 12 semanas de entrenamiento, todos los grupos aumen-taron significativamente la fuerza máxima, la resistencia muscular y la fuerza rápida. Sin embargo, los grupos no presentaron incremento en la fuerza de la semana 12 a la semana 20. En conclusión, los tres WRT promovieron incrementos en la fuerza de mujeres mayores sedentarias, sin embargo, no fueron efectivos en promover adaptaciones en mujeres entrenadas

Glycemic Threshold as an Alternative Method to Identify the Anaerobic Threshold in Patients With Type 2 Diabetes.

Purpose: To analyze the agreement between the velocity, heart rate, and oxygen uptake values corresponding to second ventilatory threshold and glycemic threshold in patients with type 2 diabetes. Methods: Twenty-four untrained patients (55.1 ± 8.9 years) were evaluated. Three different parameters of training intensity corresponding to anaerobic threshold, one mechanical (velocity) and two physiological (heart rate and oxygen uptake) parameters, were identified by a classical method (second ventilatory threshold) and by an alternative method (glycemic threshold). To determine the threshold values, patients performed an incremental treadmill test, with an initial velocity of 3 km.h-1 for 3 min, that was then increased by 1 km.h-1 every 2 min. Comparisons between mean values and the degree of agreement between second ventilatory threshold and glycemic threshold were analyzed using the paired t-test and Bland-Altman test, respectively. Results: All patients performed the tests appropriately, and no adverse effects were recorded. Patients demonstrated similar mean velocity (p = 0.25), heart rate (p = 0.97) and oxygen uptake (p = 0.71) between the ventilatory threshold (6.4 ± 0.6 km.h-1, 130.1 ± 18.7 bpm, 15.2 ± 3.5 ml.kg.min-1) and the glycemic threshold (6.2 ± 0.9 km.h-1, 130.2 ± 12.8 bpm, 15.0 ± 3.8 ml.kg.min-1). Conclusion: The present study indicates an agreement between the glycemic and second ventilatory methods in determination of the anaerobic threshold of patients with type 2 diabetes; and thus, either method may be used for these patients.

Efeitos agudos dos exercícios de hidroginástica e minitrampolim sobre os níveis pressóricos e glicêmicos de adolescentes obesos / Acute effects of water based and mini-trampoline exercises on pressoric and glycaemic levels of obese adolescents

O número de crianças com excesso de peso está aumentando na sociedade, implicando no aparecimento precoce de diabetes tipo 2 e hipertensão. Para prevenir isso, o exercício físico de baixo impacto pode ser uma alternativa segura e eficaz, podendo ser realizado tanto em meio aquático como em meio terrestre. Assim, o presente estudo objetivou analisar o efeito do exercício aeróbico de baixo impacto, em diferentes meios (hidroginástica vs mini trampolim), sobre os níveis glicêmicos e pressóricos de adolescentes obesos. Trinta e dois adolescentes obesos (12,4±2,5 anos) foram alocados randomicamente no grupo hidroginástica (GH; n = 16) e no grupo minitrampolim (GMT; n = 16). Ambos os grupos realizaram uma sessão de exercícios com duração de 32 minutos, prescrita de forma intervalada, com intensidade de estímulo em índice de esforço percebido intenso e recuperação em índice de esforço percebido muito leve. Os desfechos de glicemia capilar e pressão arterial foram avaliados pré, pós e 30 minutos pós-exercício. Uma equação de estimativas generalizadas foi usada para analisar os níveis glicêmicos e pressóricos nos diferentes momentos e modalidades, adotando-se um nível de significância de 5%. Ambos os grupos apresentaram redução glicêmica apenas imediatamente após a sessão de exercício (GH: -7,4mg/dL, GMT: -4,5mg/dL; efeito tempo, p = 0,005). A pressão arterial diastólica foi reduzida em ambos os grupos cinco minutos pós-exercício (GH: - 4mmHg, GMT: 0mmHg; efeito tempo, p = 0,017), permanecendo assim 30 minutos pós-exercício (efeito tempo; p = 0,013), enquanto a pressão arterial sistólica foi reduzida somente 30 minutos pós-exercício (GH: -14mmHg, GMT: -1,5mmHg; efeito tempo, p < 0,001). Conclui-se que sessões sob minitrampolim e hidroginástica, de forma intervalada, podem diminuir de forma similar os níveis glicêmicos e pressóricos de adolescentes obesos....(AU)

The number of children that are overweight it has been increasing in society, resulting in early-onset type 2 diabetes and hypertension. To prevent this, the physical low-impact exercise can be a safe and effective alternative and can be performed both aquatic as terrestrial environment. Therefore, this study aimed to analyze the effect of aerobic exercise with low impact in different environment (water vs/ land) on glucose and blood pressure levels in obese adolescents. Thirty-two obese adolescents (12.4 ± 2.5 years; BMI: 33.1 ± 5.3 kg / m2) were randomly allocated in two aerobics group: water group (GH; n = 16) and mini-trampoline training (GMT; n = 16). Both groups performed an exercise session lasting 32 minutes of prescribed intervals and stimulus intensity perceived intense effort index and recovery in very light perceived. The outcomes of blood glucose and blood pressure were analyze before, after and 30 minutes after exercise. An equation of generalized estimates was use to analyze the blood sugar and blood pressure levels at different times and modalities, adopting the significance level of 5%. Both groups had reduced glycemic only immediately after the exercise session (GH: -7,4mg/dL, GMT: -4,5mg/dL; time effect, p = 0,005). The diastolic blood pressure was reduced both the five minutes post-exercise groups (GH: - 4mmHg, GMT: 0mmHg; time effect, p = 0.017) and remained at 30 minutes post-exercise (time effect, p = 0.013), while the systolic blood pressure was reduced just 30 minutes post-exercise (GH: -14mmHg, GMT: -1,5mmHg; time effect; p <0.001). We conclude that interval sessions with low impact exercise can decrease similarly glycemic and blood pressure of obese adolescents....(AU)

