1. BELLARMINE UNIVERSITY, LOUISVILLE, KY The effects of aquatics versus land therapy on patients with COPD on quality of life and physical function Suzette Austin Kori Ivanchak Erica Jeszke Nancy Marshall

2. BELLARMINE UNIVERSITY, LOUISVILLE, KY Background By 2020, Chronic Obstructive Pulmonary Disease (COPD) will be the 3 rd most common cause of death globally. (Shead, 2012) COPD limits ability to do activities of daily living which results in a deterioration in health. (Wadell, 2004) People with COPD are often elderly and living with co-morbidities. (Shead, 2012)

3. BELLARMINE UNIVERSITY, LOUISVILLE, KY Background cont. Hydrotherapy is considered beneficial therapy for osteoarthritis, rheumatoid arthritis, and stroke. (McNamara, 2011) Only been considered as a treatment option for COPD in the last decade. (McNamara, 2011) Training in water was safe and applicable in patients with COPD. (Perk, 1996)

4. BELLARMINE UNIVERSITY, LOUISVILLE, KY P: Persons with COPD I: Aquatic therapy C: Dry land therapy O: Quality of life Physical Function http://goo.gl/0Yo0eL

5. BELLARMINE UNIVERSITY, LOUISVILLE, KY ArticlesTypeAgeWater TempFrequency Shead, 2012Systematic Review 60-80 Thermoneutral (5) 38 C (4) Variety Wadell, 2004 Controlled, semi- randomized study 56-7233-34 C3x/wk for 12 weeks Wadell, 2005Controlled, clinical trial 56-7233-34 C1x/wk for 6 months De Souto Araujo, 2012 RCT45-8032 + 2 C3x/wk for 8 weeks McNamara, 2011 Systematic Review N/A29-34 CVariety

6. BELLARMINE UNIVERSITY, LOUISVILLE, KY Articles Interventions Exercise in Water/Land Intensity Level Outcome Measures Shead, 2012Variety ISWT SaO 2 FEV 1 Dyspnea Wadell, 2004 Whole body strength and endurance Group 1- Land Group 2- Water High ISWT ESWT SF-36 SGRQ Wadell, 2005 Whole body strength and endurance Group 1- Land Group 2- Water High ISWT SF-36 SGRQ De Souto Araujo, 2012 Upper and Lower Aerobic and resistance Group 1- Land Group 2- Water Low FEV 1 6MWT SGRQ Dyspnea McNamara, 2011 VarietyVarieyVariety ISWT Chronic Respiratory Questionnaire Dyspnea

7. BELLARMINE UNIVERSITY, LOUISVILLE, KY Articles Pulmonary Function ISWT/ ESWT 6MWT Quality of Life Shead, 2012  SaO 2 (?) FEV 1  Dyspnea  ISWT See Wadell (2004) Wadell, 2004  VO 2peak (water and control) ISWT  land ESWT  water  Physical Health Score of SF-36  Activity score in SGRQ Wadell, 2005  VO 2 peak  ISWT  /No change in SF-36  /No change in SGRQ De Souto Araujo, 2012  FEV 1 (both)  FEV 1 /FVC (control) No change 6MWT (land v water)  6MWT (water v control)  SGRQ (land) No change SGRQ (water)  SGRQ (control) McNamara, 2011 Improvement in dyspnea (CRDQ)  ISWTSee Wadell (2004)

8. BELLARMINE UNIVERSITY, LOUISVILLE, KY Results: Wadell, 2004 Land Distance walked in Incremental Shuttle Walking Test Water Distance walked in Endurance Shuttle Walking Test Physical health score in SF- 36 Activity score in SGRQ

9. BELLARMINE UNIVERSITY, LOUISVILLE, KY Articles Pulmonary Function ISWT/ ESWT 6MWT Quality of Life Shead, 2012  SaO 2 (?) FVC 1  Dyspnea  ISWTSee Wadell (2004) Wadell, 2004  VO 2peak (water and control) ISWT  land ESWT  water  Physical Health Score of SF-36  Activity score in SGRQ Wadell, 2005  VO 2 peak  ISWT  /No change in SF-36  /No change in SGRQ De Souto Araujo, 2012  FEV 1 (both)  FEV 1 /FVC (control) No change 6MWT (land v water)  6MWT (water v control)  SGRQ (land) No change SGRQ (water)  SGRQ (control) McNamara, 2011 Improvement in dyspnea (CRDQ)  ISWTSee Wadell (2004)

10. BELLARMINE UNIVERSITY, LOUISVILLE, KY Results: Wadell, 2005 9 months vs. Baseline:9 months vs. 3 months: Increased walk distance– ISWT Decrease in VO 2 peak No significant changes in SGRQ or SF-36 –Control decreased in PCS Decreased VO 2 peak, time cycled, work rate Decreased HRQoL, SF-36

