OBJECTIVES:Various exercise strategies have been suggested to address movement deficits in order to improve motor function and quality of life for individuals in the early or moderate stages of Parkinson disease. The purpose is to evaluate the effects of an aquatic Ai Chi intervention on balance, gait speed and quality of life of patients.

DESIGN AND INTERVENTION:Twenty-nine people with Parkinson disease participated in this pilot study. People were randomized into (1) aquatic Ai Chi program (experimental group) and (2) a dry land conventional Western physical therapy intervention (control group). Twenty-two twice-weekly sessions were performed with the 14 patients assigned to the experimental group, during the same period of time as the control group (same number of sessions), who received dry land therapy.

MAIN OUTCOMES MEASURES:Visual Analogue scale (VAS), The Timed Get up and Go test, Five Times Sit-to-Stand test, single leg standing, Yesavage test and Parkinson's Disease Questionnaire (PDQ-39). A descriptive analysis was performed on all study variables.

RESULTS:The results showed a significant effect on time - of a high effect which indicates that the VAS scores (F 1.3; p < 0.001), Five time (F = 1.8; p = 0.001) and Get up and Go (F = 1.7; p < 0.001) significantly decreased in time, independent of the treatment group. In contrast, no significant differences were found in the results shown on the PDQ-39 scale, finding only changes in the section of social support (p < 0.001 F = 18.63).

CONCLUSIONS:The results of this 11-week controlled pilot trial suggest that aquatic Ai Chi applied twice weekly may potentially reduce Parkinsonian symptoms as measured on different motor symptoms, bradykinesia and rigidity.

BACKGROUND:Fibromyalgia syndrome (FMS) is a rheumatic disorder that presents with physical, psychological and social symptoms.

OBJECTIVE:The aim of this study was to assess the effects of a program of water-based Ai Chi on the health-related quality of life of subjects with FMS.

METHODS:An experimental pilot study was performed with a sample of 20 female subjects diagnosed with FM and recruited from two different settings. Assessments were performed using the a visual analog scale and the Short Form-36 physical and mental health summary scores. Measurements took place at baseline and upon completion of 10 treatment sessions.

RESULTS:After 10 treatment sessions, significant improvements (P<0.05) were found in practically all the variables under study, with significant differences in values such as pain perception, vitality, mental health, as well as perceived overall improvement in quality of life.

CONCLUSIONS:A water-based Ai Chi program may contribute to the improvement of mental and physical health and the quality of life in women with FMS.

BACKGROUND:Falls are associated with morbidity, loss of independence, and mortality. While land-based group exercise and Tai Chi programs reduce the risk of falls, aquatic therapy may allow patients to complete balance exercises with less pain and fear of falling; however, limited data exist.

OBJECTIVE:The objective of the study was to pilot the implementation of an aquatic group based on Ai Chi principles (Aquabalance) and to evaluate the safety, intervention acceptability, and intervention effect sizes.

DESIGN:Pilot observational cohort study.

METHODS:Forty-two outpatients underwent a single 45-minute weekly group aquatic Ai Chi-based session for eight weeks (Aquabalance). Safety was monitored using organizational reporting systems. Patient attendance, satisfaction, and self-reported falls were also recorded. Balance measures included the Timed Up and Go (TUG) test, the Four Square Step Test (FSST), and the unilateral Step Tests.

RESULTS:Forty-two patients completed the program. It was feasible to deliver Aquabalance, as evidenced by the median (IQR) attendance rate of 8.0 (7.8, 8.0) out of 8. No adverse events occurred and participants reported high satisfaction levels. Improvements were noted on the TUG, 10-meter walk test, the Functional Reach Test, the FSST, and the unilateral step tests (p<0.05). The proportion of patients defined as high falls risk reduced from 38% to 21%. The study was limited by its small sample size, single-center nature, and the absence of a control group.

CONCLUSIONS:Aquabalance was safe, well-attended, and acceptable to participants. A randomized controlled assessor-blinded trial is required.

BACKGROUND:Exercise training is commonly recommended for individuals with fibromyalgia. This review examined the effects of supervised group aquatic training programs (led by an instructor). We defined aquatic training as exercising in a pool while standing at waist, chest, or shoulder depth. This review is part of the update of the 'Exercise for treating fibromyalgia syndrome' review first published in 2002, and previously updated in 2007.

