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aquatic rehabilitation [keywords]
- Aquatic Exercises were Associated with an Acceptable State of Symptoms in Patients with Inflammatory Rheumatic Diseases: Results from a Study with Interrupted Time-Series Design. [JOURNAL ARTICLE]
- Musculoskeletal Care 2014 Dec 10.
The aim of this study was two-fold: to compare symptoms and daily activity in patients with inflammatory rheumatic diseases across periods with and without aquatic exercises, and to examine whether the patients reached an acceptable state of symptoms during the periods with aquatic exercises.Thirty-six patients reported pain, fatigue, stiffness and ability to carry out daily activities across periods with and without aquatic exercises. The study has an interrupted time-series design and variables were collected with text messages on mobile phones twice a week over a period of 35 weeks.There was a significant reduction in pain, fatigue, stiffness and enhanced level of daily activity (p > 0.05) during periods of aquatic exercises compared to periods without. Further, a significantly higher proportion of patients reached an acceptable state for both pain and fatigue during periods with aquatic exercises.Living with an inflammatory rheumatic disease is a lifelong challenge. Pain and fatigue are considered major obstacles for daily functioning and adequate self-management strategies are requested. Based on the high proportion of patients reporting to be in an acceptable state of both pain and fatigue during periods with aquatic exercises, the intervention should be regarded as an important self-management tool rather than a treatment option assuming long-lasting effects. Copyright © 2014 John Wiley & Sons, Ltd.
- Physical exercise and weight loss for hip and knee osteoarthritis in very old patients: a systematic review of the literature. [Journal Article]
- Open Rheumatol J 2014.:89-95.
Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient's age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients.Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles.We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients.was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation.was as effective as land-based exercise.only patients under diet + exercise had significant improvement on symptoms.Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70-80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis.
- Epidemiology of avian influenza in wild aquatic birds in a biosecurity hotspot, North Queensland, Australia. [Journal Article]
- Prev Vet Med 2015 Jan 1; 118(1):169-81.
Migratory birds may introduce highly pathogenic H5N1 avian influenza from Southeast Asia into Australia via North Queensland, a key stopover along the East Asian-Australasian Flyway, with severe consequences for trade and human health. A 3-year repeated cross sectional study on the epidemiology of avian influenza in Australian nomadic wild aquatic birds was conducted in this potential biosecurity hotspot using molecular and serological techniques. Avian influenza virus subtypes H6 and H9 were commonly present in the studied population. It is likely that one of the H6 viruses was newly introduced through migratory birds confirming the perceived biosecurity risk. The matrix gene of another H6 virus was similar to the Australian H7 subtypes, which suggests the reassortment of a previously introduced H6 and local viruses. Similarly, a H9 subtype had a matrix gene similar to that found in Asian H9 viruses suggesting reassortment of viruses originated from Australia and Asia. Whilst H5N1 was not found, the serological study demonstrated a constant circulation of the H5 subtype in the sampled birds. The odds of being reactive for avian influenza viral antibodies were 13.1(95% CI: 5.9-28.9) for Pacific Black Ducks over Plumed Whistling Ducks, highlighting that some species of waterfowl pose a greater biosecurity risk. Antibody titres were slightly higher during warm wet compared with warm dry weather. Routine surveillance programmes should be established to monitor the introduction of avian influenza viruses from Asia and the interactions of the introduced viruses with resident viruses in order to better detect emerging pathogens in aquatic birds of North Queensland. Surveillance should be targeted towards highly susceptible species such as the Pacific Black Duck and carried out during favourable environmental conditions for viral transmission such as the wet season in northern Australia.
- Evidence for Canine Rehabilitation and Physical Therapy. [REVIEW]
- Vet Clin North Am Small Anim Pract 2015 Jan; 45(1):1-27.
This article reviews some important studies regarding canine physical rehabilitation. Bones, cartilage, muscles, ligaments, and tendons undergo atrophy if loading is decreased. Knowledge of the changes that occur with immobilization and the time course of events helps in the development of a rehabilitation program to improve tissue integrity. Outcome assessment instruments are clinically useful indicators of patient progress and the success of rehabilitation programs. A number of physical modalities are used in canine rehabilitation, although there are relatively few canine-specific studies. Rehabilitation has specific benefits in the treatment of various orthopedic and neurologic conditions.
