Sarvestanil (2012) Aquatic balance training for inactive elder males

The purpose of the present research was to study the effect of ten weeks Aquatic balance training(ABT) and functional training (FT) on dynamic balance in inactive elder males. Forty inactive elder males voluntarily participated in this research and randomly divided into three groups of ABT (N=13), FT(N=14) and control (N=13). The Y-Balance Test was used to assess dynamic balance before and after training. The training procedures were elaborated for the subjects and were performed for ten weeks, 3 sessions per week and one hour per session. One-way ANOVA was applied to determine the differences between three groups at the α ≤0.05. The results revealed that there were not any significant differences between three groups in pretest and between ABT and FT in posttest (P ≤ 0.05) as well. However, there were significant differences between ABT and FT with control group (P ≤ 0.05) in posttest. Considering the results, using both types of training are recommended for increasing dynamic balance in inactive elder males. That is because these types of training are inexpensive, yet innovative and its training intensity corresponds to the physical fitness of inactive elder males.

 

Middle-East Journal of Scientific Research 11 (3): 296-303, 2012
ISSN 1990-9233
IDOSI Publications, 2012
Corresponding Author:Hajar Jahadian Sarvestani, Department of Physical Education and Sport Sciences, Faculty of Humanities,
Kazerun Branch, Islamic Azad University, Kazerun, Iran. Tel: +98-9173202061.
296
The Effect of Ten Weeks Aquatic Balance Training and
Functional Training on Dynamic Balance in Inactive Elder Males
Hajar Jahadian Sarvestani1, Hossein Berenjeian Tabrizi1,11
Ali Abbasi1 and Jamal Rahmanpourmoghaddam12
Department of Physical Education and Sport Sciences,1
Faculty of Humanities, Kazerun Branch, Islamic Azad University, Kazerun, Iran Bachelor in Physical Education and Sport Sciences,2
Abstract: The purpose of the present research was to study the effect of ten weeks Aquatic balance training
(ABT) and functional training (FT) on dynamic balance in inactive elder males. Forty inactive elder males
voluntarily participated in this research and randomly divided into three groups of ABT (N=13), FT(N=14) and
control (N=13). The Y-Balance Test was used to assess dynamic balance before and after training. The training
procedures were elaborated for the subjects and were performed for ten weeks, 3 sessions per week and one
hour per session. One-way ANOVA was applied to determine the differences between three groups at the
0.05. The results revealed that there were not any significant differences between three groups in pretest
and betweenABT and FT in posttest (P
0.05) as well. However, there were significant differences between
ABT and FT with control group (P
0.05) in posttest. Considering the results, using both types of training are
recommended for increasing dynamic balance in inactive elder males. That is because these types of training
are inexpensive, yet innovative and its training intensity corresponds to the physical fitness of inactive elder
males.
Key words: Dynamic Balance
Aquatic Balance Training Functional Training Elderly
INTRODUCTION within BOS and maintaining the stability of BOS while
Balance deficit is one of the main risk factors that perform dynamically; thus, dynamic balance is of utmost
affect falling among adults 1-3. Balance is one of the importance in performing physical activities and sports
main elements of most physical activities and it is an skills.
important factor in the performance of sports skills 4. Considering the increasing population of senior
Balance is a complex motor skill that describes the citizens around the world and the increased life
dynamics of body posture in preventing falling 5. expectancy in this group, diagnosis and prevention of
Punakallio6 defines balance as static, the ability to injuries and ailments are of particular importance in
maintain center of pressure (COP) within base of support improving their quality of life and independence 10.
(BOS) and dynamic, active movement of COP while The scientific community, especially scientists in sports
standing, walking, or performing any other skill 6. and rehabilitation, are more sensitive to and careful of
Olmsted 7 and Guskiewicz 8 categorize balance from preventing and treating these ailments. Basically, falling
the functional aspect into static (maintaining a position due to lack of balance is a threat to the elderly which
with minimum movement), semi-dynamic (maintaining a changes their quality of life and leads to increased costs
position while BOS moves) and dynamic (maintaining of sustaining them 11. Moreover, it might lead to
balance while a prescribed movement is performed) 7, 8. physical, social and economic complications or even
From biomechanical and functional perspectives, dynamic death 11. Disturbance in balance is one of the
balance can be defined as the active movement of COP driving factors in increasing the risk of falling whose performing a prescribed task 5, 9. Most daily activities

