AQUATIC RESISTANCE TRAINING:

WATER AS A POWERFUL TOOL FOR

REHABILITATION

1

Anu M Valtonen, PT, PhD

Principal lecturer

Human Movement and Functioning

Helsinki Metropolia University of Applied Sciences,

Helsinki Finland

Anu M Valtonen anu.valtonen@metropolia.fi

TAPANI PÖYHÖNEN, PhD, PT

”Father of aquatic resistance training

research”

Exercise physiologist at Rehabilitation and

Pain Clinic, Carea, Kymenlaakso Central

Hospital, Kotka

Practical work & research

Dissertation: Neuromuscular function

during knee exercises in water –With

special reference to hydrodynamics and

therapy

Anu M Valtonen anu.valtonen@metropolia.fi 2

RESISTANCE TRAINING

Progressive training program

Additional resistance

Without additional resistance

Small resistance boots

Medium size resistance boots

Large resistance boots

Group training

With maximum effort

Anu M Valtonen anu.valtonen@metropolia.fi

”More you wave your limb, more water resists”

RESISTANCE TRAINING

Warm-up, 30-40 min resistance training, cool-down

Anu M Valtonen anu.valtonen@metropolia.fi

(Pöyhönen et al. 2002, Valtonen et al. 2010, Valtonen et al. 2011, Waller et al. 2013, Munukka et al. 2016)

AQUATIC RESISTANCE TRAINING INTERVENTIONS

Anu M Valtonen anu.valtonen@metropolia.fi 5

Preoperative Aquatic Training in End-StageKnee OA

HEALTHY MILD KNEE OA SEVERE KNEE OA TKA

TRAINING IN HEALTY WOMEN

Pöyhönen et al. Med Sci Sports Exerc. 2002; 34(12):2103-9

Anu M Valtonen anu.valtonen@metropolia.fi 6

CHANGES IN HEALTHY WOMEN

Anu M Valtonen anu.valtonen@metropolia.fi 7

ISOKINETIC TORQUE CSA

Pöyhönen et al. 2002

TRAINING IN MILD KNEE OA

Waller et al. Osteoarthritis Cartilage. 2017

doi: 10.1016/j.joca.2017.02.800.

Munukka et al. Osteoarthritis Cartilage. 2016;24(10):1708-17

Anu M Valtonen anu.valtonen@metropolia.fi 8

CHANGES IN WOMEN WITH MILD KNEE OA

Training was well tolerated

Cardiorespiratory fitness

improved by 9,8% (Munukka et al.

2016)

Body weight decreased

Fat mass decreased (Waller et al.

2017)

No effect on lean tissue CSA (Waller et al. 2017)

9Anu M Valtonen anu.valtonen@metropolia.fi

Waller et al. 2017

Anu M Valtonen anu.valtonen@metropolia.fi 10

Waller et al. 2017

CHANGES IN WOMEN WITH MILD KNEE OA

No training effects on muscle

force, knee pain or other

knee symptoms (Munukka et al. 2016)

Walking speed increased by

training (Waller et al. 2017)

PREOPERATIVE TRAINING

Valtonen, Waller et al. Unpublished preliminary data

Anu M Valtonen anu.valtonen@metropolia.fi 11

KNEE PAIN AND MOBILITY LIMITATION

Anu M Valtonen anu.valtonen@metropolia.fi 12

CHANGE % (SEM)

-40

-20

0

20

40

60

Knee pain,0-100

Max walkingspeed,

m/s

Stair ascending,s

Stair descending,s

Sit-to-stand,s

Training group

Control group

%

p=.001

p=.005 p=.409 p=.052 p=.003

MUSCLE POWER AND CSA

13

-20

-10

0

10

20

30

40

OA side,W

Contralat side,W

OA side,W

Contralat side,W

OA side,cm2

Contralat side,cm2

Training group

Control group

Anu M Valtonen anu.valtonen@metropolia.fi

p=.016 p=.091 p=.021 p=.010 p=.006 p=.379

CHANGE % (SEM)

%KNEE EXTENSOR KNEE FLEXOR THIGH CSA

2 2

POSTOPERATIVE FOLLOW-UP

Training effect in maximal walking speed

maintained 6-8 months after TKA operation

Training effect in knee pain, other mobility

variables, muscle power and muscle mass

disappeared

14Anu M Valtonen anu.valtonen@metropolia.fi

POSTOPERATIVE TRAINING

Valtonen et al. Arch Phys Med Rehabil 2010; 91: 833-9.

