Aerobic Excercise Complete

8/7/2019 Aerobic Excercise Complete

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Endurance Exercise Based Test 1

Running head: ENDURANCE EXERCISE BASED TEST

Effect of standard land based endurance exercise versus pool based exercise

on pain and fitness in patients with cardiac disease and osteoarthritis

Name

Institution:

Date:


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Abstract

The study used a sample population N = 18 whereby 9 represented the land based therapy

groups and the other 9 represented the poll base therapy grouped. Poll based therapy registered

higher mean results changes as compared to land based and hence was found to be more

effective than land based therapies. Additionally, it was established that both positively impact

on management of pain and fitness for patients suffering fro osteoarthritis and cardiac disease.

Further the study also established that no tangible evidence exist which could link the exercise

successes to either gender. Rather, there is a uniform effect across all the gender.


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Table of Contents

Abstract ...................................................................................................................................... 2Introduction ................................................................................................................................ 4Statement of the problem ............................................................................................................ 6Research questions ...................................................................................................................... 6Objective and hypothesis of study ............................................................................................... 7Literature review ......................................................................................................................... 8

Background information ......................................................................................................... 8Clinically most important effects of exercise therapy and the size of effects ............................ 9Cardiovascular diseases......................................................................................................... 10Postoperative Outcomes ........................................................................................................ 12Literature gaps ...................................................................................................................... 12

Research methodology .............................................................................................................. 13Methods ................................................................................................................................ 13

Subjects............................................................................................................................. 13Design ............................................................................................................................... 13Timeline ............................................................................................................................ 14Specific Procedures ........................................................................................................... 14

Data Analysis............................................................................................................................ 16Discussion and conclusion ........................................................................................................ 19

Discussion............................................................................................................................. 19Conclusion ............................................................................................................................ 19

References ................................................................................................................................ 21

Appendix 1: Tabulated data ...................................................................................................... 23Appendix 2: Independent sample test results ............................................................................. 24


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Introduction

Cardiac disease and osteoarthritis are considered chronic diseases. Such diseases have

limited treatment resources within the healthcare system. Benefits arising from exercise therapy

in management of the diseases ranks among the widely researched areas within the field in the

recent past. Most researchers have emphasized on the importance of conducting randomized

controlled clinical trials in order to draw conclusive evidence on the success of these treatments.

Plausible recognition of such benefits can only be ascertained through identification of the

benefits associated with the same. The importance of exercise to such patients cannot be

underestimated more so considering that exercise related complications often plague the patients.

Guidelines for safe training programs is therefore of necessity (MacWilliam, 1996). However,

little research has been conducted as to the forms of exercise therapy which yield best results. A

case of interest is the effect of standard land based endurance exercise versus pool based

exercise) on pain and fitness in patients with cardiac disease and osteoarthritis.

Exercise therapy for chronic illness like cardiac disease and osteoarthritis are most

condition specific or aerobic. An example of such a test is the generalized aerobic training which

causes systematic effects e.g. insulin sensitivity enhancement in management of diabetes

mellitus. Condition specific training on the other hand includes specific designed movements

aimed at enhancing physical health of patients. These include low back strengthening exercises

for patients with low back pain. Generally, the recent past has seen a sharp increase in

randomized clinical trials aimed at widening the understanding of physical exercise therapies in


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a number of subjective symptoms ranging from sleep problems, general fatigue, joints stiffness,

gastrointestinal problems as well as depression and anxiety. In the recent past, these conditions

have been more common and of concern to clinical practitioners. In Norway for instance, a large

female population aged between 20 and 49 (13%) were found to suffer conditions characteristic

of broad pain and general fatigue resulting from either osteoarthritis or cardiac disease (Kettunen

& Kujala, 2004). The etiology and pathogenesis of these ailments remain rather vague hence

making it almost impossible to effect causal treatments. Symptomatic treatments employed

including sedatives and anti-depressants are often associated with pain modulation impacts.

