July-December 2013
International Journal of Rehabilitation Sciences (IJRS)
Volume 02, Issue 02
The Effects of Standard Land-Based Endurance Exercise versus Pool-Based Exercise on Pain and Fitness of Patients with Cardiac Disease and Osteoarthritis Awan WA1, Sumbla A2, Irfan S3, Rafaqat A4 Kashif K5
Abstract Objectives: The purpose of this study was to determine the effect of standard land based endurance exercise and pool based exercises on pain and fitness of patients with cardiac disease and osteoarthritis. Methods: This study involved 18 patients aged 65 to 81 from a private hospital, and was selected using purposive sampling. Selected patients were diagnosed with previous history of cardiac disease; coronary arteries bypass (CABG); myocardial infarction (MI); stent replacement; and secondary diagnoses were osteoarthritis. The subjects were divided into two groups. Nine subjects were randomly assigned to the standard land-based endurance exercise treatment, while nine subjects were randomly assigned to the pool-based endurance exercise treatment. Pain is measured using the 10cm visual analog scale (VAS). For the maximal oxygen consumption, it is measured by a maximal treadmill stress test (MaxVO2). Paired sample t-test was use to analyze the data. Results: The study made use of the Statistical Program for the Social Sciences (SPSS) in order to compute for independence. The statistical analysis made use of a 0.05 significance level, where an alpha of less than 0.05 would reject the null hypothesis and provide statistical evidence to suggest that the treatment has a significant effect on the pain and fitness of the subjects. The results show that for the land-based treatment, pain was lower on the posttest (M = 3.78) than on the pretest (M = 5.67). The same results were also found in the pool-based treatment, where the posttest (M = 2.11) was lower than the pretest (M = 5.78). Conclusion: The study shows that both the (land based endurance exercises and pool based exercises) have same effect on patient with cardiac disease and osteoarthritis. Both have significant decrease in pain and increase in VO2 Max. Keywords: myocardial infarction (MI), coronary artery bypass graft (CABG).
Introduction: The elderly population is vulnerable to multiple morbidities because of the physical degeneration of their bodily functions as a result of aging. Most common
comorbidities found in the geriatric
population are cardiac diseases and osteoarthritis. Cardiac diseases such as previous myocardial infarction limit the person from achieving or obtaining maximum physical capacity thus needs safe
Worse, when a patient with cardiac disease also has a
regular
exercise
for
Vice Principal IIRS, Isra University Physiotherapist Fauji Foundation Hospital Rawalpindi 3. Lecturer IIRS, Isra University Islamabad 4. Clinical Instructor, IIRS, Isra University Islamabad 5. Manager Rehabilitation Department. Shifa International Hospital. Islamabad Correspondence: Irfan Sattar. Lecturer IIRS, Isra University Farash Town Islamabad E-mail:
[email protected]
about
by
this
disorder.
Pain
symptomatology of osteoarthritis,
and effective physical therapy management. 1
osteoarthritis,
1. 2.
cardiac
is
a which
striking is a
degenerative disease in which the aging person experiences destruction of the bones especially in the
rehabilitation is further hindered by the pain brought
17
July-December 2013
International Journal of Rehabilitation Sciences (IJRS)
joints causing the elderly to have crippling bone deformities and limited physiological functioning.
2
Volume 02, Issue 02
selected using purposive sampling. Out of 18 participant 50 %( 9) were male and 50 %( 9) were
Osteoarthritis is a debilitating condition that leads to
female. Patient’s age, height and weight are given in
many physical disabilities and pain. These effects of
Figure 1 according to their groups.
the disorder lead to a vicious cycle in which the patient who experiences severe pain and limited mobility in the joints reduce his physical movement
age
thus leading to further functional loss and bone
height
degeneration.
weight
Cardiac rehabilitation has been a part of the treatment and management practice in patients with cardiac diseases. In this regard, endurance exercises are
Figure 1: Age, height and weight of group 1&2.
found to reduce disability and pain among patients –
The selection process made use of specific criteria,
which makes these exercises a good therapy for
which was limited to the type of diagnosis the
cardiac patients with osteoarthritis.
