Effects of a Hydrotherapy on Flexibility and Muscular Strength in Elderly Men

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1 Research Article Effects of a Hydrotherapy on Flexibility and Muscular Strength in Elderly Men Yaser Alikhajeh1, Amir Shahriyar Ariamanesh*, Nasser Mohamad Rahimi3, Kazem Noroozi3 1 Islamic Azad University, Mashhad, Iran Mashhad Medical University, Mashhad, Iran 3 Ferdowsi University of Mashhad, Mashhad, Iran * Corresponding Author Abstract Introduction: We designed this study to evaluate the effect of a hydrotherapy program on flexibility and muscle strength among sedentary elderly men Materials and Method: The participants were 8 healthy sedentary elderly men aged between 64 and 84 years (14 in the experimental group and 14 in the control group) Muscle strength before and after the program was assessed by means of test 30- Second Chair stand and Flexibility assessed by means of chair sit and reach test The program consisted of 36 one-hour sessions over a consecutive 1-week period The physical exercises were organized in seven levels of difficulty that were selected to obtain gains in flexibility and muscle strength Therefore, there were between and within group analyses using independent t-test Results: Hydrotherapy promoted significant increases in the elderly men's muscle strength, as assessed using the test30- Second Chair stand (p< 0001) and the chair sit and reach test (p< 0001) Conclusion: The proposed hydrotherapy program was efficient in improving flexibility and partially effective in improving muscle strength among the early elderly women who took part in the study Our results are compatible with the findings from similar studies carried out on the ground Key words: hydrotherapy; elderly men; aquatic exercises; flexibility; muscle strength Introduction The aging process may be understood as a set of unfavorable structural and functional alterations of an organism, which progressively accumulates, specifically due to advancing age These modifications interfere with the performance of motor skills, making the individual's adaptation to the environment difficult, and initiating changes of both a social and psychological nature(10) The loss of muscular strength in the muscular-skeletal system starts from 5 to 30 years of age, and occurs due to various factors(1,1): Simultaneous decreases in flexibility of all joints The lack of flexibility and muscular strength losses in elders affect balance; results inpoor posture and functional performance; increases the risk of falling and respiratory problems; decreases the speed of walking; and makes daily living activities difficult Consequently, the maintenance or gain of flexibility and muscular strength is an important aim for the control of elderly people's health Physical training programs may diminish the effects of the immobility cycle: of falls, pains, and fears(6) It is agreed upon that musculature should be strengthened in a harmonious manner from optimized joint mobility, and that, in order to prevent aging dysfunctions, the most appropriate solution is a program of low impact to moderate the intensity exercises over a long period(11) Hydrotherapy is a physical therapy re s o u rc e t h a t u t i l i z e s t h e p hys i c a l, physiological, and kinesiological effects that occur from the body's immersion in a heated 1

