Comparison of the effects of water- and land-based exercises on the physical function and quality of life in community-dwelling elderly people with history of falling: A single-blind, randomized controlled trial

Highlights

• We study the effect of water- and land-based exercises in elderly people.

• Hip abduction and adduction strength improved significantly in both groups.

• Water-based exercises would be useful to improve physical and psychological health.

Abstract

Purpose

The purpose of this study was to identify the effects of water-based exercises on the physical functions and quality of life (QOL) in community-dwelling elderly people with history of falling.

Materials and methods

Participants were randomly assigned to the water-based exercise group (n = 34) or land-based exercise groups (n = 32). To identify the effects on physical functions, muscle strength, flexibility, and mobility were measured. QOL and fear of falling were evaluated using the Short Form 36-item questionnaire and the modified falls efficacy scale (M-FES). The measurements were performed before and after the 10-week training period.

Results

Within-group analysis indicated that hip abduction and adduction strength improved significantly in both groups (p = 0.005; p = 0.007). However, no statistically significant within-group differences were found in the back scratch test (p = 0.766) and chair sit-and-reach test (p = 0.870). QOL was significantly different in both groups (health transition: p = 0.014, physical functioning: p < 0.001, role physical: p < 0.001, role emotional: p = 0.002, bodily pain: p < 0.001, vitality: p < 0.001, and mental health: p < 0.001). There was a significant difference in the M-FES in both groups (p = 0.040).

Conclusions

These results indicate that water-based exercises are beneficial to improve the QOL, as well as physical activities, of community-dwelling elderly compared with land-based exercise. Water-based exercises would be useful to improve physical and psychological health in the elderly people with history of falling.

Introduction

Fear of falling can hinder activities of daily living and mobility among the elderly, which can translate into a reduced quality of life (Arfken et al., 1994, Kim and So, 2013). Approximately 50% of falls occur to elderly people that reside alone in communities, and half of them experience twice or more falls (Masud & Morris, 2001). Once healthy elderly people experience falls, they tend to require long-term hospice care because of body fractures and psychological stress (Hardy and Thompson, 1998, Kirsebom et al., 2014). Moreover, the number of elderly people experiencing falls is increasing globally; thus, associated medical costs are expected to increase geometrically in the future (Roudsari et al., 2005, Stevens et al., 2006).

The primary cause of falls among elderly people is the decline in physical functions secondary to aging (Reinsch et al., 1992, Tinetti et al., 1988). Recent randomized controlled trials attempted to evaluate traditional land-based exercises focused on preventing falls among elderly people (Chang et al., 2004, Close et al., 1999). It was reported that land-based exercises improve the lower limb strength of elderly people, as well as other physical functions. Additionally, such exercises seemed to prevent falls among elderly people (Clemson et al., 2004, Macaluso and De Vito, 2004). Land-based exercises increase physical activity, which translates into an improved quality of life (Fraga et al., 2011, Takata et al., 2010).

Unlike land-based exercises, water-based exercises help to minimize the effect of gravity on the body, which reduces the burden on joints, and the high density of water can reduce the risk of falling (Camilotti, Rodacki, Israel, & Fowler, 2009). During water-based exercise, body balance is affected by both gravity and buoyancy. However, if one is stronger or these factors are not collinear, a metacentric effect with two powers is the result (Becker, 2009). This metacentric effect induces body perturbation and proprioception stimulation that enables an active reduction of body instability.

In previous studies, however, there were no statistically significant differences between water-based exercise groups. Additionally, there were no statistically significant differences between control groups of elderly people, and balance, function, and quality-of-life groups (Cochrane, Davey, Matthes, & Edwards, 2005). Moreover, water-based exercise training on elderly people resulted in significantly improved balance and flexibility, but no significant differences were reported regarding strength (Hale, Waters, & Herbison, 2012). In a 10-week intervention study for more than 65 years, the water-based exercise group showed increased balance compared to the land-based exercise group (Devereux, Robertson, & Briffa, 2005).

The purpose of the present investigation was to study differences between the water- and land-based exercise groups after 10 weeks of exercise for elderly people with history of falling. We hypothesized that the water-based exercise group should improve more in terms of fall efficacy, physical functions, and quality of life compared with the land-based exercise group after 10 weeks’ intervention for elderly people with history of falling. To test our hypothesis, we conducted the exercises in water- and land-based groups of elderly people with history of falling for 10 weeks.