3
patients had. The author of this study chose patients
In prescribing therapeutic exercise, two types of
who were diagnosed with previous history of cardiac
endurance exercises are commonly selected for
disease;
patients with osteoarthritis and cardiac diseases
myocardial infarction (MI); stent replacement; and
namely conventional land-based exercise and water-
secondary diagnoses were osteoarthritis. Upon
based exercise.4
selection of the subjects who passed the study’s
The existing literature on the effects of water-based
criteria, they accomplished a consent form, assuring
and land-based exercises describes the pain relief
them that their identities will be kept confidential.
provided by these aerobic exercises among patients
The subjects were divided into two groups. Nine
with
The
subjects were randomly assigned to the standard
been
land-based endurance exercise treatment, while nine
established in these well-designed methodologies that
subjects were randomly assigned to the pool-based
employed randomized controlled trial design.
endurance exercise treatment. The subjects were
The purpose of this study is to compare the effects
exposed to treatment for two hours each day for five
between standard land-based endurance exercises and
consecutive days. After the last session of the
water-based endurance exercises among elderly
treatment was facilitated, the subjects were again
patients with cardiac diseases and osteoarthritis as co-
asked to complete the VAS and the MaxVO2. Four
morbidity. This current study aims to answer the
sets of paired sample T-tests were administered in
research question.
order to assess for significant differences between
osteoarthritis
effectiveness
of
and both
cardiac
diseases.
interventions
has
coronary
arteries
bypass
(CABG);
pretest and posttest data between the two types of
Methods: This experimental study involved 18 patients aged 65 to 81 from a Shifa International Hospital and was
treatments. The study made use of the Statistical Program for the Social Sciences (SPSS) in order to compute for independence. The statistical analysis
18
July-December 2013
International Journal of Rehabilitation Sciences (IJRS)
Volume 02, Issue 02
made use of a 0.05 significance level, where an alpha
Table 1 shows the means the pretest and posttest data
of less than 0.05 would reject the null hypothesis and
on pain and fitness as measured by the VAS and the
provide statistical evidence to suggest that the
MaxVO2, respectively. The means were computed in
treatment has a significant effect on the pain and
accordance to pretest and posttest data. The results
fitness of the subjects.
show that for the land-based treatment, pain was lower on the posttest (M = 3.78) than on the pretest (M = 5.67). The same results were also found in the
Results: After the experiment has been conducted, the author of
this
study
conducted
statistical
analysis,
comprising of comparisons of means in order to determine if the two treatments, particularly, the land-based treatment, and the pool-based treatment,
Table 1: The mean ratings before and after treatment
Table 1 also shows the mean rates for fitness on each of the type of treatments. For the land-based treatment, the posttest (M = 15.12) appeared to be
found for the pool-based treatment, where the posttest mean was higher (M = 16.78), as compared
for pain and fitness. N
was lower than the pretest (M = 5.78).
greater than the pretest. The same result was also
have a significant effect on the test subjects.
Treatment
pool-based treatment, where the posttest (M = 2.11)
Mean Pretest
Mean Posttest
Pain
Fitness
Pain
Fitness
Land-Based
9
5.67
13.50
3.78
15.12
Pool-Based
9
5.78
13.70
2.11
16.78
to the pretest treatment. For both types of treatment, the means of the pretest and posttest suggest that after the treatment has been conducted, the pain of the subjects decreased while fitness tends to increase after treatment. However, the means alone are not credible enough to determine these trends.
Table 2: pretest and posttest scores on pain and fitness on land-based and pool-based treatments Std. Type of Treatment
Land-Based Treatment
Pool-Based Treatment
Mean
Deviation
t
df
Sig
Pain
1.889
0.782
7.249
8
0.000
Fitness
-1.622
0.521
-9.332
8
0.000
Pain
3.667
1.414
7.778
8
0.000
Fitness
-3.00
0.873
-10.307
8
0.000
N = 18
Table 2 shows the results of the four paired-sample
treatment (t = 7.249, p < 0.05). A significant
T-tests that were conducted in order to determine
difference was also determined for the pool-based
significant differences between the pretest and
treatment (t = 7.778, p < 0.05).
posttest data in accordance to the two types of
In terms of fitness levels as measured by the
treatments. The results of the tests shows that there is
MaxVO2, significant differences were also found. For
a significant difference between the pretest and
the land-based treatment, the differences were
posttest data in terms of pain in the land-based
significant with t = -9.332, p < 0.05. The same results
19
July-December 2013
International Journal of Rehabilitation Sciences (IJRS)
with
Volume 02, Issue 02
were generated in the pool-based treatment with t = -
calisthenics
moderate
intensity.