OBJECTIVES:The objective of this systematic review was to evaluate the benefits and harms of aquatic exercise training in adults with fibromyalgia.

SEARCH METHODS:We searched The Cochrane Library 2013, Issue 2 (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, NHS Economic Evaluation Database), MEDLINE, EMBASE, CINAHL, PEDro, Dissertation Abstracts, WHO international Clinical Trials Registry Platform, and AMED, as well as other sources (i.e., reference lists from key journals, identified articles, meta-analyses, and reviews of all types of treatment for fibromyalgia) from inception to October 2013. Using Cochrane methods, we screened citations, abstracts, and full-text articles. Subsequently, we identified aquatic exercise training studies.

SELECTION CRITERIA:Selection criteria were: a) full-text publication of a randomized controlled trial (RCT) in adults diagnosed with fibromyalgia based on published criteria, and b) between-group data for an aquatic intervention and a control or other intervention. We excluded studies if exercise in water was less than 50% of the full intervention.

DATA COLLECTION AND ANALYSIS:We independently assessed risk of bias and extracted data (24 outcomes), of which we designated seven as major outcomes: multidimensional function, self reported physical function, pain, stiffness, muscle strength, submaximal cardiorespiratory function, withdrawal rates and adverse effects. We resolved discordance through discussion. We evaluated interventions using mean differences (MD) or standardized mean differences (SMD) and 95% confidence intervals (95% CI). Where two or more studies provided data for an outcome, we carried out meta-analysis. In addition, we set and used a 15% threshold for calculation of clinically relevant differences.

MAIN RESULTS:We included 16 aquatic exercise training studies (N = 881; 866 women and 15 men). Nine studies compared aquatic exercise to control, five studies compared aquatic to land-based exercise, and two compared aquatic exercise to a different aquatic exercise program.We rated the risk of bias related to random sequence generation (selection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), blinding of outcome assessors (detection bias), and other bias as low. We rated blinding of participants and personnel (selection and performance bias) and allocation concealment (selection bias) as low risk and unclear. The assessment of the evidence showed limitations related to imprecision, high statistical heterogeneity, and wide confidence intervals. Aquatic versus controlWe found statistically significant improvements (P value<0.05) in all of the major outcomes. Based on a 100-point scale, multidimensional function improved by six units (MD -5.97, 95% CI -9.06 to -2.88; number needed to treat (NNT) 5, 95% CI 3 to 9), self reported physical function by four units (MD -4.35, 95% CI -7.77 to -0.94; NNT 6, 95% CI 3 to 22), pain by seven units (MD -6.59, 95% CI -10.71 to -2.48; NNT 5, 95% CI 3 to 8), and stiffness by 18 units (MD -18.34, 95% CI -35.75 to -0.93; NNT 3, 95% CI 2 to 24) more in the aquatic than the control groups. The SMD for muscle strength as measured by knee extension and hand grip was 0.63 standard deviations higher compared to the control group (SMD 0.63, 95% CI 0.20 to 1.05; NNT 4, 95% CI 3 to 12) and cardiovascular submaximal function improved by 37 meters on six-minute walk test (95% CI 4.14 to 69.92). Only two major outcomes, stiffness and muscle strength, met the 15% threshold for clinical relevance (improved by 27% and 37% respectively). Withdrawals were similar in the aquatic and control groups and adverse effects were poorly reported, with no serious adverse effects reported. Aquatic versus land-basedThere were no statistically significant differences between interventions for multidimensional function, self reported physical function, pain or stiffness: 0.91 units (95% CI -4.01 to 5.83), -5.85 units (95% CI -12.33 to 0.63), -0.75 units (95% CI -10.72 to 9.23), and two units (95% CI -8.88 to 1.28) respectively (all based on a 100-point scale), or in submaximal cardiorespiratory function (three seconds on a 100-meter walk test, 95% CI -1.77 to 7.77). We found a statistically significant difference between interventions for strength, favoring land-based training (2.40 kilo pascals grip strength, 95% CI 4.52 to 0.28). None of the outcomes in the aquatic versus land comparison reached clinically relevant differences of 15%. Withdrawals were similar in the aquatic and land groups and adverse effects were poorly reported, with no serious adverse effects in either group. Aquatic versus aquatic (Ai Chi versus stretching in the water, exercise in pool water versus exercise in sea water)Among the major outcomes the only statistically significant difference between interventions was for stiffness, favoring Ai Chi (1.00 on a 100-point scale, 95% CI 0.31 to 1.69).

