Transcript שקופית 1 - Aquatic Exercise Association

Presented by Mushi Harush,2005
Aquatic exercise trainer specialist
MA.Haifa University. Wingate Institute
1
The women in the experimental group who participate in the seven-month
physical activity program in water will evince no decline in bone density;
they might also register an increase in bone density.
If there is nevertheless a decline, it will be less than for
the control group.
2
Participants
Experimental group
This group included 25 postmenopausal women aged 50 to 65 who
met the following criteria:
They no longer have their monthly cycle (menses)
They do not engage in organized physical activity in any official setting
They do not suffer from osteoporosis, that is, their baseline bone density
is higher than 55% of mean bone density for the normal population of this age.
They do not suffer from one of the following medical problems
which may affect their bone density: thyroid gland problems,
blood pressure problems, and diabetes.
They do not take any of the following medications (which affect bones):
Matrix, B complor, Betoptic, Arimidex, Cosamin, Bondormine, Glucosamine,
Chondroitin, Tarivite, Normalol,, Vascace, Activelle, Normiten, Lipidal, Ocsaar,
Simvastatin, Narvasc, Aspirin.
They do not smoke.
3
Control group
The control group consisted of 10 women the same age as those in the
experimental group who met the same criteria as the experimental group.
The following table presents a comparison of variables between
women in the experimental group and women in the control group:
4
Table 1: Comparison of data for the experimental group and control group
Variable
Experimental
group
Control group
t- test
Level of
significanc
e
Mean
S.D
Mean /
S.D
Mean /
S.D
t(29)
Sig
Age in years
54.90 /
4.45
56.0 /
3.49
706.-
N.S
BMI
Kg / m²
29.55 /
5.45
28.16 /
5.31
686.
N.S
Age at
cessation of
menses years
49.57 /
6.16
49.63 /
2.41
032.-
N.S
No. of years
after menses
cessation
5.32 /
6.07
5.95 /
4.18
305.-
N.S
Height in cm
159.75 /
8.29
158.54 /
7.94
035.
N.S
Weight in kg
74.25 /
12.64
69.0 /
16.52
1.02
N.S
According to the data in Table 1, there were no significant differences between the two groups in any of the variables.
5
Physical measurements before commencing physical activity
– for all the women in the experimental group
Height
Weight using an electronic scale
Bone density measurement by means of DEXA in the following body areas:
Vertebrae L1-L4
Vertebrae L2-L4
Femoral neck of the dominant and non-dominant legs
Measurements were:
bone density in the vertebra – BMD (g/cm2),
z-score,t-score, and mineral content of vertebra
BMC (grams)
Measurement of bone density by means of Sunlight Omnisense (QUS)
in the following parts of the body:
Distal radius of dominant and non-dominant arms
Midshaft tibia of dominant and non-dominant legs
Measurements were: SOS – speed of sound in meters per second (m/sec),
t- score, and z-score.
6
The training program commenced in May 2003 and concluded at the end of November
2003, for a total of seven months.
The experimental group worked regularly on Monday Wednesday and Thursday evenings
with the same instructor (the researcher) throughout the period,.
The loads applied on the bones were increased gradually.
The water in the pool used for the study was warmed to 32 degrees C.
Celsius, and all activity was conducted at chest level. The sessions were
conducted with strict adherence to safety principles and to AEA and American
College of Sports Medicine guidelines for working with elderly women (ACSM, 2000).
7
Week
Number of
repetitions of each
exercise
Auxiliary equipment for
activity
1-2
10-12
Without equipment, use of water resistance only,
varying lever length, surface area and movement
speed
3-4
10-12
Equipment that adds resistance to drag, pool wall and
gloves
5-6
12-15
Weights to strengthen upper body with maximal
resistance and work to strengthen abdominal muscles.
Strengthening lower body through water resistance,
using noodles
7-8
15-20
Aquafines and noodles, pool wall, weights
9-12
15-20
Various equipment for circuit training
13-17
15-30
Variety of equipment to create different stimuli with
gradual and varying load on bones. Drills such as
circuit training at stations and interval training at
varying degrees of difficulty
17-28
20-30
Activity time remains the same, but exercise intensity
increases by adding more power, speed, increasing
surface area, more frontal resistance, lever length,
movements to help and resist direction of movement
8
Warm-up: 7-10 minutes
This was intended to allow the body to adapt to water temperature.
This part of the session included movements with short levers that gradually
became long levers. Stretches performed at this stage were always at normal
range of movement and included the neck, chest, deltoid, lower-back,
quadriceps, pelvic, hamstring and gastrocnemius muscles.