2 Alikhajeh Y et al pool as an auxiliary resource for the rehabilitation or prevention of functional alterations Physical properties and the heated water perform important roles for the improvement and maintenance of joint range of movement, muscular tension reduction, and relaxation(4) Decreases of joint impact during physical activities induced by flotation cause reductions in pain sensitivity, decrease the compression on the painful articulations, and bring about greater freedom of movement and decreases of painful spasms The effects of flotation aid the movement of rigid articulations in wider ranges with minima l increa ses in pa in(18) The strengthening exercises with submerged patients are based on the physical principals of hydrostatics, which allow the generation of constant multi-dimensional resistance to the movements This resistance increases proportionally while the strength is exerted, generating a minimal overload of the articulations(3) Based on what was demonstrated above and on the importance of exploring this subject, this study had the objective to assess the effects of a hydrotherapy program developed for flexibility and muscular strength gains in previously sedentary, early elderly men Materials and Methods Participants This was a quasi-experimental before/after study The participants were 8 healthy sedentary elderly men aged between 64 and 84 years, 14 elderly men in the experimental group (7579 ± 404 years) and 14 elderly men in the control group (70 ± 1330 years) The volunteers were recruited by means of posters in the association itself, and subsequently selected in accordance with the inclusion and exclusion criteria The inclusion criteria were: over 64 years of age, independence in walking, independence in activities of daily living, the absence of medical contraindications for exercise, cardiological and dermatological medical certificate, 90% participation in the treatment, and signature of the free and informed consent statement The exclusion criteria were: urinary or fecal incontinence, renal insufficiency, open wounds, contagious skin diseases, infectious diseases, catheters, vascular thrombi, cardiac insufficiency, uncontrolled arterial pressure, dyspnea upon minimal effort, use of psychotropic drugs (benzodiazepi-nes), or participation in any other physical activity or physical therapy program() Materials The materials consisted of the following: a questionnaire for interview, the test 30Second Chair stand, the chair sit and reach test (8,16), a chronometer (Sport Timer), two chairs of 45 cm in height (one of them with arms), swimming pool measuring 75 by 111 meters, with a sloping bottom with the depth going from 08 to 1 meters, and with a mean temperature of 30ºC Procedures The subjects' evaluation occurred at two d i s t i n c t m o m e n t s, b e fo re a n d a f te r interventions which were performed in the morning by the same properly trained investigator Flexibility Assessment Chair-sit-and-reach was a method used to measure the capability of the participants for general lower body flexibility Rikle and Jones (15) suggested this method of functional flexibility testing for older people The participants sat on a chair with their legs extended with feet together The participants then reached forward for their toes as far as they could reach while the examiner measured the distance between the finger tips and toe tips This procedure was repeated three times, and the mean of the three scores was recorded

3 Effects of a Hydrotherapy on Flexibility and Muscular Strength in Elderly Men Table 1 (M±SD) of the differences in elderly men control group and experimental group the program of hydrotherapy for muscles Test Muscle strength Flexibility Control Group M± SD Experimental Group M± SD Independent t-test df p-value 5 4 Pre-Test 1 % 30 0 % 11 Post-Test 0 % % Pre-Test -907 ± ± Post-Test -914 ± The rationale for selecting the sit-andreach test as a measure of lower body flexibility assessment is that flexibility decreases with age and can play a role in fallrelated injuries Muscular Strength Evaluation The thirty seconds sit-and-stand measure was used to assess lower body muscular strength and endurance Participants started the test seated in the examination chair %45 waiting for the starting signal from the examiner to prompt the commencement of the test This involved standing straight up without the use of their hands (crossed over their chest) and sat down with their full buttocks on the chair; This procedure was repeated for 30 seconds(8,15) The number of correct completed movement patterns was recorded as the score achieved for this component During execution of the test, the researcher assistant Table (M±SD) of the differences in elderly men before and after the program of hydrotherapy for Muscle Strength/Flexibility obtained by means of the paired sample t test for paired data Group Test Muscle strength Pre-Test M± SD 1 % 30 Post-Test M± SD Paird sample t-test 0 % 178 df p-value Control Flexibility -907 ± ± 831 Muscle strength -693 ± 161 % % % Experimental Flexibility 3