AUTHORS' CONCLUSIONS:Low to moderate quality evidence relative to control suggests that aquatic training is beneficial for improving wellness, symptoms, and fitness in adults with fibromyalgia. Very low to low quality evidence suggests that there are benefits of aquatic and land-based exercise, except in muscle strength (very low quality evidence favoring land). No serious adverse effects were reported.

BACKGROUND:Gait, balance disorders and pain associated with Parkinson's disease represent important therapeutic challenges, as they are related with an increased risk of falls, together with disability and physical decline.

AIM:To compare the effects of an aquatic ai chi training program on the perception of pain, the maintenance of balance and the functional independence of patients with Parkinson's disease.

DESIGN:A single-blind randomized controlled trial.

SETTING:Parkinson's associations and municipal pools.

POPULATION:Thirty individuals from two Parkinson's associations in Spain participated in the study.

INCLUSION CRITERIA:individuals diagnosed with Parkinson's disease in stages 1 to 3 (Hoehn and Yahr Scale), older than 40 years, in the off phase (not medicated) and with a score greater or equal to 24 on the Mini-Mental State Examination Scale, without any medical contraindications and who accepted the study norms.

METHODS:The experimental group (N.=15 patients) participated in a program of aquatic ai chi. The control group (N.=15) received therapy on dry land. The intervention lasted 10 weeks with sessions held twice weekly. The pain VAS, Tinetti, Berg, Test Get Up and Go, Five Times Test and Unified Parkinson's Disease Rating Scale were used.

RESULTS:Significant differences were found between the baseline and one-month follow up assessments in pain perception values (F=26.89, P<0.001), and the Tinetti Test (F=21.57, P<0.001) in the experimental group compared to the control group (P<0.05) with the exception of the FTSTS (P=0.006). In the control group, improvements were only seen on the VAS Pain Scale (F=8.3, P=0.004) and these were less significant than the changes found in the experimental group. Regarding the scores obtained on the UPDRS scale in the experimental group, there were significant differences in activities of daily living and motor examination, with the exception of mentation, behavior and mood.

CONCLUSIONS:An aquatic ai chi program appears to be a valid treatment option for patients diagnosed with mild to moderate Parkinson's disease for the treatment of pain, balance and functional capacity.

CLINICAL REHABILITATION IMPACT:Physical exercise performed in water has positive effects on some of the necessary elements that contribute towards improved biomechanical gait patterns in our patients with Parkinson's disease.

INTRODUCTION:Fibromyalgia is rheumathological disease a combination of physical, psychological and social limitations. The aim of the present study is to determinate the benefits of Ai Chi program on quality of life, depression and pain.

PATIENTS AND METHODS:An experimental study was performed with 20 fibromyalgia patients two different cities. Outcome measures were functional capacity (Fibromyalgia Impact Questionnaire), pain (Visual Analogue Scale) and quality of life (Short Form-36). Measures were performed at baseline and after ten weeks post-intervention.

RESULTS:After ten weeks of treatment, the results showed significant reduction (p<0,05) in virtually all outcome measures.

CONCLUSION:An Ai Chi aquatic therapy programme contributes to reduce pain and improve quality of life as well as physical and mental health in patients with fibromyalgia.

PURPOSE:In this study, we aimed to investigate effects of Ai Chi on balance, functional mobility, health-related quality of life, and motor impairment in patients with Parkinson's disease.

METHOD:This study was conducted as an open-label randomized controlled trial (ISRCTN26292510) with repeated measures. Forty patients with Parkinson's disease stages 2 to 3 according to the Hoehn and Yahr Scale were randomly allocated to either an Ai Chi exercise group or a land-based exercise control group for 5 weeks. Balance was measured using the Biodex-3,1 and the Berg Balance Scale. Functional mobility was evaluated using the Timed Up and Go Test. Additionally, health-related quality of life and motor activity were assessed with the Parkinson's Disease Questionnaire-39 and the Unified Parkinson's Disease Rating Scale-III.