Various pharmacological and non-medical management options have been attempted and various

studies indicate that aerobic exercise programs successfully enhance patients physical capacity.

Such exercises were also found to modulate pain and fatigue suffered by the aforementioned

group of patients.

It is on the above mentioned basis that patient rehabilitation programs in management of

osteoarthritis and cardiac disease have incorporated exercise based approaches. Clinical

experiences indicate that patients suffering the aforementioned conditions often prefer exercising

in warm water pools. Various researchers have likewise suggested a number of benefits

associated with pool-based aerobic exercise. However, aerobic exercise impacts have mostly

been reported in reference to land based exercise. Whether or not better effects are achieved

through poll based training remains rather vague and not widely researched on. This study aims

to assess the differences in efficacy of subjecting patients to pool-based and land-based aerobic


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Statement of the problem

An increasing number of patients suffering from osteoarthritis and cardiac diseases are

recorded each year. Estimates indicate that the current numbers could double by 2016 (Jones,

2008). The increase is attributed to aging effects, prosthetic advancements and an enlarged

population of young persons undergoing operations. Long waits of person awaiting hip or knee

joint replacements have been recorded across various countries globally. These people

experience high pain levels as they await the procedure. The pain profoundly affects the quality

of life they live. In some instances, the pain is believed to increase disability of the affected

parties. The importance of engaging practices which could effectively lower such pains is of

profound importance. Few studies have successfully demonstrated the best approach with regard

to land based and poll based aerobic exercises. However various researchers and medical

scholars acknowledge that patients have demonstrated positive results after being placed on

exercise based interventions. The optimal content of these interventions however remain

uncertain and in dire need of research. Limited studies have compared land-based and pool-

based exercise, and hence little is known regarding the differences associated with the effects of

the two. Research in this area is therefore critical to improvement of preoperative and

management procedures of those suffering osteoarthritis and cardiac disease.

Research questionsTo effectively ascertain or reject the hypothesis, this study will seek to answer the


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2. Is land based therapy more effective than poll based therapy in treatment of patients

with osteoarthritis and coronary disease?

3. Does the effect of exercise treatment differ across gender?

Objective and hypothesis of study

With much elaborated in stating the problem to be addressed by this study, its aim will

simply be determination whether land based exercise is more effective than poll based exercise

in pain and fitness management in patients suffering from osteoarthritis and cardiac disease.

Study hypothesis will therefore be stated as follows:

Land-based exercise aerobic exercise yields better results than pool-based aerobic

exercise in pain and fitness management for patients suffering from osteoarthritis and cardiac

disease.

This will be the null hypothesis; the alternative hypothesis will state that:

Pool-based exercise aerobic exercise yields better results than land-based aerobic

exercise in pain and fitness management for patients suffering from osteoarthritis and cardiac

disease.


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Literature review

Background information

Various published and unpublished literature materials exist on exercise therapy in

management of osteoarthritis and cardiac disease (Metsios et al, 2008). Most such research is

based systematic evaluation of randomized clinical trials investigating the impact of exercise

therapy amongst patients suffering from chronic ailments (Takken, 2008; Bartels et al., 2007;

Kettunen & Kujala, 2004). Most findings as mentioned earlier, lack statistical power to support

their findings and have hence been deemed as weak in authority. Systematic reviews however

recognize and appreciate the use of both qualitative and quantitative techniques in drawing

conclusions with respect to area of study. The choice of technique to adopt is often dependent on

the data intended for study. What is however clear, is the fact that researchers in this field have

used cross-cutting analysis techniques in statistical polling of their findings. While in most

similar researches evidential systematic reporting lacks, exercise therapy effects have often been

reported using specific meta-analyses. Various scholars have emphasized the critical importance

attached to choice of summary meta-analyses statistics and hence methodological quality. It is

also important to mention that various researches have produced biased results as a result of

poorly designed and reported trials which have ultimately misled policy makers within the

medical field. This section takes the reader through a series of existing literature opinions and

findings with respect to the area of study. It is important to reiterate that final conclusions will