Middle-East J. Sci. Res., 11 (3): 296-303, 2012
297
improvement can prevent the incidence of falling and the joint dislocation and possible falling in a specific form.
complications associated with it 12. There are various Subjects who had experienced falling over the past 12
common methods for training balance and preventing months or had any joint dislocation, chronic arthritis, or
falls. The effect of different training types has been the dizziness were excluded from further study. Y-Balance
subject of many studies that have reported contradictory Test was used to assess the dynamic balance of the
results 10, 13-17. Regarding the effect of functional subjects before and after training 24. After performing
training on the balance of the elderly, Rosendahl18 the pre-test, the training procedures were elaborated for
states that high-intensity functional training improves the subjects and were performed under the trainers
balance and gait ability in elderly people 18. However, supervision for ten weeks, 3 sessions per week and one
Manini17 found strength and functional training hour per session. At the end of the training period, post-
ineffective for the balance of the elderly 17.
test was performed. Descriptive statistics was used to
The water environment, due to its unique nature, describe the personal characteristics of the subjects, One-
such as buoyancy, viscosity and hydrostatic way ANOVA was applied to determine the differences
pressure, also makes it unique to develop confidence between three groups at the
0.05. All the statistical
and reduces the effect of weight bearing from the operations were done using SPSS 16 software.
Earth's gravity and allows adults to be interested in
doing exercise and physical activity without Pain 19, 20. Aquatic Balance Training: The ABT group performed
Recent studies have reported multiple gains from exercise exercises in water with the aim of increasing the
in water for the adults, which they include postural neuromuscular performance, balance and walking ability
oscillations reduction 21, blood lipids diminish, for ten weeks, 3 sessions per week and one hour per
increased maximal oxygen uptake, strength, muscular session in accordance with previous studies done in this
endurance and flexibility enhancement, increase in the regard 10, 20, 22, 25, 26. All exercises were conducted in
reaching distance 22, as well as greater independence in water with subjects chest high depth. Each exercise
daily tasks 23. session in water was divided into three stages: adaptation
Despite the application of various training programs with water environment, stretching exercises and static
for improving balance and decreasing falling in the elderly and dynamic ones for balance. ABT was designed to
(e.g. strength, balance, sprint training, rehabilitation improve the control of center of gravity and ability to
training, core stability training and recently whole body combine sensory information, compensatory postural
vibration training, functional training and aquatic balance control and walking. All ten-week activities were
training) the question remains which of these methods is progressively consolidated due to manipulated and
more effective and more important. Considering the switching hands position (i.e. cross arms to be placed
general view that physical activities and training has a on the breasts) or an increase in the difficulty of
positive effect on dynamic balance, the purpose of the performed activities (i.e. to move with closed eyes,
present research was to study the effect of ten weeks walking in different directions or use the insoles).
aquatic balance training and functional training on Duration of each exercise session was approximately 60
dynamic balance in inactive elder males. minutes, each session were started with a 10-minute warm-
MATERIALS AND METHODS resistance training and flexibility activities; the exercise
Current study was a Quasi-experimental one with static flexibility. The remaining time of each session
pretest - posttest design on two experimental groups and (about 40 minutes) was allocated to balance and walking
one control group. Forty inactive elder males voluntarily exercises in water.
participated in this research and randomly divided into The procedures for performing select aquatic balance
three groups of aquatic balance training (ABT) (N=13), training are presented in table 1 10, 11.
functional training (FT) (N=14) and control (N=13). The
university institutional review board approved this Functional Training: The procedures for performing
study. All participants signed an informed consent select functional exercises included health-related
document approved by the Institution human subjects physical fitness training such as endurance, strength,
review board. The subjects fully reported any record of flexibility and balance which are presented in Table 2 27. up including walking in water, aerobic activity in water,
were ended with 10-minute cool-down one, including