Aerobic set: 20 minutes
The aim of this part of the session was mainly to improve participants‘
general aerobic ability and not bone density, although it contributed to the latter as well
. Reasonable aerobic capacity was essential for participants to withstand the
training load required in other parts of the program intended especially to improve
bone density. Participants were directed to work at a load equivalent to the feeling
of effort registering 12-16 on the Borg Scale. Furthermore, throughout the lesson
emphasis was placed on proper posture.
9
Strengthening muscles and loading the bones: 20 minutes
This segment worked on specific muscle groups in order to improve
their strength and endurance, while raising the resistance load on bones
and muscles. The activities of this segment utilized four movement patterns:
compression, twisting, stretching/extension, bending, and combinations
of the four. Each exercise was repeated 16 to 32 times, in accordance with
ACSM guidelines (2000).
Cool down and stretches: 10 minutes
The duration of this part of the session depended on air and water
temperature. It included static and dynamic stretches to maintain body
heat and to promote proper posture, flexibility and relaxation.
10
Exercises to improve range of movement and flexibility
Exercises to improve posture, and to strengthen abdominal,
upper and lower back, chest and leg muscles with an emphasis
on ankle-related muscles in order to prevent falls.
Exercises to strengthen muscles and load bones –
isotonic and isometric exercises integrating the four movement patterns
(compression, stretching, bending, and twisting).
11
Equipment used in the training program
This study utilized equipment by Thera-Band (United States)
developed mainly to increase resistance to movement in water.
Aquafines Cuffs – a wing-shaped aid attachable to arms and legs that increases
resistance to limb movement in water. It was used mainly
in work on the ankle area to increase intensity of effort by the
following muscles: Hamstrings, vastus lateralis, vastus medialis,
quadriceps, gluteals, abductors and adductors.
Hand Bars – an apparatus in the shape of a hand weight
, with bar and two foamy sponge "weights."
The aid increases buoyancy and creates water
resistance to movements that try to push the bars towards
the floor of the pool. It increases resistance for arm muscles and the
upper part of the body.
Noodles – buoyant, water-resistant sponges 1.6m long
and 6cm in diameter. They are used mainly to strengthen the upper part
of the body: chest, abdominal and back muscles
(pectorals, rhomboids/trapezius, stabilizing trunk
muscles, external and internal obliques).
Pool wall – used to increase stability, strengthen muscles and increase flexibility.
Gloves – rubber-lined gloves covered with waterproof cloth.
The gloves are used to reduce gaps between fingers and thus
increasing hand surface area and water resistance.
12
Within two weeks after completing the seven months of water training,
the same type of bone density tests were conducted on the experimental
group as before the sessions.
The control group underwent only DEXA tests, seven months after the initial test.
Instruments
Electronic scale
Ultrasound: Omnisense (Sunlight, model 8000S)
DEXA: Luna model DPXIQ # 4941
13
Data were examined by means of two-way 2x2 repeated measures
(ANOVA repeated measures) with group as the independent variable
(between group factor).
Participating in this study were 35 women, mean age 55.45 years
(SD=3.97), of them 25 women in the experimental group (54.9±4.45)
and 10 women in the control group (56±3.49). During the training
period five women dropped out of the experimental group so that
only 20 women completed the study. Baseline data for the women in the study,
as presented in Table 1, indicated no significant differences in age,
BMI, age of menstrual cessation, number of years after last menses,
and height between the experimental and control groups.
14
Table 3 presents the findings for the DEXA test, comparing the
experimental and control groups for the following variables:
BMD: Bone density measured in grams per square centimeter
T-score: Number of standard deviations of BMD
values for the participant from the mean value
for a 25 year old woman
Z-score: Number of standard deviations of BMD
values for the participant from the mean value
for a women her age
BMC: Mineral content of bone, measured in grams
15
Table 3: Results of DEXA tests for vertebrae L2-L4
Variable
Pre
Post
F(1,27)
Sig
F(1,27)
Sig
F(1,27)
Sig
Mean
S.D.
Mean
S.D.
Time
Group
Time*Group
BMD
(g/cm2)
Exper
Control
1.11
1.11
.157
.233
1.12
1.08
.165
.215
.199
N.S.
0.120
N.S.
9.25
P<.01
t-score
Exper
Control
-.67
-.72
1.33
1.95
-.59
-.96
1.39
1.80
2.17
N.S.
0.122
N.S.
9.41
P<.01
z-score
Exper
Control
.005
.047
1.70
1.36
0.84
-.154
1.44
1.52
1.01
N.S.
0.029
N.S.