Valtonen et al. Arch Phys Med Rehabil 2011; 92:1944-50.

Anu M Valtonen anu.valtonen@metropolia.fi 15

Change % (95%CI)

= AT = CON

0 kk =pre

3 kk =post

15 kk =follow-up

%

-10

10

20

30

40

50

60

kk1530

0

EXTENSOR POWER

p<.001

p=.008%

-20

0

20

40

60

80

100

kk0 3 15

FLEXOR POWER

p=.008

p=.005

THIGH CSA

kk0 3 15

8

%

6

4

2

0

p=.037

Anu M Valtonen anu.valtonen@metropolia.fi

momo

mo

CHANGE % (95%CI)

= AT = CON

0 kk =pre

3 kk =post

15 kk =follow-up

kk1530

%

-8

-4

0

4

8

12

16

WALKING SPEED

p=.025

kk1530

%

-25

-20

-15

-10

0

5

10

-5

STAIR ASCENDING

p=.015

kk0 3 15

%

-25

-20

-15

-10

-5

0

5 SIT-TO-STAND

p<.001

Anu M Valtonen anu.valtonen@metropolia.fi

TAKE HOME MESSAGE

Aquatic resistance training has been well tolerated in all

phases of knee OA

Aquatic training has wide positive effects in lower limb

muscle strength and muscle mass

With aquatic training mobility limitation can be decreased

Aquatic resistance training is a powerful tool for

rehabilitation in knee OA

18Anu M Valtonen anu.valtonen@metropolia.fi

Thank you!

Anu M Valtonen anu.valtonen@metropolia.fi 19

Pöyhönen T , Sipilä S, Keskinen KL, Hautala A, Savolainen J, Mälkiä E. Ef fects of aquatic

resistance training on neuromuscular performance in healthy women. Med Sci Sports

Exerc. 2002; 34(12):2103-9.

Valtonen A, Pöyhönen T, Sipilä S, Heinonen A . Ef fects of aquatic resistance training on

mobil ity l imitat ion and lower l imb impairments af ter knee replacement. Arch Phys Med

Rehabil 2010; 91:833-9.

Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. Maintenance of aquatic training -induced

benef its in mobil ity and lower extremity muscles among persons with unilateral knee

replacement. Arch Phys Med Rehabil 2011; 92:1944-50.

Waller B , Munukka M, Multanen J, Rantalainen T, Pöyhönen T, Nieminen MT, Kiviranta I,

Kautiainen H, Selänne H, Dekker J, Sipilä S, Kujala UM, Häkkinen A, Heinonen A. Ef fects

of a progressive aquatic resistance exercise program on the biochemical composit ion and

morphology of cart i lage in women with mild knee osteoarthrit is: protocol for a randomised

controlled trial. BMC Musculoskelet Disord. 2013 Mar 7;14:82. doi: 10.1186/1471-2474-14-

82.

Munukka M, W aller B, Rantalainen T, Häkkinen A, Nieminen MT, Lammentausta E, Kujala

UM, Paloneva J, Sipilä S, Peuna A, Kautiainen H, Selänne H, Kiviranta I, Heinonen A.

Ef f icacy of progressive aquatic resistance training for t ib iofemoral cart i lage in

postmenopausal women with mild knee osteoarthrit is : a randomised controlled trial.

Osteoarthrit is Cart i lage. 2016 Oct;24(10):1708-17. doi: 10.1016/j. joca.2016.05.007. Epub

2016 May 19.

Waller B , Munukka M, Rantalainen T, Lammentausta E, Nieminen MT, Kiviranta I,

Kautiainen H, Häkkinen A, Kujala UM, Heinonen A. Ef fects of high intensity resistance

aquatic training on body composit ion and walking speed in women with mild

knee osteoarthrit is : a 4-month RCT with 12-month follow-up. Osteoarthrit is

Carti lage. 2017 Mar 3. pii: S1063-4584(17)30869-5.

doi: 10.1016/j. joca.2017.02.800. [Epub ahead of print ]