Hydrotherapya new approach to improve function in the older patient with chronic heart failure Europ

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Hydrotherapy-a new approach to improve function
in the older patient with chronic heart
failureEuropean Journal of Heart Failure Volume
5, Issue 4, August 2003,pg. 527-535 Authors
Asa Cider,Maria Schaufelberger,Katharina
Stibrant Sunnerhagen and Bert Andersson
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Purpose

• To assess the applicability of an exercise
  program in a temperate controlled swimming pool
  in older patients with CHF. The hypothesis was
  that training in warm water could be a feasible
  alternative of physical training for patients
  with CHF, resulting in enhanced physical
  performance, muscle function and quality of life.

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Methods

• N25 with Chronic Heart Failure (CHF) age 72.1
  (/-6.1)
• Participants tested in VO2 Exercise tolerance,
  exercise capacity related to ADL, muscle
  strength/endurance
• Randomized into hydrotherapy program or control
  group
• Procedure 8 weeks, 45 min. sessions heated
  pool (33-34 C) trained as a group
• Statistical SPSS 9.0 for Windows P-value lt0.01
  considered significant

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Results

• Greater improvement in exercise tolerance
  compared to control group (6 increase in peak
  VO2 in training group and 16 decrease in control
  group)
• Improved muscle function
• No significant difference between control and
  hyrdotherapy group for strength
• Significant improvement in quality of life as
  reported on repeat questionnaires

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Discussion

• Adherence was high (95)
• Participants reported enjoying training session
  wished to continue after study (long-term
  adherence important)
• Peak VO2 improvements could be due to elderly
  population
• Lack of improvement in knee extension might be
  due to not enough resistance in water
• Due to limited size of study, results could not
  be generalized for all patients with CHF

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Conclusion

• Physical training was tolerated well
• Hydrotherapy appears to significantly improve
  exercise capacity and muscle function in elderly
  patients with CHF
• Hydrotherapy may be a useful alternative for
  elderly population with co-morbidity, especially
  those that impede mobility.

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• Effects of arthritis exercise programs on
  functional fitness and perceived activities of
  daily living measures in older adults with
  arthritis
• Author R. Suomi, D. Collier
• Archives of Physical Medicine and Rehabilitation
• Vol. 84, Issue 11
• Nov. 2003, pg 1589-1594

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Purpose

• Evaluate the effectiveness of National Arthritis
  Foundation (NAF) aquatic and on-land programs on
  functional fitness and perceived ability to
  perform ADL in elderly population with arthritis

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Methods

• N30 Age 60 79 years diagnosis of rheumatoid
  or osteoarthritis arthritis
• Tested in flexibility, coordination, agility
  dynamic balance, strength endurance,
  cardiorespiratory endurance, hand-held
  dynamometry tests questionnaire for ADL
• Procedure On-land group People with Arthritis
  can Exercise program (PACE) protocol Aquatic
  group Arthritis Foundation Aquatic Program
  (AFAP) protocol both 8 week programs

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Methods (continued)

• Random assignment to aquatic, on-land or control
  group
• Statistical methods Repeated measures analysis
  of variance planned comparison approach with
  independent 3x2 (group by test) design w²
  analyses for degree of effectiveness of treatment
  for each dependent variable

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Results

• Significant differences pre to posttest in both
  aquatic and on-land groups for flexibility,
  hand-eye coordination, right left arm curl no
  significant changes for control group
• On land (but NOT aquatic) group demonstrated
  significant pre to post test differences for
  balance agility

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Results (continued)

• Aquatic group revealed significant reductions in
  pain and difficultly in ADL measures on-land
  group showed significant reduction in pain only
  ADL measures No significant difference in
  control group

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Discussion

• Confounding variables short duration (8 wk),
  time of year, paid participation, programs stress
  education social aspects of exercise
• Neither group evidenced increases in
  cardiorespiratory tests, (this was not emphasized
  in either program)

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Discussion (continued)

• Significant finding Decreased perception of pain
  and difficulty in ADLs for both groups
• Finding could be due to the exercise programs
  themselves or result of education components of
  programs (not determined from this study)
• All subjects physical fitness levels/ capacity
  were average for age/sex outcomes may vary for
  individuals with arthritis and lower or higher
  levels of physical fitness levels/capacity

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Conclusion

• Both NAF aquatic and on-land programs effective
  in increasing functional fitness and ADL measures
  for older adults with arthritis
• Strong educational and social aspects stressed in
  this program should be studied further for
  specific effects on outcomes