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Table 3 Studies and interventions (including assessments, results and limitations found in each study for clinicians and researchers)

From: Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review

Study Objective Population Intervention group
Depth & Tª Magnitude of load Assessment Outcome Limitations of the study
Silva et al., 2018 [31] To investigate the effects of two water programs on functional capacity and quality of life of elderly women. Forty-one elderly female (65 ± 4 years) were divided into aerobic training group (n = 13), combined training (n = 11) and CG (n = 9). Depth: Between the xiphoid process and shoulders.
Tª: 33 °C
AG(I): Aerobic intervention; AG(II): Combined Intervention; CG: No intervention Strength: 30-s chair-stand. The 30-s chair-stand test resulted in an increase of 32 ± 11%, 24 ± 14% and 20 ± 9% for AG1 (I), AG (II) and CG, respectively. The absence of a water-based resistance training group to compare the adaptation with water-based groups. The lack of control of the exercise program intensity and the frequency of elderly women in CG.
Volume Specific intensity control
W F D Maximum effort
1–6 sets of 30″-5′/30″-2′ rest; AT: 85–110%
12 2 N/A  
Type of exercise
Balance Not included
Strength Combined exercise UL and LL
Flexibility General - Does not specify exercises
Reichert et al., 2018 [16] To compare the effects of 1 × 30″, 3 × 10″, and 1 × 10″ water resistance training on muscle strength and functional capacity in older women. Thirty-six healthy women (60–75 years) AG (I): n = 12, AG (II): n = 13 and AG (III): n = 11 were divided into three different aquatic training. Depth: Between the xiphoid process and shoulders.
Tª: 31 °C
AG (I): 1 × 30″ AG (II): 1 × 10″; AG (III): 3 × 10” Strength: Maximal dynamic strength (1-RM)
Muscular endurance with a load of 60%RM.
The main finding was that the three groups strategies performed twice a week induced similar relevant improvements in maximal strength, muscular endurance, and functional capacity. However, only the AG (I) 1 × 30s and the AG (II) 1 × 10s showed increased maximal strength in the bench press exercise. The absence of an evaluation of the explosive strength, which is also important for the elderly population, as it is related to the capacity to perform daily life activities and risk of falls.
Volume Specific intensity control
W F D RPE: 19
12 2 N/A Maximum velocity
1–3 sets of 30″/ 2′ rest.
Type of exercise
Balance Not included
Strength Knee and elbow flexion/extension
Unilateral hip adduction and abduction
Flexibility Not included
Seyedjafari et al., 2017 [32] To investigate the effect of deep aquatic exercises on lower body strength and balance Thirty elderly men over 65 were divided into AG (n = 15) and CG (n = 15). Depth: Over 2 m.
Tª:
Does not appear.
AG: Intervention; CG: No intervention Balance: Biodex Balance System.
Strength:
Hand-Held Dynamometer
All variables including lower body strength, static balance was significantly improved (p < 0.001) in experimental group after aquatic exercises program. The method of participant selection was by volunteer and therefore subjects were not randomly selected. This could affect the generalizability of the outcomes.
Volume Specific intensity control
W F D Not included
8 3 60’
Type of exercise
Balance Float exercises
Strength Hip abduction/adduction/flexion/extension
Flexibility General - Does not specify exercises
Bento et al., 2015 [34] To evaluate the effects of a water-based exercise program on static and dynamic balance. Sixty-five independent participants (over 60 years old) were divided in AG (n = 20) and CG (n = 16). Depth: Xiphoid process.
Tª:
28–30 °C.
AG: Intervention; CG: No intervention Balance: Displacement of the center of pressure in a quiet standing position and 8-Foot Up-and Go. No differences were found in the center of pressure variables; however, the AG group showed better performance in the 8 Foot Up-and-Go Test after training (5.61–0.76 vs. 5.18–0.42; p < 0.01). The physical conditioning of the participants at baseline revealed a good status, which may have reduced the magnitude of the training effects.
Volume Specific intensity control
W F D RPE: 12–16
12 3 N/A HRR: 40 to 60%
3 sets × 40″ / 20″ rest
Type of exercice
Balance Not included
Strength Hip/knee flexion/extension and dorsal and plantar flexion of the ankle
Flexibility General - Does not specify exercises
Kim y O’Sullivan, 2013 [28] To examine the effects of aquatic exercise on biomechanical and physiological elements influencing gait. Healthy women (70–78 years) bone mineral density score up −1.
AG: n = 8
CG: n = 7
Depth: Between waist and chest.
Tª:
28 ± 1 °C.
AG: Intervention; CG: No intervention Balance: Gait observations, kinematics at 60 Hz were recorded by 8 cameras, and kinetics on by 2 force platforms.
Strength:
30″ chair stand, arm curl.