Static balance behavior along a deep water periodization in older men / Comportamiento del equilibrio estático a lo largo de una periodización de carrera en aguas profundas en hombres mayores

The aim of this study was to evaluate static balance along a deep water periodization in older men. Twenty-two older men (65.2±3.8 years) completed 16 weeks of training in deep water. In the first four weeks (weeks 1-4) low intensity training was conducted twice a week, emphasizing familiarization exercises with running technique in deep water and with aquatic environment. In the following weeks (weeks 5-16) an aerobic training of high intensity was performed three times a week, using only deep water running exercise. Static balance was assessed at week 0, 5 and 17 using an accelerometer in four positions: double- and single-legged stances with eyes open and eyes closed. Statistical analysis: We performed a repeat measures ANOVA with Bonferroni post-hoc (α=0.05). Static balance improved significantly after the first four weeks of training (week 1 to 4) in both single-legged stances (~33%) and double-legged stances (~54%) (p<0.001).Whereas after the high intensity training period (week 5 to 16) the values remained (p>0.05). The results showed an improvement in static balance throughout a deep water periodization. However, improvement is found after the first four weeks that were emphasized exercises of low intensity and familiarization with deep water running technique and with aquatic environment. Following, the high-intensity aerobic training was sufficient to keep these improvements

El objetivo del estudio fue evaluar el equilibrio estático a lo largo de la periodización de carrera en aguas profundas en hombres mayores. Veintidós hombres mayores (65,2 ± 3,8 años) completaron 16 semanas de entrenamiento de carrera en aguas profundas. En las primeras cuatro semanas (semanas 1-4) el entrenamiento fue de baja intensidad y se realizó dos veces por semana. Los ejercicios fueron de familiarización con la técnica de carrera en aguas profundas y con el medio acuático. En las semanas siguientes (semana 5-16) se realizó un entrenamiento aeróbico de alta intensidad tres veces a la semana, usando solamente la carrera en agua profunda. El equilibrio estático fue evaluado en la semana 0, 5 y 17 utilizando un acelerómetro en cuatro posiciones: apoyo sobre ambos pies con los ojos abiertos y vendados y apoyo sobre un pie con los ojos abiertos y vendados. Análisis Estadístico: ANOVA para medidas repetidas con post hoc de Bonferroni (α=0,05). El equilibrio estático se ha mejorado significativamente después de las primeras cuatro semanas de entrenamiento (semanas 1-4) en las posiciones en apoyo en un solo pie (~33%) y en los apoyos en los dos pies (~54%) (p<0,001). Mientras después del período de entrenamiento de alta intensidad (semanas 5-16) los valores se mantuvieron (p>0,05). Los resultados mostraron una mejora en el equilibrio estático durante todas la periodización en aguas profundas. Sin embargo, la mejora se encuentra después de las primeras cuatro semanas de entrenamiento, en los que fueron realizados ejercicios de baja intensidad y la familiarización con la técnica de la carrera en agua profunda y con el medio acuático. Después, el entrenamiento aeróbico de alta intensidad fue suficiente para mantener estas mejoras

Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: A randomized clinical trial.

OBJECTIVES: To compare the effects of two aerobic training methods in water and on dry-land on glycemic, lipid, inflammatory, hormonal, cardiorespiratory, and functional outcomes in patients with type 2 diabetes. DESIGN: Randomized clinical trial. METHODS: Thirty-five patients with type 2 diabetes were randomly assigned to aquatic aerobic training group (n=17) or dry-land aerobic training group (n=18). Exercise training interventions had duration of 12 weeks, performed in three weekly sessions (45min/session), with intensity progressing from 85% to 100% of heart rate of anaerobic threshold during interventions. All outcomes were evaluated at baseline and 12 weeks later. RESULTS: Patients were 56.7±7.9 years old. Decreases in glycated hemoglobin were observed in both groups (AT: -0.42±0.28%, DLT: -0.35±1.8%). Total cholesterol, high density lipoprotein, low density lipoprotein levels, plasma renin activity, angiotensin II concentrations, C-reactive protein, systolic blood pressure, resting heart rate, and timed up and go test performed at the usual speed also decreased in both groups in response to both interventions (p<0.05), without between-group differences. Both groups increased the ratio between oxygen uptake at the anaerobic threshold and oxygen uptake of peak (p=0.01). CONCLUSIONS: Aerobic training in an aquatic environment provides effects similar to aerobic training in a dry-land environment in patients with type 2 diabetes.