Mean |
Mean Difference |
||
Land Therapy |
Pre-Test TUG |
12.28 |
0.63 |
Post-Test TUG |
11.65 |
||
Land Therapy |
Pre-Test FES |
69.4 |
5.67 |
Post-Test FES |
63.73 |
Table I shows the comparison of pre-test and post-test values of Group B. The mean value of 12.28 in pre-test and 11.65 in post-test of TUG in Group B
Table II shows the comparison between pre-test and post-test results of pool therapy in TUG test and Tinetti FES. A p-value of 0.002 in Tinetti FES and 0.00 in Timed up and go test was found which are significant. The mean difference of 0.63 is seen in TUG test and 6.07 is seen in Tinetti FES in pool therapy.
Table II: Comparison between pre-test and post-test of group A (pool therapy)
Mean |
Mean Difference |
||
Pool Therapy |
Pre-Test TUG |
11.51 |
0.63 |
Post-Test TUG |
10.88 |
||
Pool Therapy |
Pre-Test FES |
79.07 |
6.07 |
Post-Test FES |
73.00 |
The mean value of post-test of FES in group A is 73 while it is 63.73 in group B. The mean value of TUG test in group A is 10.88 and group B is 11.65
Table III shows the comparison between post-test results of pool therapy and land therapy in TUG test and Tinetti FES. The p-value of the post-test results of land therapy and pool therapy in TUG test and Tinetti FES is 0.00 which is significant. The mean value of post-test of TUG test in pool therapy is 10.88 and in land therapy is 11.65. The mean value of 63.73 and 73 was found in the post-test results of Tinetti FES of land therapy and pool therapy respectively.
Table III: Comparison between post- tests of group A and group B
Mean |
Std. Deviation |
||
Post-test of FES |
Land therapy |
63.73 |
12.37 |
Pool therapy |
73 |
8.65 |
|
Post-test of TUG |
Land therapy |
11.65 |
1.28 |
Pool therapy |
10.88 |
1.05 |
The mean value of 69.4 in pre-test and 63.73 in post-test of FES in group A was found.
The bar graph I depict the comparison of pre-tests and post-tests of TUG test and Tinetti FES land therapy. The mean value of pre-test of TUG test for land therapy is 12.28 and post-test is 11.65 with a mean difference of 0.633. The mean value of pre-test and post- test of Tinetti FES for land therapy is 69.4 and 63.73 respectively with a mean difference of 5.67.
Graph I: Comparison of pre-test and post-test of land therapy.
The bar graph II shows the comparison of pre-test and post-test of TUG test and Tinetti FES of pool therapy. The mean value of pre-test and post-test of TUG test for pool therapy is 11.51 and 10.88 respectively with a difference of 0.63. The mean value of pre-test and post-test of Tinetti FES for pool therapy is 79.07 and 73 respectively and the mean difference is 6.07. The bar graph III shows the comparison between post-test results of TUG test and Tinetti FES of both pool therapy and land therapy.
Graph II: Comparison of pre-test and post-test of land therapy.
Discussion
The objective of this study was to explore whether the balance exercises, conducted either in the pool or on the land environment, would be capable of improving the balance in the elderly population. In order to test the hypothesis, exercises were used that are capable of being reproduced and applied easily. This study is mainly concerned with balance exercises for the elderly population as they are the high-risk group for falls. Studies reveal that there is an increasing rate of falls in the elderly population recently. They fall frequently due to changes related to aging. Aging comprises the capability of the central nervous system to process the vestibular, visual, and proprioceptive signals that are accountable to retain body balance as well as reducing the individual’s capability to cope up with adaptive reactions limiting functional mobility which is responsible for making the older adults more dependent [29]. Fall has many etiology like muscle weakness, arthritis, a history of falls, use of four or more prescription medications, depression, and use of an assistive device, impairments in gait, balance, vision, cognition, and activities of daily living [28].
There are studies that have used land-based exercises to improve balance and there are studies that use water to increase balance in the elderly population separately. But there are only a few studies that compare both the therapies to investigate which has better results. Land-based exercises can be done at home with minimum support at any time. Pool therapy demands less from the body and it also reduces the joint load [5]. Buoyancy and water pressure can be utilized as resistance for strengthening exercises [6]
This study includes balance exercises for elders that were given for six weeks. These exercises were done twice a week which has one set of exercises that were repeated two times. There is an increase in balance in pool therapy as it is a proprioceptive training that increases the stability by providing time to stimulate the postural reaction to perturbations in the environment [27] and also due to the properties of water such as density, hydrostatic pressure, viscosity, buoyancy, specific gravity, and thermodynamics. Immersion of the body improves balance abilities by increasing proprioception, body alignment, stability, and sensory feedback. As resistance to movement in water is greater than air the sensory output to the muscles increases and the muscles contract to stabilize the postural alignment [16, 26]. The improvement in land therapy is produced by the change in the anticipatory center of pressure and the feedback to maintain balance and also by the development in the somatosensory system which includes proprioceptive and tactile sensors [20, 30]. The exercises helped in improving the body righting and equilibrium through higher cortical reactions facilitation (protective, equilibrium, and righting reactions) [7, 8].
According to the statistics group B have a significant value in TUG test but it doesn’t have a significant value in FES whereas both TUG and FES have a significant value in group A. Hence pool therapy is effective in improving balance among the elderly population. This result is contradicted by Nubia C.P. Avelar et.al., Robyn Lin Anderson who found that there is no significant difference between the land and aquatic group [17, 29].
Lund. H et.al., (2010) and Marco Bergamin (2013) compared the aquatic and land-based exercises and found that aquatic exercise has a better result and these studies support this study [4, 23]. Hence a conclusion can be drawn that pool therapy can be used to improve balance effectively in the elderly population.
Limitations and Recommendations
Limitations
This study was carried out for a short duration of 6 weeks with only 2 outcome measures. As convenient sampling was done samples were not segregated into land therapy and pool therapy through the proper method. The quality of life was not analyzed.
Recommendations
Duration of study can be elongated with more outcome measures and proper sampling methods along with the long-term benefits of the rehabilitation protocol.
Conclusion:
Both land therapy and pool therapy have a significant value in the TUG test wherein FES pool therapy alone has a significant value. Hence a conclusion can be drawn that when comparing the effects of pool therapy and land therapy on balance in elderly population, pool therapy is effective in improving balance among the elderly population.
DECLARATIONS
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of Interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Acknowledgment
First and foremost, I would like to thank my parents and my guide Mr. K.Vadivelan, M.P.T., Associate Professor for their encouragement and support at all levels. Last but not least, I would like to thank my sister and my close ones for their valuable suggestions and support in the completion of my project.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Please write to vadivelk@srmist.edu.in , karulvela@gmail.com
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