Flexibility: Chair sit-and-reach
Back scratch
AG obtain reductions (p < 0.05) in body weight, and body fat mass, and stride time. Significant increases (p > 0.05) in leg strength corresponded to the maximum joint moment of the landing leg, getting better the ability for recovery of balance after any perturbation. High dropout rate. The evaluation of the balance is not clear and the study does not indicate clearly the load magnitude of training in AG.
Large sample difference between intervention group and control group.
Volume Specific intensity control
W F D RPE: 7–11
12 3 60’  
Type of exercise
Balance Static and dynamic
Strength General Exercise for UL and DL
Flexibility General - Does not specify exercises
Sanders, Takeshima, Rogers, Colado y Borreani, 2013 [36] To evaluate the aquatic environment in the improvement of the ADL in women over 60 years. Women (60–89 years), sedentary, independent and confirmed by a physician their healthy situation.
AG: n = 48
CG: n = 18
Depth: Xiphoid process.
Tª:
28–29 °C.
AG: Intervention; CG: No intervention Balance: One leg with eyes open and maintain balance while they walk in a circle.
Strength: Sit-to- stand and arm curl.
Flexibility: Sit-and-reach
AG obtained improvements with respect to CG in balance, flexibility, strength and agility (p < 0.05). Long difference in sample size between intervention group and control group. Short duration of intervention and important difference of age between participants. Absence of specificity of training load. The type of exercise in the AG is not specified.
Volume Specific intensity control
W F D Progressive to Moderate;
16 3 25–45’ 2 sets × 10 rep. /15″ rest.
Type of exercise
Balance Static and dynamic
Strength Combined exercise for UL and DL.
Flexibility Does not specify exercises
Bergamin et al., 2013 [30] To evaluate the effects of aquatic exercise on the strength and functionality of the elderly. Healthy elderly (70–76 years) were divided into aquatic group (n = 17), land group (n = 17) and control group (n = 19) Depth: 1.30–1.80 m.
Tª: 36 °C.
AG and LG: intervention; CG: no intervention Balance: 8-ft up-and go
Strength: Dynamometry for hand-grip and isometric knee flexion-extension
Flexibility: Back-scratch test and sit-and-reach.
It has found significant improvement (p < 0.05) in flexibility, mobility and balance, obtaining AG a greater improvement dynamic balance a loss weight (P < 0.05) Low sample size. Lack of specificity of the height of the water during the development of exercises.
Volume Specific intensity control
W F D RPE: 13–16
6 2 60’ HRmáx: 55–65%
3 sets × 1′ / 30″ rest
Type of exercise
Endurance Combined exercise for UL and DL
Strength Combined exercise for UL and DL
Flexibility Combined exercise of UL and DL maintaining movement 90″.
Elbar et al., 2013 [33] To evaluate a perturbation programme of balance targeted compensatory and voluntary stepping to improve speed of stepping. 34 healthy volunteers (64–88 years) was divided in two groups n = 17, respectively. Depth: Xiphoid process.
Tª: Does not appear.
AG: Intervention; CG: No intervention Balance: Fall Efficacy Scale.
Folstein Mini-Mental State Examination.
Voluntary Step Execution Test Stabilogram-Diffusion Alysis.
Berg Balance Scale.
Get-up-and-go.
A significant interaction effect between group and time was found for the step execution, due to improvement in initiation phase and swing phase durations in the AG. Also, significant improvement in postural stability in eyes open and closed conditions is noted. No benefits for performance aspects of balance control. Although this lack of improvement could be due to ceiling effects, it may reflect the specificity of training principle and the need for therapists to tailor balance training programs to target specific aspects.
Volume Specific intensity control
W F D Progressive levels of balance intensity
12 2 40’
Type of exercise
Balance Level 1: Standing - External support
Level 2: Standing - No external support
Level 3: Single leg – No external support
Level 4: Gait exercise – No support
Level 5: Perturbation and water turbulence
Strength Not included
Flexibility Not included
Javaheri, Rahimi, Rashidlamir y Alikhajeh, 2012 [24] To compare aquatic and terrestrial environment in the improvement of the static and dynamic balance for elderly. Thirty older adults (63–70 years); independents in the daily activities was divided in two groups (n = 15) Depth: Between waist and chest.
Tª: 33 °C.
AG: Aquatic intervention; LG: Land intervention Balance: Sharpened Romberg (open eyes and closed eyes) and Timed up & Go. After the intervention, improvements were found in AG and LG in balance (p < 0.05). It was not found differences between groups AG and LG (p > 0.05). Low sample size and only male.
Absence of specificity in both groups.
Volume Specific intensity control
W F D Progressive levels of balance intensity
1 set × 15 rep.
   
