- Researchers report that Aquatic High Intensity Interval Training (AHIIT) improves exercise capacity in adults with chronic conditions.
- They noted that AHIIT has similar effects to land-based exercise (LBHIIT) and may be a safe and valuable alternative for people with chronic conditions who are unable to perform land-based exercise.
- Experts say exercising in water can help reduce stress on joints, allowing people to complete movements they can’t necessarily do on land, but there is conflicting evidence about its physiological benefits.
Researchers have a message for people with chronic conditions who find land training too difficult.
Come in. The waters are good.
Published today in the magazine BMJ Open Sport & Exercise Medicine. study reports that high-intensity interval training in water, often called aquatic HIIT (AHIIT), improves exercise capacity in adults with chronic conditions such as diabetes and arthritis.
The researchers also say that AHIIT has similar effects to land-based training (LBHIIT) and may be a safe and valuable alternative for people with chronic conditions who are unable to perform LBHIIT.
Dr. Mark Slabaugh, a sports medicine specialist at Mercy Medical Center in Baltimore, said Medical news today The benefits of water exercise are clear for people suffering from conditions such as tendinitis, arthritis and chronic pain.
“This study gives us as clinicians even more options for patients who are interested in cross-training and HIIT exercises but can’t because of joint pain,” said Slabaugh, who was not involved in the study. I advise my patients to start with these light AHIIT sessions and gradually work up to longer swimming, which has been shown to be a sport that can be applied well into later years.
HIIT is interval training that involves short bursts of high-intensity movement followed by short recovery periods with lower-intensity movement.
Moderate-intensity exercise is thought to have more health benefits for people with and without chronic conditions. It is an attractive exercise option because it increases aerobic capacity and endurance while being time efficient.
On the other hand, researchers say that exercising in water can help reduce stress on joints, allowing people to complete movements they can’t necessarily do on land.
However, there is conflicting evidence regarding the physiological benefits of AHIIT.
The research team analyzed 18 trials, comparing how AHIIT improved participants’ exercise capacity (as measured by oxygen consumption, walking tests and other tests of physical fitness) compared to LBHIIT.
They also compared AHIIT with moderate-intensity aquatic exercise (AMICT) and a non-exercise control group.
Researchers assessed the safety of the evidence using the recognized GRADE system.
They looked at 868 participants, 74% of whom were women who had a range of conditions including back pain, arthritis, chronic lung disease (COPD), type 2 diabetes and multiple sclerosis. Some participants had more than one chronic condition.
The study expressed differences between groups as standardized mean differences (SMD). An SMD of 0.2-0.49 indicates a small effect, 0.5-0.79 a moderate effect, and 0.8 or more a large effect.
The researchers reported that AHIIT moderately improved participants’ exercise capacity compared to no exercise (SMD 0.78) and had a small beneficial effect compared to AMICT (SMD 0.45). Additionally, no difference in exercise capacity was observed for AHIIT compared to LBHIIT.
There were fewer adverse events reported in AHIIT than in LBHIIT. Adherence rates for AHIIT ranged from 84% to 100%.
A key finding of this meta-analysis suggests that AHIIT may be as beneficial as LBHIIT, giving people with chronic conditions a second choice for effective HIIT or a potentially more successful setting to initiate and continue high-intensity training, the researchers said in a statement.
They added that the natural support and buoyancy of water can facilitate this efficiency.
They also emphasized that it was an observational study and acknowledged that some trials did not include a blinded assessor, which could have affected the results. No studies looked at long-term improvements in exercise capacity or quality of life.
They concluded that a detailed search strategy and the inclusion of several chronic conditions, adverse events, and adherence allowed for a greater depth of understanding of AHIIT in different populations.
The team said future research should examine the relationship between exercise capacity and key patient outcomes, barriers to HIIT, and ongoing independent commitment to exercise.
Sidney Corbin is a physical therapist and clinic director at SporTherapy in Texas, where they use the pool for therapy.
Corbin, who was not involved in the study, said Medical news today that water-based therapy relieves joint stress while giving people increased resilience to help with conditions such as osteoarthritis, balance deficits, sensory processing disorders and general weakness/deconditioning, as well as post-operative patients.
The pool is a great opportunity to provide sensory feedback while also providing resistance, a unique property that is difficult to replicate on land, Corbin said. An aquatic environment can be an excellent way to reach a patient population that is otherwise sedentary or inactive.
Corbin said people with osteoarthritis, chronic low back pain or other chronic conditions may be limited in their tolerance for LBHIIT and may not be able to fully participate in and enjoy the benefits that HIIT can offer.
We can be more inclusive of those populations and reduce further health risks for those populations by introducing AHIIT, she said. The water environment provides relief for the joints, but also sensory input to their system that can otherwise be sensitive to chronic pain, constant water resistance, and if performed in a heated pool can provide relaxation of otherwise painful muscles and joints.
Dr. William Ashford, an orthopedic surgeon at AICA Orthopedics in Atlanta, who was not involved in the study, said Medical news today that AHIIT is a very effective treatment modality, especially for people with musculoskeletal conditions such as arthritis and chronic back pain.
Ashford said the buoyancy of water provides natural resistance while minimizing stress on joints, allowing people to perform exercises that would be painful or impossible on land.
What’s more, the cardiovascular benefits of HIIT are well documented, and translating to an aquatic environment appears to amplify these benefits for certain populations, Ashford said.
Ashford said sticking to an exercise regimen is a critical factor in managing chronic disease.
There are also restrictions on water-based exercise.
While effective for many, it may not be right for all patients, especially those with certain types of chronic lung disease, where water pressure can present breathing challenges, Ashford said. Also, access to appropriate facilities can be an obstacle for some patients.
However, Ashford said more research should be done to identify ways to make water-based therapy more accessible to more people.
AHIIT stands out as a powerful, adaptive and patient-friendly approach to managing various chronic conditions, he said. It combines the benefits of HIIT with the unique properties of water, offering a synergistic effect that can be especially beneficial for patients who struggle with land-based exercise.
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