Aqua walking as an alternative exercise modality during cardiac rehabilitation for coronary artery disease in older patients with lower extremity osteoarthritis

Abstract

BackgroundThe purpose of this study was to examine the effects of aqua walking (AW) on coronary artery disease (CAD) and cardiorespiratory fitness in older adults with osteoarthritis in the lower extremity and compare it with that of traditional over-ground walking.MethodsSixty consecutive eligible patients who had undergone percutaneous coronary intervention for CAD with limited ambulation due to lower extremity osteoarthritis were recruited. They were randomly assigned to the AW program group, treadmill/track walking (TW) program group, or non-exercise control group (CON). Assessments were performed before and after 24 weeks of medically supervised exercise training.ResultsSignificant differences were observed in the change in %body fat (TW: −2.7%, AW: −2.8%, CON: −0.4%), total cholesterol level (TW: −23.6 mg/dL, AW: −27.2 mg/dL, CON: 15.8 mg/dL), resting heart rate (TW: −6.3 bpm, AW: −6.9 bpm, CON: 1.3 bpm), and cardiorespiratory fitness expressed as VO2 peak (TW: 2.3 mL/kg·min−1, AW: 2.0 mL/kg·min−1, CON: −2.5 mL/kg·min−1) over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the TW and AW groups.ConclusionAW appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with CAD and osteoarthritis.

Short-Term Water- and Land-Based Exercise Training Comparably Improve Exercise Capacity and Vascular Function in Patients After a Recent Coronary Event: A Pilot Randomized Controlled Trial

“…End-of-study trueV˙O 2 peak in our trial was also significantly higher in the aquatic exercise group ( p < 0.001 after co-variance analysis adjusting for age and baseline capacity). Larger improvements with water- vs. land-based exercise training in CAD were observed previously (Teffaha et al, 2011; Lee et al, 2017). However, the magnitude of difference (2 ml kg -1 min -1 ) was larger in our study when compared to previous reports (1 ml kg -1 min -1 ) (Mourot et al, 2010; Teffaha et al, 2011), but the confidence intervals for our estimations were large and the study was underpowered to provide a definite conclusion as to whether differences in end-of-study trueV˙O 2 peak between aquatic and land-based training are indeed relevant.…”

“…In terms of specific physiology, water immersion is linked with hemodynamic and peripheral responses associated with improved myocardial efficiency and endurance (DiCarlo et al, 1991; Tei et al, 1995; Mourot et al, 2010). Previous studies (Teffaha et al, 2011; Lee et al, 2017) compared water- vs. land-based calisthenics on top of land-based endurance training (cycling), whereas our aquatic training protocol (both endurance and calisthenics) was entirely carried out in xiphoid-level water. In terms of the intensity, exercise prescription was based on peak heart rate achieved during symptom-limited graded exercise testing on a land bicycle ergometer.…”

“…Moreover, our intervention protocol did employ the aquatic heart rate adjustment (i.e., to a maximum rate 13% or 10 bpm lower than in land-based exercise) (Gabrielsen et al, 2000). In this respect, previous research yielded inconclusive results: some studies have corroborated the higher intensity (and thus the rationale for heart rate adjustment) of aquatic exercise (Lee et al, 2017), while others – including research in CAD populations exercising to up to 75% trueV˙O 2 peak – have not (Tokmakidis et al, 2008; Laurent et al, 2009; Teffaha et al, 2011). These inconclusive results may be reconciled by addressing the specific protocols of aquatic exercise, suggesting that the level of water may play an important role.…”

“…Volaklis et al, 2007 randomized 24 patients with stable CAD to 16 weeks of either water cycling plus water games, land cycling plus resistance training, or no exercise at all, and showed that water- and land-based protocols comparably improved exercise test time, muscle strength and blood lipid profiles. Conversely, Lee et al (2017) randomized 60 older (>65 years old) patients with CAD and osteoarthritis to 24 weeks of either aqua walking or treadmill walking, and showed that both protocols comparably improved aerobic exercise capacity, but the improvements in body composition and lipid levels were significantly more pronounced with aqua walking. Teffaha et al (2011) randomized 24 patients with CAD and 24 patients with heart failure to 3 weeks of cardiac rehabilitation, comprising land cycling plus calisthenics either on land or in water; both protocols were associated with significant increase in aerobic exercise capacity in patients with CAD.…”

Peculiarities of aqua fitness exercises influence on the physical preparedness of women 30-49 years old using endogenous-hypoxic breathing method

“…• Aqua walking appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with coronary artery disease and osteoarthritis [16]; • Aerobic activity in water seems to have had better effects on the mood state and on the physical efficiency than a comparable activity carried out in a gym. The aqua fitness programs are therefore highly recommendable as a sport for elderly women [17].…”