- Comparison of Cardiorespiratory Responses During Aquatic and Land Treadmill Exercise in Patients With Coronary Artery Disease. [JOURNAL ARTICLE]
- J Cardiopulm Rehabil Prev 2014 Nov 18.
To investigate cardiorespiratory responses during exercise stress tests using an aquatic treadmill and a land-based treadmill in patients with coronary artery disease (CAD).Twenty-one stable CAD patients were enrolled. All patients participated in 2 symptom-limited incremental exercise tests, using both an aquatic and a land treadmill. For the aquatic treadmill protocol, patients were submerged to the upper waist in 28°C water. The treadmill speed started at 2.0 km/h and increased 0.5 km/h every minute thereafter. For the land treadmill protocol, the speed and gradient were started at 2.4 km/h and 1.5%, respectively. The speed was increased by 0.3 km/h and grade by 1% every minute thereafter. Oxygen consumption (VO2), heart rate (HR), and respiratory exchange ratio were measured continuously and peak values recorded. Rating of perceived exertion, percentage of age-predicted maximal HR, and total exercise duration were also recorded.Peak cardiorespiratory responses during both protocols were compared. The peak VO2 and peak HR did not show any significant differences. The peak respiratory exchange ratio was significantly greater using the land treadmill than the aquatic treadmill protocol. Rating of perceived exertion, age-predicted maximal HR percentage, and total exercise duration were similar for both protocols. There was a significant linear relationship between HR and VO2 with both protocols.This study demonstrated that aquatic treadmill exercise elicits similar peak cardiorespiratory responses compared with land treadmill exercise, suggesting that aquatic treadmill exercise may be effective for CAD patients in cardiac rehabilitation.
- The effects of aquatic therapy on mobility of individuals with neurological diseases: A systematic review. [REVIEW]
- Clin Rehabil 2014 Nov 13.
To summarize evidence on the effects of aquatic therapy on mobility in individuals with neurological diseases.MEDLINE, EMBASE, PsycInfo, CENTRAL, CINAHL, SPORTDiscus, PEDro, PsycBITE and OT Seeker were searched from inception to 15 September 2014. Hand-searching of reference lists was performed in the selected studies.The search included randomized controlled trials and quasi-experimental studies that investigated the use of aquatic therapy and its effect on mobility of adults with neurological diseases. One reviewer screened titles and abstracts of retrieved studies from the search strategy. Two reviewers independently examined the full texts and conducted the study selection, data extraction and quality assessment. A narrative synthesis of data was applied to summarize information from included studies. The Downs and Black Scale was used to assess methodological quality.A total of 116 articles were obtained for full text eligibility. Twenty studies met the specified inclusion criteria: four Randomized Controlled Trials (RCTs), four non-randomized studies and 12 before-and-after tests. Two RCTs (30 patients with stroke in the aquatic therapy groups), three non-randomized studies and three before-and-after studies showed "fair" evidence that aquatic therapy increases dynamic balance in participants with some neurological disorders. One RCT (seven patients with stroke in the aquatic therapy group) and two before-and-after tests (20 patients with multiple sclerosis) demonstrated "fair" evidence on improvement of gait speed after aquatic therapy.Our synthesis showed "fair" evidence supporting the use of aquatic therapy to improve dynamic balance and gait speed in adults with certain neurological conditions.
- Cardiovascular response during submaximal underwater treadmill exercise in stroke patients. [Journal Article]
- Ann Rehabil Med 2014 Oct; 38(5):628-36.