11. BELLARMINE UNIVERSITY, LOUISVILLE, KY Articles Pulmonary Function ISWT/ ESWT 6MWT Quality of Life Shead, 2012  SaO 2 (?) FVC 1  Dyspnea  ISWTSee Wadell (2004) Wadell, 2004  VO 2peak (water and control) ISWT  land ESWT  water  Physical Health Score of SF-36  Activity score in SGRQ Wadell, 2005  VO 2 peak  ISWT  /No change in SF-36  /No change in SGRQ De Souto Araujo, 2012  FEV 1 (both)  FEV 1 /FVC (control) No change 6MWT (land v water)  6MWT (water v control)  SGRQ (land) No change SGRQ (water)  SGRQ (control) McNamara, 2011 Improvement in dyspnea (CRDQ)  ISWT See Wadell (2004)

12. BELLARMINE UNIVERSITY, LOUISVILLE, KY Results: de Souto Araujo, 2012 SQRQ: Improvement in floor group No change in aquatics group Decline in control group

13. BELLARMINE UNIVERSITY, LOUISVILLE, KY Articles Pulmonary Function ISWT/ ESWT 6MWT Quality of Life Shead, 2012  SaO 2  FVC 1  Dyspnea  ISWTSee Wadell (2004) Wadell, 2004  VO 2peak (water and control) ISWT  land ESWT  water  Physical Health Score of SF-36  Activity score in SGRQ Wadell, 2005  VO 2 peak  ISWT  /No change in SF-36  /No change in SGRQ De Souto Araujo, 2012  FEV 1 (both)  FEV 1 /FVC (control) No change 6MWT (land v water)  6MWT (water v control)  SGRQ (land) No change SGRQ (water)  SGRQ (control) McNamara, 2011 Improvement in dyspnea (CRDQ)  ISWT See Wadell (2004)

14. BELLARMINE UNIVERSITY, LOUISVILLE, KY Discussion Overall, increase in pulmonary function Both groups showed improvements in endurance Conflicting evidence in SGRQ

15. BELLARMINE UNIVERSITY, LOUISVILLE, KY Discussion Patients with secondary health conditions Reducing the frequency of training was not effective for maintaining fitness level

16. BELLARMINE UNIVERSITY, LOUISVILLE, KY Limitations Limited number of studies on topic Small sample sizes Low to moderate quality Motivational factor/patient preference Exclusion of people with certain comorbidities

17. BELLARMINE UNIVERSITY, LOUISVILLE, KY Conclusion Based on available studies, there is not enough quality evidence to support if hydrotherapy increases quality of life and physical function in comparison to land therapy.

18. BELLARMINE UNIVERSITY, LOUISVILLE, KY Additional Resources APTA Aquatics Section –http://www.aquaticpt.org/about.cfmhttp://www.aquaticpt.org/about.cfm American Lung Association –http://www.lung.org/lung-disease/copd/http://www.lung.org/lung-disease/copd/ PT Opinion Article –http://physical- therapy.advanceweb.com/Columns/Water- Wisdom/Aquatic-Therapy-for-COPD-Patients.aspxhttp://physical- therapy.advanceweb.com/Columns/Water- Wisdom/Aquatic-Therapy-for-COPD-Patients.aspx

19. BELLARMINE UNIVERSITY, LOUISVILLE, KY Questions ???

20. BELLARMINE UNIVERSITY, LOUISVILLE, KY References 1.de Souto Araujo ZT, de Miranda Silva Nogueira PA, Cabral EE, de Paula Dos Santos L, da Silva IS, Ferreira GM. Effectiveness of low-intensity aquatic exercise on COPD: a randomized clinical trial. Respir Med. Nov 2012;106(11):1535-1543. 2.McNamara RJ, Alison JA, McKeough ZJ. Water-based exercise in chronic obstructive pulmonary disease. Physical Therapy Reviews. 2011;16(1):25-30. 3.Perk J, Perk L, Boden C. Cardiorespiratory adaptation of COPD patients to physical training on land and in water. European Respiratory Journal. 1996;9(2):248-252. 4.Shead D, Aswegen HV. Hydrotherapy in the management of chronic obstructive pulmonary disease: a qualitative systematic review. Physical Therapy Reviews. 2012;17(5):271-283. 5.Wadell K, Henriksson-Larsén K, Lundgren R, Sundelin G. Group training in patients with COPD-long-term effects after decreased training frequency. Disability & Rehabilitation. 2005;27(10):571-581. 6.Wadell K, Sundelin G, Henriksson-Larsén K, Lundgren R. High intensity physical group training in water—an effective training modality for patients with COPD. Respiratory Medicine. 2004;98(5):428-438.