4 Alikhajeh Y et al supported the chair by holding it in place This was to ensure that the participant did not bump the chair out of the way while performing the exercise The researcher assistant also made sure that the participant did not stumble or miss-judge the chair during testing by guiding the participant into the chair and out of the chair The scales were applied before the treatment (pre-test) and after 1 weeks (post-test 1) of hydrotherapy The arterial pressure (AP) was measured before and after the treatment sessions, with the aim of checking the individuals' conditions for performing the aquatic activities, without statistical intentions The study lasted 1 weeks, with one-hour sessions, three times a week The hydrotherapy program was carried out with seven elderly men per group and included adaptation to the aquatic environment, hydrokinesiotherapy and inclusion of aquatic exercises from other studies (7,13,19) that were run to challenge balance Each session was divided into three phases: the aquatic environment adaptation phase, the stretching phase, and a phase for strengthening exercises The intensity was low to moderate, with constant intensity, frequency, and speed, for 1 weeks Each series was performed continuously and during the time of each one, there was a oneminute rest Statistical Analyses For comparisons over the course of time for the measurable variables, the Student t test was performes for paired data, by means of comparing scores or times after the treatment, with corresponding results for the same individuals from the preceding evaluation() The data have been shown as mean differences and standard deviations of the difference Statistical significance was set at the (p<005) level of probability All a n a lys e s we re c o n d u c te d u s i n g t h e Statistical Package for Social Sciences (ver19) 4 Results Hydrotherapy promoted significant increases in the elderly men's muscle strength, as assessed using the test 30Second Chair stand (p< 0001) flexibility, and the chair sit and reach test (p< 0001)(Tales 1and) Discussion The fun, the enjoyment, and the social aspects of water exercise are highly significant It provides motivation for the isolated and frail elderly to be active(17) Water is a supportive, low risk exercise environment that may reduce the likelihood of acute injury and fear of falling, while improving participation and adherence Aquatic exercise in warm water increases blood circulation to involved joints, increases strength and range of motion to involved joints, relaxes muscles, temporarily decreases levels of pain, and increases confidence in functional ability(0) Buoyancy provides support to the body weight and reduces the compression to the weight bearing joints(1) Therefore, although water-based exercising is nonweight bearing, the added resistance to movements may be sufficient to stress the bones and therefore it leads to improvement in bone density Strengthening of the muscles and the other tissues surrounding the joints can improve posture and joint stability H yd ro s t a t i c p re s s u re i m p rove s t h e circulation of blood around the body, and thus causing a lower working heart rate, assists in the removal of waste products, promotes more effective recovery from exercise, reduces swelling in joints, but makes it harder to breathe, if water is pressing against the rib-cage(1) According to the obtained results, muscle strength and flexibility increased significantly after conducting the hydrotherapy program, according the test 30-Second Chair stand, the chair sit and reach test A previous study

5 Effects of a Hydrotherapy on Flexibility and Muscular Strength in Elderly Men assessed the flexibility using the same methodology in response to a program of physical exercises performed on the ground, including stretching, muscular strength, respiratory, balance and motor skills exercises, or a general exercise program The study was conducted with 15 early elderly women in the experimental group and 15 participants in the control group, who were trained for four months, twice a week The study showed improvements in experimental group's flexibility, and decreasing the average wrist-ankle distance to half of the values found on the pre-test, that is, an average decrease of 19 ± 43 m The control group did not show significant alterations(5) These results are compatible with the data of Rauchbach,(14) who studied the effects of a general exercise program (stretching, respiratory, muscular strength training, joint mobilization, balance training, and relaxation, together with walking), applied for three months, three times a week, in sessions of one hour, of 4 subjects with an average age of 64 years The authors found a relationship between performing the proposed physical activities and improvement of the range of motion of the articulations of the upper and lower limbs The flexibility of the lumbar spine measured during the anterior flexion of the trunk showed an average increase of 5 cm in 881% of the participants after training, indicating that the association of the training proposed by the author increases flexibility Judge et al (9) assessed the effects of 1 weeks of postural balance-and-strength training of the knee extensors, hip adductors, foot dorsal flexors, hip extensors, and knee flexors with muscular exercise training with 16 participants The control group, with 15 participants, performed general stretching exercises while seated on a chair The average age of the participants was 81 years The authors found that the experimental group demonstrated increases in strength and walking velocity This study is compatible with our findings, thus strengthening the idea that hydrotherapy programs, as well as general ground exercises, promote increases in strength and flexibility Conclusion The proposed program has shown it-'s efficiency in generating improvements in muscular flexibility and strength of previously sedentary early elder men, and has confirmed the clinical findings reported in most didactic books about hydrotherapy The muscular flexibility and strength increases found are similar to those found in ground-based studies This research contributes to the development of more detailed programs of physical exercise directed towards the elderly population, with more exercise routines The demonstration of the effects of various programs may facilitate more adequate exercise prescriptions, for the needs of the elderly Yaser Alikhajeh Facualy of department of Physical education and Sport Sciences, Young Researchers Club and elites, Mashhad Branch, Islamic Azad University, Mashad, Iran Amir Shahriyar Ariamanesh Facualty of Mashhad Medical University, Hip and Knee Surgeon, Mashhad, Iran Corresponding author Ariamanesha@mumsacir Nasser Mohamad Rahimi Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran 5