5.35
P<.05
BMC
(grams)
Exper
Control
45.13
45.95
7.77
12.55
45.38
44.13
7.57
12.10
4.61
P<.05
0.003
N.S.
7.99
P<.01
According to the findings, the Time factor by itself (differences between pre and post)
appears to have had a significant effect only on the BMC variable.
In the other dimensions no significant pre and post differences were found.
On the other hand, the interaction of Time*Group was found to be significant for each of the measures.
Figures 1-4 detail the interactions for each of the variables.
These figures indicate the positive effect of the treatment and the general trend
of bone density maintenance or increase in the experimental group, and a downward
trend in bone density for the control group.
16
1.13
2
BMD (gr/cm )
1.12
1.11
exper.
1.1
control
1.09
1.08
1.07
1.06
Pre
post
Figure 1: BMD values pre and post treatment in the
experimental and control groups for vertebrae L2-L4
17
0
t-score BMD
-0.2
-0.4
exper.
control
-0.6
-0.8
-1
-1.2
pre
post
Figure 2: t-score values for BMD pre and post treatment for the
experimental and control groups for vertebrae L2-L4
18
z-score BMD
0.1
0.05
0
exper.
-0.05
control
-0.1
-0.15
-0.2
pre
post
Figure 3: z-score values for BMD pre and post treatment in the
experimental and control groups for vertebrae L2-L4
19
46.5
BMC (grams)
46
45.5
45
exper.
control
44.5
44
43.5
43
pre
post
Figure 4: BMC values pre and post treatment for the experimental
and control groups for vertebrae L2-L4
20
DEXA test findings for vertebrae L1-L4
Table 4 presents the DEXA test findings and a comparison between the experimental and control groups
for the variables BMD, t-score and z-score and BMC.
, Table 4: Results of DEXA test for vertebrae L1-L4
Variable
Pre
Post
F(1,27)
Sig
F(1,27)
Sig
F(1,27)
Sig
Mean
S.D.
Mean
S.D.
Time
Group
Time*Group
BMD
(g/cm2)
Exper
Control
1.09
1.08
0.14
0.22
1.09
1.06
0.15
0.20
2.47
N.S.
0.081
N.S.
11.01
P<.01
t-score
Exper
Control
-.737
-.770
1.23
1.84
-.658
-.978
1.31
1.70
2.41
N.S.
0.096
N.S.
11.92
P<.01
z-score
Exper
Control
-.084
.020
1.29
1.58
0.00
-.189
1.36
1.42
1.60
N.S.
0.006
N.S.
8.84
P<.01
BMC
(grams)
Exper
Control
56.39
57.68
9.51
15.58
56.74
55.67
9.44
14.86
3.62
N.S.
0.001
N.S.
7.25
P<.05
It appears that no significant differences were found for the Time factor or the Group factor, as there are no pre and post treatment
differences between the experimental and control groups. On the other hand, there is a significant interaction, that is, the combination
of Treatment and Group indicates a significant difference in Group behavior. The interactions in Figures 5-8 illustrate the positive
effect of the treatment and testify to the general trend towards maintenance or improvement of bone density in the
21
Experimental group and a trend towards declining bone density for the control group.
2
BMD (g/cm )
1.1
1.09
1.08
exper.
1.07
control
1.06
1.05
1.04
Pre
post
Figure 5: BMD values pre and post treatment for the experimental
and control groups for vertebrae L1-L4
22
t-score BMD
0
-0.2
-0.4
exper.
-0.6
control
-0.8
-1
-1.2
pre
post
Figure 6: t-score values for BMD pre and post treatment for
the experimental and control groups for vertebrae L1-L4
23
z-score BMD
0.05
0
-0.05
exper.
control
-0.1
-0.15
-0.2
pre
post
Figure 7: z-score values for BMD pre and post treatment for the
experimental and control groups for vertebrae L1-L4
24
58
BMC (grams)
57.5
57
56.5
exper.
56
control
55.5
55
54.5
Pre
post
Figure 8: BMC values pre and post treatment for the experimental
and control groups for vertebrae L1-L4
25
Table 5 presents the findings of the DEXA tests and a comparison of the experimental and control
groups for the following variables:
Total BMD right: mean bone density in right femoral neck (g/cm2)
Total BMD left: mean bone density in left femoral neck (g/cm2)
Total BMC right: mean mineral content of right femoral neck (gr)
Total BMC left: mean mineral content of left femoral neck (gr)
26
Table 5: Results of DEXA test for femoral neck,
right and left legs
Pre
Post
Test
Total
BMD
right
F(1,27)
Sig
F(1,27)
Sig
F(1,27)
Sig
Mean
S.D.
