BELLARMINE UNIVERSITY, LOUISVILLE, KY The effects of aquatics versus land therapy on patients with...

BELLARMINE UNIVERSITY, LOUISVILLE, KY

The effects of aquatics versus land therapy on patients with COPD on

quality of life and physical function

Suzette AustinKori IvanchakErica Jeszke

Nancy Marshall


Background

• By 2020, Chronic Obstructive Pulmonary Disease (COPD) will be the 3rd most common cause of death globally. (Shead, 2012)

• COPD limits ability to do activities of daily living which results in a deterioration in health. (Wadell, 2004)

• People with COPD are often elderly and living with co-morbidities. (Shead, 2012)


Background cont.

• Hydrotherapy is considered beneficial therapy for osteoarthritis, rheumatoid arthritis, and stroke. (McNamara, 2011)

• Only been considered as a treatment option for COPD in the last decade. (McNamara, 2011)

• Training in water was safe and

applicable in patients with COPD. (Perk, 1996)


P: Persons with COPD

I: Aquatic therapy

C: Dry land therapy

O: Quality of life Physical Function

http://goo.gl/0Yo0eL


Articles

Type AgeWater Temp

Frequency

Shead, 2012 Systemati

c Review 60-80Thermoneutral (5)38 C (4)

Variety

Wadell, 2004

Controlled, semi-randomized study

56-72 33-34 C 3x/wk for 12 weeks

Wadell, 2005

Controlled, clinical trial

56-72 33-34 C 1x/wk for 6 months

De Souto Araujo, 2012

RCT 45-80 32 + 2 C 3x/wk for 8 weeks

McNamara, 2011

Systematic Review N/A 29-34 C Variety


Articles

Interventions

Exercise inWater/Land

Intensity Level

Outcome Measures

Shead, 2012 Variety Variety Variety

ISWTSaO2

FEV1

Dyspnea

Wadell, 2004

Whole body strength and endurance

Group 1- Land

Group 2- WaterHigh

ISWTESWTSF-36SGRQ

Wadell, 2005

Whole body strength and endurance

Group 1- Land

Group 2- WaterHigh

ISWTSF-36SGRQ


Upper and LowerAerobic and resistance

Group 1- Land

Group 2- WaterLow

FEV1

6MWTSGRQDyspnea

McNamara, 2011 Variety Variey Variety

ISWTChronic Respiratory QuestionnaireDyspnea


ArticlesPulmonary Function

ISWT/ ESWT6MWT

Quality of Life

Shead, 2012

SaO2

(?) FEV1

Dyspnea

ISWT See Wadell (2004)

Wadell, 2004

VO2peak

(water and control)

ISWT land

ESWT water

Physical Health Score of SF-36

Activity score in SGRQ

Wadell, 2005 VO2 peak ISWT /No change in SF-36

/No change in SGRQ


FEV1 (both) FEV1/FVC (control)

No change 6MWT (land v water)

6MWT (water v control)

SGRQ (land)No change SGRQ (water) SGRQ (control)

McNamara, 2011

Improvement in dyspnea (CRDQ)



Results: Wadell, 2004

Land• Distance walked in

Incremental Shuttle Walking Test

Water• Distance walked in

Endurance Shuttle Walking Test

• Physical health score in SF-36

• Activity score in SGRQ



ISWT/ ESWT6MWT

Quality of Life

Shead, 2012

SaO2

(?) FVC1

Dyspnea


Wadell, 2004

VO2peak

(water and control)

ISWT land

ESWT water




/No change in SGRQ






McNamara, 2011




Results: Wadell, 2005

9 months vs. Baseline:9 months vs. 3 months:

• Increased walk distance– ISWT

• Decrease in VO2 peak• No significant

changes in SGRQ or SF-36– Control decreased

in PCS

• Decreased VO2peak, time cycled, work rate

• Decreased HRQoL, SF-36



ISWT/ ESWT6MWT

Quality of Life

Shead, 2012

SaO2

(?) FVC1

Dyspnea


Wadell, 2004

VO2peak

(water and control)

ISWT land

ESWT water




/No change in SGRQ






McNamara, 2011




Results: de Souto Araujo, 2012

SQRQ: Improvement in floor group

No change in aquatics group

Decline in control group



ISWT/ ESWT6MWT

Quality of Life

Shead, 2012

SaO2

FVC1

Dyspnea


Wadell, 2004

VO2peak

(water and control)

ISWT land

ESWT water




/No change in SGRQ






McNamara, 2011




Discussion

• Overall, increase in pulmonary function

• Both groups showed improvements in endurance

• Conflicting evidence in SGRQ


Discussion

• Patients with secondary health conditions

• Reducing the frequency of training was not effective for maintaining fitness level


Limitations

• Limited number of studies on topic

• Small sample sizes

• Low to moderate quality

• Motivational factor/patient

preference

• Exclusion of people with certain

comorbidities


Conclusion

Based on available studies, there is not enough quality evidence to

support if hydrotherapy increases quality of life and physical function in

comparison to land therapy.


Additional Resources

• APTA Aquatics Section– http://www.aquaticpt.org/about.cfm

• American Lung Association– http://www.lung.org/lung-disease/copd/

• PT Opinion Article– http://physical-therapy.advanceweb.com/

Columns/Water-Wisdom/Aquatic-Therapy-for-COPD-Patients.aspx

http://www.aquaticpt.org/about.cfm

http://www.lung.org/lung-disease/copd/

http://www.lung.org/lung-disease/copd/

http://physical-therapy.advanceweb.com/Columns/Water-Wisdom/Aquatic-Therapy-for-COPD-Patients.aspx





Questions

???


References

1. de Souto Araujo ZT, de Miranda Silva Nogueira PA, Cabral EE, de Paula Dos Santos L, da Silva IS, Ferreira GM. Effectiveness of low-intensity aquatic exercise on COPD: a randomized clinical trial. Respir Med. Nov 2012;106(11):1535-1543.

2. McNamara RJ, Alison JA, McKeough ZJ. Water-based exercise in chronic obstructive pulmonary disease. Physical Therapy Reviews. 2011;16(1):25-30.

3. Perk J, Perk L, Boden C. Cardiorespiratory adaptation of COPD patients to physical training on land and in water. European Respiratory Journal. 1996;9(2):248-252.

4. Shead D, Aswegen HV. Hydrotherapy in the management of chronic obstructive pulmonary disease: a qualitative systematic review. Physical Therapy Reviews. 2012;17(5):271-283.

5. Wadell K, Henriksson-Larsén K, Lundgren R, Sundelin G. Group training in patients with COPD-long-term effects after decreased training frequency. Disability & Rehabilitation. 2005;27(10):571-581.

6. Wadell K, Sundelin G, Henriksson-Larsén K, Lundgren R. High intensity physical group training in water—an effective training modality for patients with COPD. Respiratory Medicine. 2004;98(5):428-438.

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