Iphoid. The exercises were abdominal hollowing, abdominal bracing, and anteroposterior and mediolateral pelvic tilts. During the exercises, surface EMG activity of muscles rectus abdominis (RA), external oblique, lower abdominals, multifidus, and erector spinae (ES) were recorded. EMG data were normalized to a maximal voluntary contraction (MVC), and the subsequent percentage of activity was compared between environments (water and land) with paired t-tests. Results: Normalized EMG values for muscles RA, external oblique, lower abdominals, multifidus, and ES were significantly greater for all exercises performed on land than in water (P = 0.026-0.001, effect sizes = 0.52-1.61). The only exception was for mediolateral pelvic tilts where muscle ES values were not different between environments (P = 0.098). Conclusions: When healthy adults perform abdominal hollowing, abdominal bracing, and pelvic tilt exercises in water, most trunk muscles display substantially lower EMG activity when compared with performing the same exercises on land (e.g., abdominal bracing for RA = 20% MVC for land and 10% MVC for water). It is possible that with hydrostatic pressure and buoyancy, trunk muscles play less of a stabilizing role in the aquatic environment, which minimizes their EMG activity levels. Regardless of the mechanism, patients with back pain may find it easier to perform trunk muscle exercises in an aquatic environment first then progress to the land environment because EMG activity may be gradually increased....

Background: Balance impairments are the leading causes of falls in older adults. Aquatic-based exercises have been broadly practiced as an alternative to land-based exercises; however, the effects on dynamic balance have not been comprehensively reviewed and compared to land exercises. Thus, the purpose of this systematic review and meta-analysis was to compare the effectiveness of aquatic exercises (AE) to land exercises (LE) on dynamic balance in older adults. Methods: Electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, psycINFO), from inception to November 2019, were searched. Studies met the following eligibility criteria: Randomized controlled trials, English language, older adults aged 65 years or older, a minimum of one AE and LE group, at least one assessment for dynamic balance. For the meta-analysis, the effect sizes of dynamic balance outcomes were calculated using a standardized mean difference (SMD) and a 95% confidence interval (CI). Results: A total of 11 trials met the inclusion criteria, and 10 studies were eligible for the meta-analysis. The meta-analysis presented that older adults in AE groups demonstrated comparable enhancements in dynamic steady-state balance (SMD = − 0.24; 95% CI, −.81 to .34), proactive balance (SMD = − 0.21; 95% CI, −.59 to .17), and balance test batteries (SMD = − 0.24; 95% CI, −.50 to .03) compared with those in LE groups. Conclusions: AE and LE have comparable impacts on dynamic balance in older adults aged 65 years or older. Thus, this review provides evidence that AE can be utilized as a reasonable alternative to LE to improve dynamic balance and possibly reduce the risk of falls.

Background: Reactive balance is the last line of defense to prevent a fall when the body loses stability, and beneficial effects of various exercise-based interventions on reactive balance in older adults have been reported. However, their pooled evidence on the relative effects has yet to be described.Objective: To review and evaluate the comparative effectiveness of various exercise-based interventions on reactive balance in older adults.Methods: Nine electronic databases and reference lists were searched from inception to August 2021. Eligibility criteria according to PICOS criteria were as follows: (1) population: older adults with the mean age of 65 years or above; (2) intervention and comparison: at least two distinct exercise interventions or one exercise intervention with a no-exercise controlled intervention (NE) compared in each trial; (3) outcome: at least one measure of reactive balance; (4) study: randomized controlled trial. The main network meta-analysis was performed on data from the entire older adult population, involving all clinical conditions as well as healthy older adults. Subgroup analyses stratified by characteristics of participants (healthy only) and reactive balance outcomes (simulated slip or trip while walking, simulated forward falls, being pushed or pulled, and movable platform) were also conducted.Results: Thirty-nine RCTs (n = 1388) investigating 17 different types of exercise interventions were included in the network meta-analysis. Reactive balance training as a single intervention presented the highest probability (surface under the cumulative ranking (SUCRA) score) of being the best intervention for improving reactive balance and the greatest relative effects vs. NE in the entire sample involving all clinical conditions [SUCRA = 0.9; mean difference (95% Credible Interval): 2.7 (1.0 to 4.3)]. The results were not affected by characteristics of participants (i.e., healthy older adults only) or reactive balance outcomes.Summary/Conclusion: The findings from the NMA suggest that a task-specific reactive balance exercise could be the optimal intervention for improving reactive balance in older adults, and power training can be considered as a secondary training exercise.