RESULTS:Although patients in both groups showed significant improvement in all outcome variables, improvement of dynamic balance was significantly greater in the Ai Chi group (p < 0.001), Berg Balance Scale (p < 0.001), Timed Up and Go Test (p = 0.002), Parkinson's Disease Questionnaire-39 (p < 0.001), Unified Parkinson's Disease Rating Scale-III (p < 0.001).

CONCLUSION:Our results suggest that an Ai Chi exercise program improves balance, mobility, motor ability, and quality of life. In addition, Ai Chi exercise was more effective as an intervention than land-based exercise in patients with mild to moderate Parkinson's disease. Implications for rehabilitation Ai Chi exercises (aquatic exercises) may help improve balance, functional mobility, health-related quality of life, and motor ability in patients with mild to moderate Parkinson's disease more efficiently than similar land-based exercises. Ai Chi exercises should be considered as a rehabilitation option for treatment of patients with mild or moderate Parkinson's disease.

BACKGROUND:Multiple Sclerosis (MS) patients are often referred to aquatic physical therapy, but unfortunately, researches on the effects of aquatic therapy in MS patients are limited.

OBJECTIVE:The purpose of this study was to investigate the effects of Ai-Chi on balance, functional mobility, strength and fatigue in ambulatory patients with MS.

METHODS:Twenty-three ambulatory female patients were divided into two groups as experimental (n = 15) or control (n = 8) for an 8-week treatment program. The experimental group underwent Ai-Chi exercises in a swimming pool and the control group performed active arm and leg exercises combined with abdominal breathing exercises at home. Static standing balance was measured with duration of one-leg stance, functional mobility was evaluated with Timed-up and Go test and 6 minute walk test, upper and lower muscle strength was assessed with hand-held dynamometer and fatigue was evaluated with Fatigue Severity Scale.

RESULTS:Improvements were observed in static standing balance, functional mobility, upper and lower extremity muscle strength and fatigue in the Ai-Chi group (p<0.05), but no significant differences in any outcome measures were observed in the control group (p>0.05) after the intervention.

CONCLUSIONS:According to these findings Ai-Chi may improve balance, functional mobility, upper and lower extremity muscle strength and fatigue in patients with MS.

INTRODUCTION:One of the main symptoms of Parkinson's disease is the high incidence of falls occurring due to the decline of both static and dynamic balance. The aim of this study is to determine the effect of an Ai Chi programme designed to prevent falls in patients with Parkinson's disease by improving both functional independence and perception of physical pain.

METHODS:Fifteen patients diagnosed with Parkinson's disease (Hoehn and Yahr stages 1-3) participated in a 10-week Ai Chi programme consisting of 30 to 45-minute aquatic exercise sessions twice a week. The assessment measures used in this study were the pain visual analogue scale (VAS), the Tinetti gait and balance assessment tool, and the Timed Get up and Go test.

RESULTS:The results were calculated by applying the Friedman test to 3 related measurements: patients at baseline, at post-treatment (at the end of the 10 week programme) and after one month of follow-up. The data obtained showed a significant improvement (p<.001) in scores for pain perception, balance, and gait function after the treatment programme. Furthermore, patients continued to show significant improvements and the benefits remained at the one-month follow-up visit.

CONCLUSION:Ai Chi is a promising and feasible aquatic treatment for improving pain perception, balance, and functional capacity in patients diagnosed with mild or moderate Parkinson's disease.

PURPOSE:A high fat diet and sedentary lifestyle may predispose men to prostate cancer through effects on serum factors such as hormones. We evaluated the effects of a low fat, high fiber diet and exercise intervention on serum stimulated growth of established prostate cancer cell lines.

MATERIALS AND METHODS:Fasting serum was obtained from 13 overweight men before and after undergoing an 11-day low fat, high fiber diet and exercise intervention. Serum was also obtained from 8 men who had complied with the regimen for a mean of 14.2 years. Hormone dependent LNCaP and independent PC-3 prostate cancer cell lines were grown in culture medium containing 10% of subject pre-intervention or post-intervention serum and viable cells were counted after 48 hours. Anthropometry, serum free testosterone, lipids and glucose were measured in all subjects.

