o RIG I N AlAR TIC l E
Stephen lord Dionne Mitchell Philippa Williams
Effect of water exercise on balance and related factors in older people
A
Fifteen subjects enrolled to take part in awater number of studies have shown that land-based exercise can exercise programme (mean age = 69.7 years) and 13 control subjects (mean age 72.6 years) improve physiological measures underwent assessments of quadriceps and ankle such as muscle strength, balance, dorsiflexion strength. reaction time. neuro- reaction time and joint flexibility in muscular control. body sway. flexibility and older persons (Aniansson et al1984, joint pain. All subjects were then retested for Morey et a11991, Munns 1981). There the same measures after completion of the are, however, few reports on the effect nine-week programme. The experimental of water exerCise on such measures. subjects showed improved quadriceps strength One study, which included both pre and reduced body sway when compared with and post tests (Oanneskiold-Samsoe et the control group. Therewasalso atrend towards al1987) found a two month trial of increased flexibility. improved reaction times twice weekly water exercise and reduced jointpain inthe experimental group. significantly improved isometric and [Lord SR. Mitchell D and Williams P: Effect of isokinetic quadriceps strength in eight water exercise on balance and related factors persons aged 35 to 66 years with in older people. Australian Journal of rheumatoid arthritis. In another uncontrolled study, Smit and Harrison Physiotherapy39: 217-222] (1991) found that a fourweektrial of hydrotherapy had a benefiCial effect on lower back pain and spinal mobility in 20 subjects of mean age 59 years (SO = Key words: Aged; Exercise 14.3) who were suffering from chronic therapy; Pain; Posture lower back pain. In an evaluation of a water exercise programme for frail elderly people, Rissel (1987) found that most of the 51 partiCipants who completed the trial SR Lord PhD is a project scientist at the School reported increased fitness, improved of Community Medicine. University of New body tone and reduced stiffness. South Wales. Participants also showed significantly D Mitchell BAppSc(Phtyl. AMusA is a improved scores on a scale of affect, physiotherapist at Roma Private Hospital. reported that they felt more relaxed Handwick. NSW. and calm,and stated that they enjoyed P WilliamsBSS is a research assistant at the the programme, socialised and made School of Community Medicine. University of new friends. Weiss and Jameson (1987) have also found that water exercise New South Wales. programmes enhance social interaction Correspondence: Dr Stephen Lord. School of and have beneficial effects on affect. Community Medicine. University of New South Water exerCise provides a viable Wales, PO Box 1. Kensington. NSW 2033.
alternative for older persons who are unable to participate in land-based exerCise programmes because of impairments to balance or other disabilities. The buoyancy of water allows some elderly people to undertake exercises and movements that they could not do on land. Buoyancy and water pressure can also be utilised as resistance in strengthening exercises (Golland 1981). Reduced mobility and independence and increased risk of falls in older people have been assoCiated with impairments in strength, coordination, postural stability and flexibility (Campbell et a11989, Lord etall991a, Whipple etaI1987). Thus it is of considerable importance to determine whether water exerCise, which has been advocated as a means of improving or maintaining functional performance in older people, has beneficial effects on these physiological parameters. This paper examines the effect of a nine-week pilot programme of water exercise on muscle strength, neuromuscular control, reaction time, body sway, flexibility and joint pain in a group of older persons, comparing these outcomes with age and gender matched controls.
Method Subjects Fifteen persons participating in their first water activity programme and 13
...
ORIGINAL ARTICLE
From Page 217 control subjects took part in the study. There were two men in each group. The water activity group was recruited from persons on a waiting list for the programme, whilst the controls were recruited from members of an adult learning and leisure activity (ALER'!) group who met weekly at a senior citizens centre. Those in the ALERT group attended classes on current affairs and Australian history and took part in activities such as painting and craft. The mean age of the water activity group 69.7 years (SD=8.6), was not significantly different to the mean age of the controls, 72.6 years (SD=8.7), (t26=0.88,p=0.3 9). The water activity and control groups were similar across a number of health and lifestyle measures. Table 1 shows the numbers and proportions in each group who reported medical conditions, drug use, inactivity, falls, use of walking aids and disability. The proportion with diabetes was significantly higher in the control group, but all other measures showed no significant differences. The presence of one or more of these conditions did not preclude any of the water activity subjects from undertaking the exercise programme.