Middle-East J. Sci. Res., 11 (3): 296-303, 2012
298
Table 1: The procedures for performing select ABT
PhaseTrainingPositioning Activity Time
1- Adaptation Respiratory control Semi Seated, without posterior Slow and prolonged expiration through the mouth over 2 min
with water support, with immersion to the water, then with the mouth immersed and subsequently
environment the shoulder level, shoulder at with both mouth and nose immersed
90
flexion and with extended elbow
2- Stretching Hamstring Orthostatic position with back Elevation of one of the lower limbs, maintaining 30 sec
(each hold for 30 sec) supported against the wallknee extension and ankle dorsal flexion
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
The triceps surae Orthostatic position with hands Taking a large step forward, while maintaining the anterior 30 sec
and iliopsoas on the edge of the pool knee in flexion, the posterior knee in extension and feet in
contact with the bottom of the pool
3- Static and dynamic Walking in circles Hand-in-hand with sporadic Walking sideways, facing forwards, alternating the direction 3 min
exercises for balance change of directionfrom clockwise to anticlockwise, 3 times in each kind of walk
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Walking in line Hands supported on the waist of Moving in the pool making circles and changes in direction 3 min the individual in front
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Walking forward Walking forward pushing lower Walking with higher speed and 4 min
members vigorously propulsion (45 m, speed: 0.5 ms)
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Walking backward Standing Walking backward (45 m, speed: 0.2 ms) 4 min
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Side walking Standing Lateral walk with large steps (45 m, speed: 0.55 ms) 4 min
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Tandem walking Standing Walking supporting one foot immediately in front of the other 4 min
(45 m, speed: 0.20 ms)
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
walking Walking with trunk rotation Walking forwards hand to opposite knee in flexion, alternately 4 min
(45 m, speed: 0.30 ms)
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Walking Walking with one-leg support pause Walking and, at the physical therapists command, 4 min
maintaining one-leg support with the opposite knee n flexion
for 10 sec (12 pause in 45 meters, speed: 0.50 ms)
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bilateral shoulder Semi-seated position Performing shoulder flexion and extension while keeping 4 min
flexion-extension the elbows in extension. Starting with maximum shoulder
hyperextension and going until 90
flexion
(10 rep, f: 12 rep per min)
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bilateral horizontal Semi-seated position Starting in adduction and going until 90
of horizontal 4 min
shoulder abduction abduction (10 rep, F: 12 rep per min)
-adduction
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Ankle pumping Orthostatic position, Extension of the knees associated with plantar flexion, 4 min
with immersion up to maintaining this position for 5 s and then knee flexion
the xiphoid process level associated with dorsiflexion, also maintaining this for 5 s
(10 rep, F: 3 rep per min)

100
3
Anterior Posteromedial Postrolateral
Y ++
=
Middle-East J. Sci. Res., 11 (3): 296-303, 2012
299
Table 2: The procedures for performing select FT
Movement GoalProcedures
Jogging Endurance 152.4 m
Lifting Heavy Objects StrengthLifting sandbags (1.1-3.33 kg) up to the waist, shoulder and above the head
Push-Ups Strength-Endurance Body against the wall with 45-60
angle, 15 repetitions per set with both
open and closed arms
Sitting and Rising from a Chair Strength- Endurance 15 repetitions, fast performance
Reaching for the Ground in the Standing Position Flexibility Performed on both legs for 1 minute
Unilateral Dorsiflexion in the Standing Position Strength 15 repetitions
Swaying the Body Backwards and BalanceTwo minutes, 10-second pause between the forward and backward movements
Forwards in Standing Position
Single-Leg Standing BalanceStanding on each leg two times for one minute
Kneeling from the Standing Position and Rising Balance, Strength Two rounds with 15 repetitions and Flexibility
Static Extension of Hamstring Muscles FlexibilitySitting with open legs, trunk leaning forward, isometric knee extension and
ankle dorsiflexion
Raising the Arm and Leg while crouching on all fours Balance-Strength Two rounds with 15 repetitions
Parallel StrengthTwo rounds with 15 repetitions, in the seated position on an armchair
360
Rotation in the Standing Position Balance10 repetitions for each direction
Fig. 1: Y-Balance Test procedures RESULTS
Y-Balance Test Procedures: In this test, three Table 3 presents the descriptive characteristics of the
directions (anterior, posteromedial and posterolateral) subjects and table 4 presents the data related to reaching
are set in a central plateau. The angles between these distance of the subjects in the balance test (both pretest
three directions are specified with graded bars and posttest).
which are fixed on the sides of the plateau in three Results of one-way ANOVA revealed that there are
directions and an indicator is installed on each of not any significant differences in reaching distance
the bars 27. Before starting the test, the preferred between three groups in pretest (P
0.05). However, there
leg of the subjects is determined. If the right leg is the are significant differences in reaching distance between
preferred limb, the test is performed counterclockwise three groups in posttest. The results of Tukey post-hoc
and it will be performed clockwise if otherwise 27. test revealed that there are significant differences in
The subject stands with their preferred leg (single-leg) reaching distance between FT (P
0.003) and ABT
on the plateau where the three directions meet and (P
0.004) with control group in posttest, while there was
performs reaching by moving the indicators with the not any significant differences between FT and ABT in
other leg in a direction that the examiner randomly posttest (P
0.05).
chooses, as long as there is no error (without
moving the stance leg from the plateau, or using the
reach foot as support, or falling down). Then, the
subject returns to the beginning position on both legs
and the extent to which they have moved the indicator is
recorded as their reaching distance. Each subject performs
three trials for each of the directions and finally their
average was calculated, divided by leg length (in
centimeters). The dynamic balance calculated as follow
27 (Figure 1):