RESULTS:Post-intervention serum from each of the 11-day intervention subjects reduced LNCaP cell growth by a mean of 30% compared with pre-intervention serum from each (p<0.01). LNCaP cell growth in serum from long-term subjects was 15% below that of post-intervention serum (p<0.01). There was no difference in the growth of PC-3 cells when cultured with serum from either intervention group. Serum free testosterone, body weight, glucose and lipids were significantly reduced in 11-day subjects.

CONCLUSIONS:A low fat, high fiber diet and exercise intervention resulted in serum changes that significantly reduced the growth of androgen responsive LNCaP prostate cancer cells in vitro.

Background. Multiple sclerosis (MS) is a chronic demyelinating neurological disease. Several studies have reported that complementary and alternative therapies can have positive effects against pain in these patients. Objective. The objective was to investigate the effectiveness of an Ai-Chi aquatic exercise program against pain and other symptoms in MS patients. Methods. In this randomized controlled trial, 73 MS patients were randomly assigned to an experimental or control group for a 20-week treatment program. The experimental group underwent 40 sessions of Ai-Chi exercise in swimming pool and the control group 40 sessions of abdominal breathing and contraction-relaxation exercises in therapy room. Outcome variables were pain, disability, spasm, depression, fatigue, and autonomy, which were assessed before the intervention and immediately and at 4 and 10 weeks after the last treatment session. Results. The experimental group showed a significant (P<0.028) and clinically relevant decrease in pain intensity versus baseline, with an immediate posttreatment reduction in median visual analogue scale scores of 50% that was maintained for up to 10 weeks. Significant improvements were also observed in spasm, fatigue, disability, and autonomy. Conclusion. According to these findings, an Ai-Chi aquatic exercise program improves pain, spasms, disability, fatigue, depression, and autonomy in MS patients.

[Purpose] To examine the efficacy of Ai Chi in relieving the pain and stiffness of knee osteoarthritis and improving, physical functioning, proprioception and quality of life. [Subjects and Methods] Twenty-five persons with knee osteoarthritis completed 5 weeks Ai Chi practice (60 minutes per session, twice per week, 10 sessions in total). Knee pain and stiffness were measured before and after the intervention program. [Results] Significant improvements in pain, self-perceived physical functioning and self-perceived stiffness were observed after the Ai-Chi intervention. On average, no significant change in knee range of motion, 6-minute walk test distances or proprioception was observed. [Conclusion] A five-week Ai Chi intervention can improve the pain and stiffness of knee osteoarthritis and self-perceived physical functions and quality of life improvement. Ai Chi may be another treatment choice for people with knee OA to practice in the community.

OBJECTIVE:To evaluate the effect of an aquatic therapy programme designed to increase balance in stroke survivors.

DESIGN:A randomized, controlled pilot trial.

SETTING:Rehabilitation department of a university hospital.

SUBJECTS:Ambulatory chronic stroke patients (n = 25):13 in an aquatic therapy group and 12 in a conventional therapy group.

INTERVENTIONS:The aquatic therapy group participated in a programme consisting of Ai Chi and Halliwick methods, which focused on balance and weight-bearing exercises. The conventional therapy group performed gym exercises. In both groups, the interventions occurred for 1 hour, three times per week, for eight weeks.

MAIN MEASURES:The primary outcome measures were Berg Balance Scale score and weight-bearing ability, as measured by vertical ground reaction force during four standing tasks (rising from a chair and weight-shifting forward, backward and laterally). Secondary measures were muscle strength and gait.

RESULTS:Compared with the conventional therapy group, the aquatic therapy group attained significant improvements in Berg Balance Scale scores, forward and backward weight-bearing abilities of the affected limbs, and knee flexor strength (P<0.05), with effect sizes of 1.03, 1.14, 0.72 and 1.13 standard deviation units and powers of 75, 81, 70 and 26%, respectively. There were no significant changes in the other measures between the two groups.

CONCLUSIONS:Postural balance and knee flexor strength were improved after aquatic therapy based on the Halliwick and Ai Chi methods in stroke survivors. Because of limited power and a small population base, further studies with larger sample sizes are required.