Exercise programme The WAVES (Water Activities for Vitality in the Eastern Suburbs) programme, comprised the intervention. This programme, which was specifically designed for older people, consisted of one hour sessions, conducted once a week for nine weeks. The exercises were undertaken in the months of February, March and April in pools where the temperature ranged from 25 to 29 degrees C. Major aims of the programme were: to instil water confidence, to increase body flexibility and joint range of motion, to improve postural awareness, balance and coordination skills, to increase muscle strength and endurance, to enhance social contacts and maximise enjoyment (RisseI1987). Physiotherapists and trained water exercise leaders used a standard exercise warm-up, conditioning and
'-~~ ':~F-:.;-
,'",'
Figure 1. Exercise class format.
cool-down period (American College of Sports Medicine 1980) modified for the target group and the medium of .water. Participants of differing physical disabilities were encouraged to work at their own pace. The typical class format is outlined in Figure 1.
Sensori-motor function and flexibility assessments The assessment, conducted prior to the commencement of the exercise trial, included tests of muscle strength, reaction time, neuromuscular control, body sway, flexibility (passive ankle dorsiflexion) and joint pain. Each full assessment took approximately 30 minutes. Subjects were re-assessed on all ofthe test measures at the end of the eight 'Week programme by the same research personnel. Quadriceps stre~gth was measured by placing a strap around the subjects' dominant leg, lethe right leg in a
right-handed person and the left leg in a left-handed person. The strap was connected to a fixa~on point behind a chair so that when the subject (seated on the chair) attempted to extend the leg, a spring gauge was extended, giving a measure of maximal quadriceps strength. The subject had three experimental trials and the greatest force measured by the spring gauge was recorded (in kg). Ankle dorsiflexion strength was measured by having the subject place the dominant foot on a foot rest. A strap (which protruded through the foot rest) was placed Over the foot just proximal to the little toe. The strap was connected to the base of the foot rest so that when the seated subject attempted to dorsiflex the foot (whilst keeping the heel placed on the foot rest) a spring gauge 'Was extended, giving a measure 'of maximal ankle dorsiflexion strength. The subject had
ORIGINAL ARTICLE
·.·.w~
Stephen lord Dionne Mitchell Philippa Williams
Effect of water exercise on balance and related factors in older people
A
Fifteen subjects enrolled to take part in awater number of studies have shown that land-based exercise can exercise programme (mean age = 69.7 years) and 13 control subjects (mean age 72.6 years) improve physiological measures underwent assessments of quadriceps and ankle such as muscle strength, balance, dorsiflexion strength. reaction time. neuro- reaction time and joint flexibility in muscular control. body sway. flexibility and older persons (Aniansson et al1984, joint pain. All subjects were then retested for Morey et a11991, Munns 1981). There the same measures after completion of the are, however, few reports on the effect nine-week programme. The experimental of water exerCise on such measures. subjects showed improved quadriceps strength One study, which included both pre and reduced body sway when compared with and post tests (Oanneskiold-Samsoe et the control group. Therewasalso atrend towards al1987) found a two month trial of increased flexibility. improved reaction times twice weekly water exercise and reduced jointpain inthe experimental group. significantly improved isometric and [Lord SR. Mitchell D and Williams P: Effect of isokinetic quadriceps strength in eight water exercise on balance and related factors persons aged 35 to 66 years with in older people. Australian Journal of rheumatoid arthritis. In another uncontrolled study, Smit and Harrison Physiotherapy39: 217-222] (1991) found that a fourweektrial of hydrotherapy had a benefiCial effect on lower back pain and spinal mobility in 20 subjects of mean age 59 years (SO = Key words: Aged; Exercise 14.3) who were suffering from chronic therapy; Pain; Posture lower back pain. In an evaluation of a water exercise programme for frail elderly people, Rissel (1987) found that most of the 51 partiCipants who completed the trial SR Lord PhD is a project scientist at the School reported increased fitness, improved of Community Medicine. University of New body tone and reduced stiffness. South Wales. Participants also showed significantly D Mitchell BAppSc(Phtyl. AMusA is a improved scores on a scale of affect, physiotherapist at Roma Private Hospital. reported that they felt more relaxed Handwick. NSW. and calm,and stated that they enjoyed P WilliamsBSS is a research assistant at the the programme, socialised and made School of Community Medicine. University of new friends. Weiss and Jameson (1987) have also found that water exercise New South Wales. programmes enhance social interaction Correspondence: Dr Stephen Lord. School of and have beneficial effects on affect. Community Medicine. University of New South Water exerCise provides a viable Wales, PO Box 1. Kensington. NSW 2033.