To evaluate the cardiovascular response during head-out water immersion, underwater treadmill gait, and land treadmill gait in stroke patients.Ten stroke patients were recruited for underwater and land treadmill gait sessions. Each session was 40 minutes long; 5 minutes for standing rest on land, 5 minutes for standing rest in water or on treadmill, 20 minutes for treadmill walking in water or on land, 5 minutes for standing rest in water or on treadmill, and 5 minutes for standing rest on land. Blood pressure (BP) and heart rate (HR) were measured during each session. In order to estimate the cardiovascular workload and myocardial oxygen demand, the rate pressure product (RPP) value was calculated by multiplying systolic BP (SBP) by HR.SBP, DBP, mean BP (mBP), and RPP decreased significantly after water immersion, but HR was unchanged. During underwater and land treadmill gait, SBP, mBP, DBP, RPP, and HR increased. However, the mean maximum increases in BP, HR and RPP of underwater treadmill walking were significantly lower than that of land treadmill walking.Stroke patients showed different cardiovascular responses during water immersion and underwater gait as opposed to standing and treadmill-walking on land. Water immersion and aquatic treadmill gait may reduce the workload of the cardiovascular system. This study suggested that underwater treadmill may be a safe and useful option for cardiovascular fitness and early ambulation in stroke rehabilitation.
- Aquatic exercise training for fibromyalgia. [Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review]
- Cochrane Database Syst Rev 2014.:CD011336.
Exercise training is commonly recommended for individuals with fibromyalgia. This review examined the effects of supervised group aquatic training programs (led by an instructor). We defined aquatic training as exercising in a pool while standing at waist, chest, or shoulder depth. This review is part of the update of the 'Exercise for treating fibromyalgia syndrome' review first published in 2002, and previously updated in 2007.The objective of this systematic review was to evaluate the benefits and harms of aquatic exercise training in adults with fibromyalgia.We searched The Cochrane Library 2013, Issue 2 (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, NHS Economic Evaluation Database), MEDLINE, EMBASE, CINAHL, PEDro, Dissertation Abstracts, WHO international Clinical Trials Registry Platform, and AMED, as well as other sources (i.e., reference lists from key journals, identified articles, meta-analyses, and reviews of all types of treatment for fibromyalgia) from inception to October 2013. Using Cochrane methods, we screened citations, abstracts, and full-text articles. Subsequently, we identified aquatic exercise training studies.Selection criteria were: a) full-text publication of a randomized controlled trial (RCT) in adults diagnosed with fibromyalgia based on published criteria, and b) between-group data for an aquatic intervention and a control or other intervention. We excluded studies if exercise in water was less than 50% of the full intervention.We independently assessed risk of bias and extracted data (24 outcomes), of which we designated seven as major outcomes: multidimensional function, self reported physical function, pain, stiffness, muscle strength, submaximal cardiorespiratory function, withdrawal rates and adverse effects. We resolved discordance through discussion. We evaluated interventions using mean differences (MD) or standardized mean differences (SMD) and 95% confidence intervals (95% CI). Where two or more studies provided data for an outcome, we carried out meta-analysis. In addition, we set and used a 15% threshold for calculation of clinically relevant differences.We included 16 aquatic exercise training studies (N = 881; 866 women and 15 men). Nine studies compared aquatic exercise to control, five studies compared aquatic to land-based exercise, and two compared aquatic exercise to a different aquatic exercise program.We rated the risk of bias related to random sequence generation (selection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), blinding of outcome assessors (detection bias), and other bias as low. We rated blinding of participants and personnel (selection and performance bias) and allocation concealment (selection bias) as low risk and unclear. The assessment of the evidence showed limitations related to imprecision, high statistical heterogeneity, and wide confidence intervals. Aquatic versus controlWe found statistically significant improvements (P value < 0.05) in all of the major outcomes. Based on a 100-point scale, multidimensional function improved by six units (MD -5.97, 95% CI -9.06 to -2.88; number needed to treat (NNT) 5, 95% CI 3 to 9), self reported physical function by four units (MD -4.35, 95% CI -7.77 to -0.94; NNT 6, 95% CI 3 to 22), pain by seven units (MD -6.59, 95% CI -10.71 to -2.48; NNT 5, 95% CI 3 to 8), and stiffness by 18 units (MD -18.34, 95% CI -35.75 to -0.93; NNT 3, 95% CI 2 to 24) more