6 Alikhajeh Y et al Kazem Noroozi Faculty of Physical Education and Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran Acknowledgments The authors would like to express their gratitude to elderly to participate in related field work of this research Financial Disclosure None declared References 1Balfites BSH, Sargent IIF Human physiological adaptability through the life sequence J Gerontol: 3(4):40-10, 1977 Candeloro JM, Caromano FA Effects of a hydrotherapy program on flexibility and muscular strength in elderly women Rev bras fisioter Sa o Carlos: 11(4):67-7, Candeloro JM, Caromano FA Graduaça o da resiste ncia ao movimento durante a imersa o na a gua Rev Fisioter Brasil: 5(1):73-6, C a r o m a n o FA, C a n d e l o r o J M Fundamentos da Hidroterapia para Idosos Arq Cie ncias Sau de Unipar: 5():187-95, Caromano FA Efeitos do treinamento e da manutença o de dois programas de exercıc ios em idosos sedenta rios sauda veis [tese] Sa o Paulo: USP: Daley MJ, Spinks WL Exercise, mobility and aging Sports Med: 9(1):1-1, Douris P, Southard V, Varga C, Schauss W, Gennaro C, Reiss A The effect of land and aquatic exercise on balance score in older adults J Geriatr Phys Ther 6(1):3-6, H Scott Kieffer, Marie Attanasi Lehman, 6 Danielle Veacock, and Larua Korkuchthe Effects of a Short-Term Novel Aquatic Exercise Program on Functional Strength and Performance of Older Adults International Journal of Exercise Science: 5(4): , 01 9 Judge JO, Lindsey C, Underwood M, Winsemius D Balance improvements in older women: effects of exercise training Phys Ther: 73(4):54-6, Kalache A, Veras RP, Ramos LR O envelhecimento da populaça o mundial: um desafio novo Rev Sau de Pu blica: 1(3):0010, King AC, Taylor B, Haskell WLEffects of differing intensities and formats of 1 months of exercise training on psychological outcomes in older adults Health Psychol; 1(4):9-300, Lawrence, D The complete guide to exercise in wat er nd ed London A & C Black publishers Ltd: p 9-10, 54, Lord SR, Matters B, George RS The effects of water exercise on physical functioning on older people Aust J Ageing: 5(1):36-41, Rauchbach R A atividade fıs ica para a terceira idade Curitiba: Lovise: Rikle, RE & Jones, CJ Exercise and Older Adults In Howley, TE & Franks, BD (eds), Health Fitness Instructor's Handbook 4th ed Champaign, IL: Human Kinetics, p Rikle, RE & Jones, CJ Senior Fitness Test Manual Champaign, IL: Human Kinetics Rissel, C Water Exercises for the Frail Elderly: A Pilot Programme, The Australian Journal of Physiotherapy, vol 33, no 4, p 6-3, Ruoti, RG, Troup, JT & Berger, RA 'The Effects of Non-swimming Water Exercises on Older Adults', JOSPT Research Study, vol 19, no 3, p , Simmons V, Hansen PD Effectiveness of water exercise on postural mobility in the well elderly: an experimental study on

7 Effects of a Hydrotherapy on Flexibility and Muscular Strength in Elderly Men balance enhancement J Gerontol51A: (5):M33-8, Takeshima, N, Rogers, ME, Watanabe, E, Brechue, WF, Okada, A, Yamada, T, Islam, MM and Hayano, J Water-based exercise improves health-related aspects of fitness in older women, Medicine & Science in Sports & Exercise: vol 34, on 3, p 54, 00 1 Williams GN, Higgins MJ, Lewek MD Aging skeletal muscle: physiologic changes and the effects of training Phys Ther: 8(1):6-8, 00 Yaser Alikhajeh, Seyyed Reza Attarzadeh Hosseini &Amir Moghaddam Effects of hydrotherapy in static and dynamic balance among elderly men Procedia - Social and Behavioral Sciences: 46: p 0 4, 01 7

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