alternative for older persons who are unable to participate in land-based exerCise programmes because of impairments to balance or other disabilities. The buoyancy of water allows some elderly people to undertake exercises and movements that they could not do on land. Buoyancy and water pressure can also be utilised as resistance in strengthening exercises (Golland 1981). Reduced mobility and independence and increased risk of falls in older people have been assoCiated with impairments in strength, coordination, postural stability and flexibility (Campbell et a11989, Lord etall991a, Whipple etaI1987). Thus it is of considerable importance to determine whether water exerCise, which has been advocated as a means of improving or maintaining functional performance in older people, has beneficial effects on these physiological parameters. This paper examines the effect of a nine-week pilot programme of water exercise on muscle strength, neuromuscular control, reaction time, body sway, flexibility and joint pain in a group of older persons, comparing these outcomes with age and gender matched controls.
Method Subjects Fifteen persons participating in their first water activity programme and 13
...
ORIGINAL ARTICLE
From Page 217 control subjects took part in the study. There were two men in each group. The water activity group was recruited from persons on a waiting list for the programme, whilst the controls were recruited from members of an adult learning and leisure activity (ALER'!) group who met weekly at a senior citizens centre. Those in the ALERT group attended classes on current affairs and Australian history and took part in activities such as painting and craft. The mean age of the water activity group 69.7 years (SD=8.6), was not significantly different to the mean age of the controls, 72.6 years (SD=8.7), (t26=0.88,p=0.3 9). The water activity and control groups were similar across a number of health and lifestyle measures. Table 1 shows the numbers and proportions in each group who reported medical conditions, drug use, inactivity, falls, use of walking aids and disability. The proportion with diabetes was significantly higher in the control group, but all other measures showed no significant differences. The presence of one or more of these conditions did not preclude any of the water activity subjects from undertaking the exercise programme.
Exercise programme The WAVES (Water Activities for Vitality in the Eastern Suburbs) programme, comprised the intervention. This programme, which was specifically designed for older people, consisted of one hour sessions, conducted once a week for nine weeks. The exercises were undertaken in the months of February, March and April in pools where the temperature ranged from 25 to 29 degrees C. Major aims of the programme were: to instil water confidence, to increase body flexibility and joint range of motion, to improve postural awareness, balance and coordination skills, to increase muscle strength and endurance, to enhance social contacts and maximise enjoyment (RisseI1987). Physiotherapists and trained water exercise leaders used a standard exercise warm-up, conditioning and
'-~~ ':~F-:.;-
,'",'
Figure 1. Exercise class format.
cool-down period (American College of Sports Medicine 1980) modified for the target group and the medium of .water. Participants of differing physical disabilities were encouraged to work at their own pace. The typical class format is outlined in Figure 1.
Sensori-motor function and flexibility assessments The assessment, conducted prior to the commencement of the exercise trial, included tests of muscle strength, reaction time, neuromuscular control, body sway, flexibility (passive ankle dorsiflexion) and joint pain. Each full assessment took approximately 30 minutes. Subjects were re-assessed on all ofthe test measures at the end of the eight 'Week programme by the same research personnel. Quadriceps stre~gth was measured by placing a strap around the subjects' dominant leg, lethe right leg in a
right-handed person and the left leg in a left-handed person. The strap was connected to a fixa~on point behind a chair so that when the subject (seated on the chair) attempted to extend the leg, a spring gauge was extended, giving a measure of maximal quadriceps strength. The subject had three experimental trials and the greatest force measured by the spring gauge was recorded (in kg). Ankle dorsiflexion strength was measured by having the subject place the dominant foot on a foot rest. A strap (which protruded through the foot rest) was placed Over the foot just proximal to the little toe. The strap was connected to the base of the foot rest so that when the seated subject attempted to dorsiflex the foot (whilst keeping the heel placed on the foot rest) a spring gauge 'Was extended, giving a measure 'of maximal ankle dorsiflexion strength. The subject had
ORIGINAL ARTICLE
·.·.w~