Mean
S.D.
Time
Group
Time*Group
Exper
Control
.998
.975
0.122
0.095
1.00
.952
0.127
0.114
1.69
N.S.
0.43
N.S.
4.14
N.S.
Exper
Control
1.00
.937
0.11
0.12
1.00
.942
0.11
0.11
0.20
N.S.
1.08
N.S.
0.20
N.S.
Exper
Control
31.79
31.73
5.29
3.72
32.46
30.40
5.34
4.85
0.35
N.S.
0.25
N.S.
8.08
P<.01
Exper
Control
31.78
28.66
5.38
5.23
32.01
29.20
5.69
5.30
0.96
N.S.
1.15
N.S.
0.161
N.S.
(g/cm2)
Total
BMD left
(g/cm2)
Total
BMC right
(grams)
Total
BMC left
(grams)
Two-way ANOVAs with repeated measures reveal no significant differences
between the groups before and after treatment.
Significant interaction was found only for BMC in the right leg,
and it is presented in Figure 9.
27
total BMC (grams)
33
32.5
32
31.5
exper.
31
30.5
30
control
29.5
29
Pre
post
Figure 9: Total BMC values for right femoral neck pre and post treatment
in the experimental and control groups
From this figure it can be seen that the women in the experimental group
exhibited a trend towards improved bone density. Among the women in the
control group there is a trend towards declining bone density.
This interaction was found to be significant statistically.
28
Table 6 presents the findings of the QUS test for the
experimental group with a comparison of bone density
pre and post treatment for the following variables:
t-score: the number of standard deviations of SOS (speed of sound)
values in bone density of the participant from the mean for
a 25 year old woman
z-score: the number of standard deviations of SOS (speed of sound)
values in bone density of the participant from the mean
value of a woman the participant's age.
The variables were measured in values of speed of the returning
wave in meters per second (m/sec) in the following sites:
Raddom: proximal radius of the dominant arm
Radnon: proximal radius of the non-dominant arm
29
QUS test Table 6: Pre and post study QUS test findings
for the proximal radius of dominant and non-dominant arms
of women in the experimental group
Pre
Post
F(1,14)
Sig
Type of test
Mean
S.D.
Mean
S.D.
Time
Raddom
Exper
4058.73
135.44
4092.27
105.55
2.008
N.S.
Raddom t-score
Exper
-1.125
1.38
-.783
1.07
2.00
N.S.
Raddom z-score
Exper
.464
1.41
-.281
.93
3.73
N.S.
Radnon
Exper
4093.36
90.22
4081.0
83.94
.624
N.S.
Radnon t-score
Exper
-.772
.920
-.898
.856
.624
N.S.
Radnon z-score
Exper
.464
1.41
-.281
.93
3.73
N.S.
It can be seen that no significant changes were observed in the
ultrasound test between the commencement and the conclusion
of the program.
30
Summary of studies of water exercise and bone density
Researcher
Harush
Yurtkuran
Bravo
Tsukahara
Goldstein
Year of
publication
Unpublished
2003
1997
1994
1994
Country
Israel
Turkey
Canada
Japan
Israel
Duration
7 months
6 months
12 months
36 months
5 months
Frequency
of training
sessions
3 times per
week
3 times per week
3 times per week
1 time per week
3 times per week
Duration of
session
60 minutes
40 minutes
60 minutes
45 minutes
45 minutes
Structure of
session
10 min warmup 20 min
aerobic activity
20 min muscle
strengthening,
10 min cooldown
Week 1: 5 min
warm-up, 10 min
aerobics, 5 min
relaxation ex, 5 min
stretches outside
pool.
Week 2: aerobics 15
min, Week 3: 20
min; Week 4 to end:
25 min. Other
elements remained
unchanged
10 min warm-up
(flexibility &
stretching ex),
40 min jumps in
intervals and
muscle
strengthening
ex. 10 min cooldown including
relaxation ex.,
stretches,
balance &
coordination
10 min warm-up
20 min aerobic
activity and deep
breathing
10 min swimming
5 min cool-down
10 min warm-up 25
min strength
training
10 min cool-down
and stretches
Measureme
nt tools
DEXA
QUS
QUS
DEXA
DEXA
Compton scattering
method
31
Researcher
Harush
Yurtkuran
Bravo
Tsukahara
Goldstein
Areas of
measurement
1.Vertebrae L1-L4
2.Vertebrae L2-L4
3.Femoral neck (both legs)
4.Proximal radius
5.Midshaft tibia
Heel bone
Vertebrae
L2-L4
Femoral neck one
leg( right)
Vertebrae
L1-L4
Distal radius
Participants
35 postmenopausal women
41
postmenopaus
al women
77 postmenopausal
women
65 postmenopausal
women
50 post menopausal
women
Findings
1.Vertebrae: significant
interaction between Time &
Group factors in all four
measures: BMD, BMC, tscore, z-score.