Aquatic
10.307, p < 0.05. This means that the trends showed
calisthenics require lower demands on the cardiac
by the means were significant, indicating an increase
workload and energy when performing aquatic
in fitness levels and a decrease in terms of pain levels
training exercises than land-based exercises among
after the implementation of treatment, whether it was
patients with heart failure.5,7
land-based, or pool-based.
The increasing prevalence of elderly patients affected with osteoarthritis and cardiac diseases cover a widespread problem that incurs pain and disability,
Discussion: A study was conducted in order to determine the effect of two types of therapy on the pain levels and fitness levels of subjects diagnosed with cardiac disease and osteoarthritis. The study involved an experimental design. Purposive sampling was used, through a set of criteria, in determining 18 patients who participated in the study. They were randomly assigned to two different treatment conditions, either on the land-based treatment or the pool-based treatment. Before they were given treatment, they were tasked to complete the VAS and the MaxVO2 in order to provide the baseline for the experiment by measuring pain and fitness levels. After the treatments, the subjects took the assessments again. Using statistical analysis, significant differences were
which consequently decreases the quality of life of patients.6,9 However, elderly patients usually have multiple comorbidities and one of the most frequent co morbidity of cardiac disease is osteoarthritis. Thus, pain becomes a barrier in the performance of regular exercise among these patients. This current study is a response to the need for the best intervention that will provide an exercise that will improve the endurance and fitness of the patient while reducing the pain. The procedures of the study had a certain degree of similarities with previous studied conducted such as those of Vernochet et al.10 As compared to the present study, there’s also used VO2 in order to determine the effect of land-based and water-based treatments. However, the effects they study measured
computed. In a study by Vernochet et al.10 the oxygen consumption and cardiac activity of patients with heart failure, specifically depressed left ventricular function, during two types of exercise were explored. The water-based exercise was compared with land-
were oxygen uptake and heart rate, which is different from the pain and fitness levels of the present study. However, the results indicted in both studies were similar, indicating that both water-based and landbased treatments were effective.
based exercise to determine the effectiveness of using aquatic calisthenics in cardiac rehabilitation of these
Conclusion:
patients. 11The patients tolerated the aquatic training
The results of the present study suggest a number of
as evident in their oxygen consumption and cardiac
implications as well as significances. The results
responses. Heart rate at rest is lower during aquatic
suggest that regardless of whether patients are
calisthenics than in land.
8,12
In addition, the average
diagnosed with cardiac disease or osteoarthritis, the
heart rate of the patients as well as their peak VO2
type of treatment would not matter and would be
are lower in water training than in land during
20
July-December 2013
International Journal of Rehabilitation Sciences (IJRS)
Volume 02, Issue 02
similarly effective, whether the treatment is land-
in the US: evidence from national survey data.
based or water-based.
Arthritis Rheum. 2009;60(12):3546-3553. 5.
Kolt GS, Snyder-Mackler L. Physical therapies in sport and exercise. PA:Elsevier Health
Limitations and Recommendations:
Sciences;2007.
Although the results of the present study were similar to previous experiments, the present study consisted
6.
walking
of a number of limitations. Firstly, the number of
7.
8.
Bandy WD, Sanders B. Therapeutic exercise for
PA:
Lippincott
Williams
&
Wilkins;2007.
should include at least 30 or more subjects in order to
treatments have the possibility to have a significant
Buckley JP. Exercise in physiology in special
intervention.
recommended that future researches on this topic
be studied, where land-based and water-based
for
physical therapist assistants: techniques for
Due to the limitations of the present study, it is
of the study. It is also recommended that more factors
exercise
populations. PA: Churchill-Livingston; 2008.
limitation of the study is the type of disorders
generate a stronger statistical power in the outcomes
strengthening
Ann Rheum Dis. 2005; 64(4):544-548.
study made use of purposive sampling, the number of
assessed as well as the levels measured.
or
osteoarthritis of the knee? A systematic review.
respondents was limited to 18. Since the author of the
potential subjects was dramatically reduced. Another
Roddy E, Zhang W, Doherty M. Aerobic
9.
Brown SP, Miller WC, Eason JM. Exercise physiology: basis of human movement in health and
disease.
PA:Lippincott
Williams
&
Wilkins;2006. 10. Vernochet P, Monpere C, Pianeta A, Galland T.
effect.
Oxygen consumption and ECG response of water-based versus land-based calisthenics in
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