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Clinically most important effects of exercise therapy and the size of effects

Exercise therapy positively affects peoples physical health via specific disease treatment

approaches. A consistent approach shown by evaluation of various researches conducted to date

indicate that aerobic capacity and functionality as well as muscle strength capacity can be great

enhanced through incorporation of exercise training among patients suffering from chronic

ailments (MacWilliam, 1996); Metsios et al.: 2008; Takken, 2008; Lloyd-Williams, Mair &

Leitner, 2009). This is a finding critical to medical practitioners considering that the proportion of

aged person sis increasing and exercise therapy could play a fundamental role in reducing

disability and dependency with community. Discovery that aerobic training exercises

consistently enhances physical performance capability in addition to maximizing oxygen intake

capacity amongst chronically ill patients is important in re-designing of management initiatives

of various illnesses. It is important to mention that low aerobic fitness has often been mentioned

as a leading cause of mortality amongst chronically ill patients. The same is true amongst healthy

people. According to Jones (2008) Intensive training is effective in improving physical health

and fitness amongst patients suffering from osteoarthritis and cardiac ailment as well as healthy

persons. However, little research have yet specified the intensity of training that would be

appropriate for long term prognosis of the aforementioned ailments. Research has also

established that other cardio-metabolic risk factors are also beneficiaries of such trainings

(Roddy, Zhang, & Doherty, 2009; Lange, 2008; Bartels et al., 2007; Kettunen & Kujala, 2004).

Perhaps of interest is the discovery that visceral fat among adults and childrens body fat are


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Various literatures have however offered vital information regarding effects of the two

approaches in management/treatment of cardiac disease and osteoarthritis.

Cardiovascular diseases

Based on findings of Joliife et al, (2006), exercise therapy successfully reduces effect of

coronary heart disease and hence all cause mortality by up to 27% and up to 31% for total

cardiac mortality. However, he mentions that the same can not be said for non-fatal myocardial

infarction. In another research by Taylor et al (2004), it was established that the effect of

endurance trainings alongside psychological and educational dissemination confirmed the

findings by Joliife et al. this is in respect to exercise based rehabilitation and cardiac mortality

evaluations. Reviewing 16 other RCT based research resources indicated that exercise

training/therapy enhanced heart rate variability amongst patients diagnosed with heart failure

problems.

An evaluation of 14 clinical trial results showed positive effect of physical training

among cardiac disease and osteoarthritis patients. However, two of the trials returned

inconclusive results. Their interpretations were however biased towards positive effect based on

the findings of majority of the trials reviewed. It is important to mention that most researches are

based on findings from patients with no co-existing illnesses i.e. either predominantly suffering

from osteoarthritis only or cardiac disease alone. In a similar study by Rees et al. (2007) the

findings confirmed the earlier assumption that exercise training enhances uptake of oxygen

h i ll ill i I ddi i k h d l f d h bi


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Despite the inconsistent findings recorded in Smart and Marwicks research, most

research works on aerobic physical exercise on intermittent claudication have shown that training

exercises improves the overall physical conditions of patients suffering from cardiac disease.

The general resulting scenario is that aerobic exercise improves patients pain management and

overall fitness on patients suffering cardiac disease (Fransen, McConnell, & Bell, 2008).

Osteoarthritis

A review of 32 RCT statistics based research indicate that land based exercise improved

management to patient self-reported pain as well as physical fitness of patients suffering from

osteoarthritis. More positive effects are recorded in cases where aerobic exercise is used as an

intervention with increased number of supervision sessions compared to non-supervised sessions. On

most researches, aerobic walking and low limb strengthening, alleviated pain and positively impacted

on patients overall fitness. Additionally, the effect recorded in management of hip osteoarthritis

showed similar results to case of knee osteoarthritis. In a rather unique research by Roddy, Zhang &

Doherty (2009), where land based exercise was compared to aquatic exercise, the effects were rather

similar. However no research has been able to offer conclusive evidence as to the effect of exercise

on osteoarthritis progression.