Middle-East J. Sci. Res., 11 (3): 296-303, 2012
300
Table 3: Descriptive characteristic of the subjects
Group Height (Cm) Mass (Kg) Age (Years)
FT167.447.55 71.647.23 56.344.35
ABT 170.645.33 73.659.74 59.442.21
Control 171.967.25 75.128.28 58.293.19
Table 4: Data related to the reaching distance of the subjects in Y-Balance Test
Time Group Y-Balance F P-value
Pretest FT 71.855.82 9.88 0.551
ABT 72.836.44
Control 72.247.57
Posttest FT 82.744.78 279.49 0.007
ABT 81.276.34
Control 73.876.64
DISCUSSION AND CONCLUSION
The purpose was to study the effect of ten weeks
aquatic balance training and functional training on
dynamic balance in inactive elder males. The results, in
accord with the findings of previous research such as
Rosendahl 28, Resndende 11 and De Bruin 16,
suggested the increased balance control after performing
FT and ABT in inactive elder subjects 11, 16, 28. In
addition, the effect of both training types on balance
control was equal and no significant difference was
observed between them. In order to identifying the causes
and mechanisms underlying the improvement in balance
after performing exercises, one needs to point to different
elements of the sensorimotor system which are
responsible for maintaining balance. This system includes
sensory, motor and the central processing components.
The function of this system relies on the feedbacks
obtained from different senses that are related to various
motor behaviors, flexibility and adaptability. Thus,
balance occurs based on functional motor skills that are
flexible and these skills can improve through training and
experience 10, 13, 14, 29, 30. Central nervous system evaluates the feedbacks from
sensory receptors around the body in order to be
informed of the position and movement of the body in
space. Normally, this information is transferred to the
central nervous system via visual, vestibular and
somatosensory senses so that CNS evaluates the position
and movement of body in space with respect to gravity
and the surrounding environment. In central processing
regions, these feedbacks are combined and evaluated so
that the importance and relationship between them is determined and proper motor responses including
equilibrium responses are selected and performed with
proper speed and intensity 31. The information collected
by visual, vestibular and somatosensory systems are
processed in three separate levels of motor control which
are the spinal cord, brain stem and higher regions such
as cerebellum, basal ganglia and cortex 31. The
effectiveness of training for balance requires a response
in three motor levels. At the spinal cord level, its main role
is to adjust muscle reflex. The sensory data from
mechanoreceptors of the joint following balance reflexes
lead to a compensatory contraction around the joint and
prevent extra pressure to the passive factors that inhibit
the movement of the joint 32. At the brain stem level,
balance reflexes helps balance control and at higher
nervous centers (cortex and cerebellum), with conscious
focus and attention, the individual tries to consciously
control the joint positions and body balance 32. Control
at each of these levels requires the sensory data collected
from visual, vestibular and somatosensory systems. As a
result, with additional training, the proper load will be
applied on these senses and proprioceptors 33.
Due to physiological and sensorimotor adjustments
in skill learning, functional exercises can decrease the
variability in recruitment of motor units, increase the
plasticity of the motor cortex, or help the elderly learn (or
relearn) how to employ their muscles for optimal
performance of the motor task 34. It seems that neural adaptations achieved through
these types of training remain for a long period signifying
the importance of training-specificity. An important issue
in designing functional training programs is to pay
specific attention to the principle of training-specificity
16 that can be one of the reasons for the effectiveness of
these types of training in improving the balance of the
elderly. The training program used in the present research
highly emphasized balance training which included
functional activities of everyday life like walking, moving
up and down the stairs and siting and rising from a chair
that basically require maintaining balance. Generally, due
to the connection between the bones and limbs and the
fact that the body structure is not a hard material,
performing each voluntary movement will disturb balance
35. To compensate for this internal weakness, voluntary
movements perform along with feedforward postural
adjustment. These automatic, involuntary movements are
a source for ensuring precise, coordinated movements
35. In fact, activation of the muscles that control this
postural adjustment takes place before the activation of
the voluntary muscle activity. Considering the manifest

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301
principle of specificity in functional exercises, this type of greater safety associated with ABT and the satisfaction of
training may have had an effect on the activation of the the subjects performing this training method, it is more
muscles responsible for feedforward postural adjustment appropriate and this type of training can be recommended
and voluntary movements for controlling balance. On the to the geriatric society.
other hand, improvement in balance can be due to better
distribution of attention between the motor tasks of
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