6 2 N/A
Type of exercise    
Balance Combination of displacement
Strength Marching in place. Hip flexion/extension. Hip abduction/adduction. Toe raises/heel raises. Shallow knee bends. Sit to stand from chair in land group. Sit to stand from pool shelf in aquatic group.
Flexibility Not included
Alikhajeh, Moghaddam & Moghaddam, 2012 [35] To evaluate the effect of hydrotherapy on the static and dynamic balance. Twenty-eight healthy sedentary elderly men (64–79 years; 14 in the experimental group and 14 in the CG). Depth: Xiphoid process.
Tª:
28–29 ° C.
AG: Intervention; CG: No intervention Balance: Sharpened Romberg test and Timed Up & Go. AG obtained improvements with respect to CG in balance, flexibility, strength and agility (p < 0.05). Low sample size, short duration of intervention and important difference of age between participants. Absence of specificity of training load. The type of exercise in the AG is not specified.
  Specific intensity control
W F D Progressive to Moderate;
2 set × 10 rep. / 1′ rest
   
8 2 60’
Type of exercise    
Balance Static and dynamic
Strength Combined exercise for UL and DL.
Flexibility Does not specify exercises
Bento, Gleber Pereira y Rodacki, 2012 [29] To analyze the effects of aquatic exercise on improving LL strength and older functionality. Elderly (60–75 years) able to walk and perform their daily tasks independently.
AG: n = 24
CG: n = 14
Depth: Xiphoid process.
Tª: 28–30 °C.
AG: Intervention; CG: No intervention Balance: 8-ft up-and go
Strength: 30″ chair-stand test.
MVIC: peak torque and rate of torque development tests
Flexibility: Sit-and-reach
AG obtained improvement in strength of UL (p < 0.05) and functionality (p < 0.05). Importance difference between intervention group and control group. Absence of specificity of training load.
Volume Specific intensity control
W F D HRmáx: 40–60%
RPE: 12–16
40″ moderate speed / rest 20”
   
12 3 60
Type of exercise    
Endurance Displacement
Strength Combined exercise for UL and DL
Flexibility General - Does not specify exercises
Walia y Shefali, 2012 [28] Comparing aquatic and land exercise in the improvement of balance in elderly. Healthy asymptomatic elderly (65–71 years) who were divided in a land group (n = 30) and an aquatic group (n = 30). Depth: Between waist and chest.
Tª: 35° ± 2 ° C.
AG: Aquatic intervention; LG: Land intervention Balance: Sharpened Romberg (open eyes and closed eyes) and Timed up & Go. After the intervention, improvements were found in AG and LG in balance (p < 0.05). It was not found differences between groups AG and LG (p > 0.05). Small sample size and shorter duration are the major limitations of the study. Lack of information about the periodization of the intervention in AG. Absence of specificity of training load.
Volume Specific intensity control
W F D Not included    
2 5 60’
Type of exercise    
Balance Alternate and dynamic movements of UL and DL
Strength Not included
Flexibility Not included
Katsura et al., 2010 [27] To assess the efficacy of aquatic exercise in older adults using resistance material. Twenty healthy elderly individuals (68–75 years) who did not exercise regularly. A resistance equipment group (n = 12) and a non-resistance equipment group (n = 8). Depth: Does not appear.
Tª: 30–32 °C
AG (I): Intervention with resistance equipment
AG (II): Intervention without resistance equipment
Balance: Timed Up & Go
Strength: Hand held dynamometer
Flexibility: Sit and reach
AG (I) and AG (II): improvements (p < 0.05) in flexibility, strength (plantar flexion) and in static equilibrium. AG (I) obtained greater improvements (p < 0.05) than GA (II). Low sample size.
Under sample size and long duration of the training programme. Too much gender difference in the sample (women 16, men 4). Absence of control group. Absence of load magnitude for the intervention group.
Volume Specific intensity control
W F D RPE: Moderately strong
8 3 90’
Endurance Displacements
Strength UL and abdomen
Flexibility General - Does not specify exercises
Tsourlou, Benik, Konstantina, Dipla y Kellis, 2006 [25] To determine the effectiveness of an aquatic training programme in healthy women over age 60. Twenty two healthy elderly (60–75 years; AG: n = 12; CG: n = 10) without any medical contradiction. Depth: From the xiphoid process to the axillary region.
Tª: 30 °C.
AG: intervention; CG: no intervention Balance: Timed Up & Go
Strength: Isometric test of knee’s flexo-extension; Isometric wrist grip. 3 RM in machine for UL and DL.
Flexibility: Sit and reach.
AG obtained improvement in pre/post-test in balance, strength and flexibility (p < 0.0125). AG obtained improvement (p < 0.0125) with respect to CG in strength and balance. Low sample size.
Volume Specific intensity control
W F D EV, MA, Rhythm of movement. ± 60 b / min
2–3 set × 12–15 rep./20–30″ rest
24 3 60
Type of exercise
Balance Not included
Strength 15–25 min of global exercise for UL and LL
Flexibility Not included
  1. CG Control group, AG Aquatic group, LG Land group; (I), First group; (II), Second group; (III), Third group, ADL Activity daily life, Temperature, N/A Not included in the text, W Weeks of intervention, F Frequency, D Total duration of season, RPE Rating of perceived exertion Borg Scale 6–20, EV Execution velocity, MA Materials of resistance, HRmáx Maximum heart rate, AT Anaerobic threshold, HRR Heart-rate reserve, UL Upper limb, LL Lower limb, RM Repetition maximum, MVIC Maximal voluntary isometric contraction