Based on more than 10 RCTs, a conclusion is drawn that exercise therapy successfully

enhances aerobic capacity alongside muscle strength in patients diagnosed with rheumatoid arthritis.

However, appropriate meta-analyses on the same are lacking. In another study based on patients

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Whether or not this is true remains an issue that other researches will address in future. However, it is

important to mention a few perspectives held by previous researches touching on the issue.

Postoperative Outcomes

Various medical studies have established that post-operative procedures are influenced by

preoperative procedures. However, most studies have filed to provide adequate information to

support the assumption that preoperative procedures are influenced by aerobic exercises.

However, as logic would dictate, oxygen intake and general body fitness determine post-

operational outcomes and often medics would want someone to be in the best of their health

prior to operation.

Literature gaps

Critical review of literature on land based and aquatic based aerobic therapy reveal a gap

in distinguishing of the individual effects of the procedures. Most if not all the research identified

and evaluated treat the two approaches from a single perspective and hence policy decisions on

which should be given more priority is likely to suffer information inadequacy. The effect of

each approach need to be independently studied and conclusive evidence utilized to back up

conclusions drawn.


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Research methodology

Methods

As earlier mentioned, this research aims to come up with conclusive meta-analyses of the

impact of land-based aerobic exercise in comparison to pool-based aerobic exercise on patients

with cardiac disease and osteoarthritis. To achieve this, a study sample is selected and

appropriate method of conducting the research and analysis are chosen prior to the study as

discussed hereafter.

Subjects

The study involves a parallel group design. The groups are pool-based group of patients

and land-based group. The finings of each group are compared against each other and used to

draw conclusion as to whether the hypothesis stands or not.

Design

Noting that there existed a possibility of some variations, the mean of the two

assessments was considered a more valid approach as compared to a single assessment. Patients

suffering from the two conditions were identified and grouped according to their respective

conditions; the patients were then subjected to respective exercise trainings where one group

underwent poll-based aerobic therapy while the other group underwent land-based aerobic

therapy. The research variables used in the study were identified as shown below:

I d d t i bl


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Pool based endurance exercise

Dependent Variables:

The dependent variables were identified as pain which was measured by the 10cm visual

analog (VAS) and maximal oxygen consumption which was measured using the maximal;

treadmill stress test (MaxVO2).

Pain was measured prior to implementation of respective exercises (PrePain) and after

conclusion of the exercise period (Post pain). Likewise, maximal oxygen consumption was

measured prior to implementation of respective therapy (PreVO2) and after implementation

(PostVO2).

Timeline

The study was run for a period of 20 weeks. Patients were examined at commencement of

the study after which they were subjected to respective therapies. One group underwent pool-

based therapy while the other group underwent land-based therapy. Each group consisted of a set

of patients constituting of 0steathritis patients and cardiac disease patients. The patients were re-

examined at the end of the 20 weeks and the obtained results documented (see attached appendix

1). For consistency, all patients were examined and re-examine by the same physiotherapist.

Specific Procedures

A number of procedures were initiated in order to make data collection and eventually


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unique numbers rather than their individual names. The physiotherapist was then invited to

conduct a post-therapy analysis of the state of patients with respect to pain and maximal oxygen

consumption. 10cm Vas and maximal treadmill tests were applied in measurement of pain and

oxygen consumption respectively. Once the data has been obtained, descriptive statistics will be

used to present eth overall case scenario disregarding the effect the effect of land or pool therapy.

However, a further independent t-test analysis will be performed to determine the individual

effect record for each individual therapy.


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Data Analysis

SPSS 17 data analysis tool pack was used in evaluation of data with respect to the

aforementioned variables.

