suzette austin kori ivanchak erica jeszke nancy marshall
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The effects of aquatics versus land therapy on patients with COPD on quality of life and physical f unction. Suzette Austin Kori Ivanchak Erica Jeszke Nancy Marshall. Background. - PowerPoint PPT PresentationTRANSCRIPT
BELLARMINE UNIVERSITY, LOUISVILLE, KY
The effects of aquatics versus land therapy on patients with COPD on
quality of life and physical functionSuzette AustinKori IvanchakErica Jeszke
Nancy Marshall
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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)
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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)
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P: Persons with COPD
I: Aquatic therapy
C: Dry land therapy
O: Quality of life Physical Function
http://goo.gl/0Yo0eL
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Articles Type Age Water
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
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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
De Souto Araujo, 2012
Upper and LowerAerobic and resistance
Group 1- Land
Group 2- WaterLow
FEV1
6MWTSGRQDyspnea
McNamara, 2011 Variety Variey Variety
ISWTChronic Respiratory QuestionnaireDyspnea
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Articles Pulmonary 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
De Souto Araujo, 2012
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)
ISWT See Wadell (2004)
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Results: Wadell, 2004Land• 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
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Articles Pulmonary Function
ISWT/ ESWT6MWT Quality of Life
Shead, 2012
SaO2
(?) FVC1
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
De Souto Araujo, 2012
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)
ISWT See Wadell (2004)
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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
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Articles Pulmonary Function
ISWT/ ESWT6MWT Quality of Life
Shead, 2012
SaO2
(?) FVC1
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
De Souto Araujo, 2012
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)
ISWT See Wadell (2004)
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Results: de Souto Araujo, 2012
SQRQ: Improvement in floor group No change in aquatics group Decline in control group
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Articles Pulmonary Function
ISWT/ ESWT6MWT Quality of Life
Shead, 2012
SaO2 FVC1
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
De Souto Araujo, 2012
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)
ISWT See Wadell (2004)
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Discussion
• Overall, increase in pulmonary function
• Both groups showed improvements in endurance
• Conflicting evidence in SGRQ
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Discussion• Patients with secondary health
conditions • Reducing the frequency of training
was not effective for maintaining fitness level
BELLARMINE UNIVERSITY, LOUISVILLE, KY
Limitations
• Limited number of studies on topic
• Small sample sizes
• Low to moderate quality
• Motivational factor/patient preference
• Exclusion of people with certain comorbidities
BELLARMINE UNIVERSITY, LOUISVILLE, KY
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.
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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/C
olumns/Water-Wisdom/Aquatic-Therapy-for-COPD-Patients.aspx
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Questions
???
BELLARMINE UNIVERSITY, LOUISVILLE, KY
References1. 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.