in the aquatic than the control groups. The SMD for muscle strength as measured by knee extension and hand grip was 0.63 standard deviations higher compared to the control group (SMD 0.63, 95% CI 0.20 to 1.05; NNT 4, 95% CI 3 to 12) and cardiovascular submaximal function improved by 37 meters on six-minute walk test (95% CI 4.14 to 69.92). Only two major outcomes, stiffness and muscle strength, met the 15% threshold for clinical relevance (improved by 27% and 37% respectively). Withdrawals were similar in the aquatic and control groups and adverse effects were poorly reported, with no serious adverse effects reported. Aquatic versus land-basedThere were no statistically significant differences between interventions for multidimensional function, self reported physical function, pain or stiffness: 0.91 units (95% CI -4.01 to 5.83), -5.85 units (95% CI -12.33 to 0.63), -0.75 units (95% CI -10.72 to 9.23), and two units (95% CI -8.88 to 1.28) respectively (all based on a 100-point scale), or in submaximal cardiorespiratory function (three seconds on a 100-meter walk test, 95% CI -1.77 to 7.77). We found a statistically significant difference between interventions for strength, favoring land-based training (2.40 kilo pascals grip strength, 95% CI 4.52 to 0.28). None of the outcomes in the aquatic versus land comparison reached clinically relevant differences of 15%. Withdrawals were similar in the aquatic and land groups and adverse effects were poorly reported, with no serious adverse effects in either group. Aquatic versus aquatic (Ai Chi versus stretching in the water, exercise in pool water versus exercise in sea water)Among the major outcomes the only statistically significant difference between interventions was for stiffness, favoring Ai Chi (1.00 on a 100-point scale, 95% CI 0.31 to 1.69).Low to moderate quality evidence relative to control suggests that aquatic training is beneficial for improving wellness, symptoms, and fitness in adults with fibromyalgia. Very low to low quality evidence suggests that there are benefits of aquatic and land-based exercise, except in muscle strength (very low quality evidence favoring land). No serious adverse effects were reported.
- Effect of different types of exercise on postural balance in elderly women: A randomized controlled trial. [Journal Article]
- Arch Gerontol Geriatr 2014 Nov-Dec; 59(3):506-14.
Different types of exercise are indicated for the elderly to prevent functional capacity limitations due to aging and reduce the risk of falls. This study aimed to evaluate the effect of three different exercises (mini-trampoline, MT; aquatic gymnastics, AG and general floor gymnastics, GG) on postural balance in elderly women. Seventy-four physically independent elderly women, mean age 69±4 years, were randomly assigned to three intervention groups: (1) MT (n=23), (2) AG (n=28), and (3) GG (n=23). Each group performed physical training, including cardiorespiratory, muscular strength and endurance, flexibility and sensory-motor exercises for 12 weeks. To determine the effects on each intervention group, five postural balance tasks were performed on a force platform (BIOMEC 400): the two-legged stand with eyes open (TLEO) and two-legged stand with eyes closed (TLEC); the semi-tandem stand with eyes open (STEO) and semi-tandem stand with eyes closed (STEC) and the one-legged stand. Three trials were performed for each task (with 30s of rest between them) and the mean was used to compute balance parameters such as center of pressure (COP) sway movements. All modalities investigated such as the MT, AG and GG were significantly (P<0.05) efficient in improving the postural balance of elderly women after 12 weeks of training. These results provide further evidence concerning exercise and balance for promoting health in elderly women.
- Molecular biomarkers in grey seals (Halichoerus grypus) to evaluate pollutant exposure, health and immune status. [Journal Article]
- Mar Pollut Bull 2014 Nov 15; 88(1-2):311-8.
Grey seals as top-predators bioaccumulate contaminants and can be considered as sentinels of eco-system health. Pups are weaned after a short nursing period, characterised by an enormous lipid transfer and exposure to contaminants. This study established molecular biomarkers of the xenobiotic metabolism and immune system to help assess health and immune status. mRNA transcription of AHR, ARNT, PPARα and cytokine IL-2 and heat-shock-protein HSP70 was measured in blood of grey seal pups and adults in rehabilitation and permanent care using RT-qPCR and compared to rehabilitating harbour seal pups and haematology values. In pups highest levels at admission in xenobiotic biomarker, HSP70 and cytokine transcription may show contaminant exposure via lactation, stress during abandonment and dehydration. The significant decrease may be linked to diet, health improvement and adaptation. Adults showed higher levels and more variation in biomarker transcription and clear species-specific differences between harbour and grey seal pups were found.