Table 1: Overall Descriptive results

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

PrePain 18 4 8 5.72 1.074

PostPain 18 1 5 2.94 1.056

PreVO2 18 11 17 13.64 1.413

PostVO2 18 13.100 18.800 15.95000 1.593830

Valid N (listwise) 18

The descriptive statistics provide the overall results of the research irrespective of the aerobic

exercise method adopted. It generally confirms the findings of previous research. The mean of

pain recorded prior to introduction of the exercises amongst the patients is 5.72. After

implementation of the exercise, the overall mean of pain recorded reduces to 2.94. This confirms

that exercise reduces pain in patients suffering from osteoarthritis and cardiac disease. In terms

of oxygen, the recorded value prior to implementation of the exercise is 13.64, a value that rise to

15.95 after implementation of the exercise. This one too confirms the findings of previous


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Table 2: Group Statistics Presentation

Group Statistics

Group N Mean Std. Deviation Std. Error Mean

PrePain Land based therapy 9 5.67 1.000 .333

Pool based therapy 9 5.78 1.202 .401

PostPain Land based therapy 9 3.78 .667 .222

Pool based therapy 9 2.11 .601 .200

PreVO2 Land based therapy 9 13.50 1.675 .558


PostVO2 Land based therapy 9 15.12222 1.556260 .518753


The table abode reflects the findings of t-test using SPSS data pack. Mena comparison of

the two therapies are provides. For land-based therapy, prior to implementation, the recorded

means are 5.67 and 13.50 for pre-pain and preVO2 respectively. After implementation, the

values change to 3.78 and 15.122 for pre-pain and preVO2 respectively. Both record positive

outcomes. The same case is witnessed for pool based therapy where prior to implementation

values of 5.78 and 13.50 are recorded for pre-pain and preVO2 respectively. After

implementation the values change to 2.11 and 16.778 pre-pain and preVO2 respectively.

Generally from this presentation, it is evident that pool-based therapy has been able to yield

better results as compared to land-based therapy despite both producing positive results.

Addi i ll h l i h h b i d l i ifi 955 fid


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Table 3: Gender Based Group Statistics

Group Statistics

Gender N Mean Std. Deviation Std. Error Mean

PrePain Male 9 5.33 .500 .167

Female 9 6.11 1.364 .455

PostPain Male 9 2.89 1.054 .351

Female 9 3.00 1.118 .373

PreVO2 Male 9 13.31 .865 .288

Female 9 13.97 1.804 .601

PostVO2 Male 9 15.77778 1.247776 .415925

Female 9 16.12222 1.942793 .647598

While females record higher levels of pain compared to men, they record relatively

higher maximal oxygen circulation. The impact of the exercise though, offers no clear

distinctions as to which groups gains more from exercise. However, one thing that is clear is the

fact that exercise based therapy is effective irrespective of gender affiliation.


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Discussion and conclusion

DiscussionThe findings of statistical analysis confirm earlier stated findings by other researchers

that exercise be it pool-based or land based yields positive results on both patients fitness and

patients. Exercise therapy positively impacts of patient pain management and general fitness

measured by oxygen uptake for purposes of this papers evaluation. The findings are consistent

with previous researches findings. However they bridge the gap that earlier researches have

failed to highlight by creating a distinction between the impacts of pool based therapy against

that of land based therapy. Pool based therapy yields better results. Something of which may be

attributed to patients attitude as earlier it had been mentioned that it was the patients preference.

The finding goes against earlier stated hypothesis that land based therapy yield better results than

pool based therapy. We therefore discard the null hypothesis and adopt the alternative hypothesis

which in this case will read as follows: Pool based therapy yields better results in management of

pain and general fitness of patients diagnosed with osteoarthritis and cardiac disease.

ConclusionIt is important to conclude by mentioning that the research other than expanding what

other researchers have provides a reference point for comparison of the dependent effect of

individual therapies. It recommends a common adoption of pool based therapy over land based

therapies perhaps based on the attitudes associated with the same. The reverence of pool based

therapy by most patients seems to play a fundamental role in realization of the goal of therapy.


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the alternative hypothesis. In general though, exercise in treatment and management of chronic

illnesses is an interesting area that would still require vast research.