2.Bone density in femoral
neck: significant interaction
between Time & Group only
for BMC and right leg
(p<0.01)
3.No significant changes in
bone density in radius and
tibia
Increase of
19% and 63%
in t-scores of
broadband
ultrasound
attenuation
and speed of
sound,
respectively;
decrease in
control group
1. Significant decline
of 1 % in vertebral
bone density
2. No change in
femoral neck bone
density
1. Veteran exercisers
showed mean increase of
1.55% in bone density;
novice exercisers
showed mean increase of
2.16%; control group
showed mean decrease
of 0.92%.
2. For the two active
groups, there was not
correlation to number of
years since cessation of
menses
1.Significant increase
of 1% in bone density
in water group over
baseline.
2.No significant
change in the landbased group
Conclusions
Regular water exercise a
number of hours per week
may help maintain bone
density
Water
exercise was
found to
effectively
create an
anabolic
effect on
postmenopaus
al women's
bones
No positive effect of
water exercise was
found on the skeletal
system
Regular water exercise is
an important component
in preventing bone
density loss
Weight-loading
activity using water
resistance is effective
in treating loss of bone
density
32
Researcher
Research
problems
Harush
1. Too small a
sample
2. No SOS data for
control group
Yurtkuran
1. Small sample
2. Too short a
research period
3. Activity
sessions were
only 40 minutes.
4. Bone density
measurement in
only one site
Bravo
1.Instructors were
lifeguards not
water exercise
instructors
2.Lack of bone
stimulus variety
3.No auxiliary
aids used to
heighten
resistance
Tsukahara
1.Sessions were 45
minutes instead of 60
2.10 min of each
lesson were devoted
to swimming. Hard
to know whether the
physical activity or
the swimming or
both affected bone
density
3.Additional physical
activity (outside
study) was not
neutralized
4.No special
equipment was used
in the water
Goldstein
1.Additional
physical activity
was not neutralized
2.Bone density was
measured at only
one site
33
1. water exercise allows the option of creating the types of loads that have a positive effect
on bone density
2. This study provides support for the idea that non-body-weight-bearing physical activity
can stimulate bone density,
Gross and colleagues(2004) assumed that integrating rest periods between loading cycles
might reproduce the maximal flow effect and thus significantly increase the potential
for rebuilding bone and enhancing its density
3. water exercise as performed in the present
study provided the required hiatuses
between loads and thereby allowed the
vertebrae to respond positively.
.
34
5.the effect of water exercise on bone density of the femoral neck
in the present study, a significant interaction was found between the Time variable and the Group
variable only for BMC and only in the right leg (p<0.01). The meaning of this finding is that the training program
increased bone density in the femoral neck of the right leg only in the experimental group, in contrast to a decline
among women in the control group who did not engage in physical activity at all. At the same time,
it should be emphasized that the other measures (BMD, t-score and z-score) did not register a positive effect
for the treatment and no interaction was found.
A possible explanation for the increase in bone density only in the right femoral neck may be attributable to the fact
that the right leg is dominant for most people. As seen earlier, the professional literature offers evidence of higher
bone density in the dominant side among athletes (basketball, soccer, squash, baseball and badminton players)
, because of their greater and more correct use of that limb (Bailey et al., 1996)
study, required symmetric, equal work by both legs which was supposed to affect bone density in both equally.
Perhaps the natural tendency of the dominant leg to work harder explains the greater effect of physical
activity on its bone density.
35
6. The effect of water exercise on bone density of the proximal radius and
of the midshaft tibia
in the present study, no significant pre- post-differences in bone density were found using
the Sunlight Omnisense apparatus among women in the experimental group
These findings are consistent with the study hypothesis that among women in the experimental
group there would be no decline in bone density, and the findings
reinforce the conclusion that water exercise contributes to maintaining bone density.
The effect of water exercise on bone density of the tibia and the radius was tested only for
the experimental group, and without data on the control group it is difficult to draw clear
conclusions about possible effects of the treatment on the experimental group
At the same time, and even though no differences were observed in bone density of the proximal
radius and the midshaft tibia, it was possible to identify in both of them
an increase in density of the dominant limb in contrast to the non-dominant limb
This increase might actually signal a rise in bone density but this is only supposition as the
change was not significant.
36