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References

Altman, D. et al. (2004).The revised CONSORT statement for reporting randomized trials:

Explanation and elaboration.Ann Intern Med, 43(4), pp.134:663-94.

Bartels, E. et al. (2007). Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane

Database Syst Rev, (4).

Fransen, M., McConnell, S., & Bell M. (2008). Exercise for osteoarthritis of the hip or knee.

Cochrane Database Syst Rev, 4(5), pp 456-476.

Jolliffe, J. et al. (2006). Exercise-based rehabilitation for coronary heart disease. Cochrane Database

Syst Rev, 1.

Jones, C. A, et al. (2008). Health related quality of life outcomes after knee arthroplasties and

cardiac management in a community based population.Journal of Rheumatology, 27(3),

pp. 1745-52.

Kettunen J. & Kujala, U. M. (2004). Exercise therapy for people with rheumatoid arthritis and

osteoarthritis. Scand J Med Sci Sports, 14, pp. 138-42.

Kujala, U. (2004). Evidence for exercise therapy in the treatment of chronic disease based on at least

three randomized controlled trials summary of published systematic reviews. Scand J Med

Sci Sports, 14, pp. 339-45.

Lange, A. (2008). Strength training for treatment of osteoarthritis of the knee: A systematic review.

Arthritis Rheum.Arthritis Care & Research Journal, 59, pp. 1488-94.

Lloyd-Williams, F., Mair F. S., & Leitner, M. (2009). Exercise training and heart failure: a


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Appendix 1: Tabulated data

Group Age Height Weight Gender CardDx 2Dx PrePain PostPain PreVO2 PostVO2

1 66 69 188 1 1 4 5 3 12.2 13.91 78 63 150 2 1 4 6 4 11.4 13.1

1 65 62 122 2 2 4 4 3 14.5 16.6

1 69 64 154 2 3 4 7 4 12.2 13.51 71 68 188 1 1 4 6 5 13.1 14.9

1 73 70 207 1 2 4 5 4 15.1 17.1

1 65 60 111 2 2 4 7 4 16.5 17.31 79 63 136 2 3 4 6 4 14.2 15.1

1 81 71 191 1 2 4 5 3 12.3 14.62 65 68 190 1 1 4 6 2 13.5 15.9

2 77 64 149 2 1 4 7 3 16.5 18.8

2 68 62 120 2 1 4 6 2 14.1 17.5

2 65 66 155 2 2 4 8 1 12.2 15.6

2 73 70 185 1 2 4 6 3 13.5 16.62 72 71 201 1 3 4 5 2 13.4 17.7

2 80 62 110 2 3 4 4 2 14.1 17.6

2 80 69 134 1 2 4 5 2 12.9 16.2

2 66 70 195 1 1 4 5 2 13.8 15.1


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Appendix 2: Independent sample test results

Independent Samples Test

Levene's Test for

Equality of

Variances t-test for Equality of Means

95% Confidence Interval

of the Difference

F Sig. t df Sig. (2-tailed) Mean Diff.e Std. Error Diff. Lower Upper

PrePain Equal variances

assumed

.116 .738 -.213 16 .834 -.111 .521 -1.216 .994

Equal variances not

assumed

-.213 15.488 .834 -.111 .521 -1.219 .997

PostPain Equal variances

assumed

.419 .527 5.571 16 .000 1.667 .299 1.032 2.301

Equal variances not

assumed

5.571 15.831 .000 1.667 .299 1.032 2.301

PreVO2 Equal variances

assumed

2.772 .115 -.407 16 .690 -.278 .683 -1.726 1.171

Equal variances not

assumed

-.407 14.385 .690 -.278 .683 -1.740 1.184

PostVO2 Equal variances

assumed

.598 .451 -2.529 16 .022 -1.655556 .654590 -3.043224 -.267887

Equal variances not

assumed

-2.529 15.015 .023 -1.655556 .654590 -3.050656 -.260455

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