Benefits of aquatic physiotherapy in the health of the elderly

INTERVENTION: After the application of the pre‐intervention evaluation protocol, the sample will be divided in order of arrival for the evaluation. The first group will be Group 1 (G1) ‐ Experimental group that will receive care in the form of aquatic physiotherapy and the last Group 2 (G2) ‐ Control group that will not receive care during the study period. After completion of the research and if the results are satisfactory for G1 participants, aquatic physiotherapy will be offered to the G2 ‐ Control group for the same period of time and weekly frequency. The intervention of aquatic physiotherapy will be performed during three months with a frequency of three times weekly, on Mondays, Wednesdays and Fridays, lasting 40 minutes each session. Blood pressure will be checked before each session. For the application of the protocol an instructor will be at the edge of the pool being responsible for showing the exercise to be performed and controlling the time and the repetitions. Two other instructors will assist in positioning and performing the exercises properly within the pool, in addition to avoiding possible falls and accidents in the pool. There will be a rest period of ten seconds between each exercise. In aerobic and strengthening exercises it will be advised that participants maintain a frequency of 40 to 60 repetitions per minute. Each session will consist of warm‐up exercises: 1. Front walk in a row in the pool, 2. Side walk on the right and left in a row. Two minutes each exercise. Strengthening and balance exercises with cube position (water level at shoulder girdle: 3. Abduction and adduction of horizontal shoulder with open palm and neutral forearm position, 4. Abduction and adduction of shoulder with open palm and position Forearm neutral, 5. Shoulder flexion and extension with open palm and neutral forearm position, 6. Flexion and elbow extension with open palm and neutral forearm position One minute each exercise. Strengthening and balancing exer E02.779 E02.779.492 CONDITION: C18.452.394.750 E02.779.492 Essential hypertension (primary); Elderly; Diabetes Mellitus; Hydrotherapy. ; I10 ; M01.060.116.100 ; C18.452.394.750 ; E02.779.492 M01.060.116.100 PRIMARY OUTCOME: Expected outcome: Better quality of life after aquatic physiotherapy and better quality of life in the elderly who underwent aquatic physical therapy compared to those who did not. Quality of life was assessed by the SF‐36 questionnaire, composed of eight domains in which the score ranges from zero to one hundred, where zero represents a worse and one hundred the best quality of life score. Expected outcome: Decreased clinical vulnerability of the elderly after aquatic physiotherapy. The elderly attended by aquatic physiotherapy are less vulnerable than those who did not. The vulnerability is assessed by the Functional Clinical Vulnerability Index consisting of 20 questions with a maximum value of forty points, zero to three points being considered as robust; Four to nine points presents a risk of embrittlement; 10 points or more is in fragile condition. Expected outcome: Decreased risk of falls and improved mobility after aquatic physiotherapy. Older people who do aquatic physiotherapy have better mobility and less risk of falls compared to those who do not get evaluated by the Timed up and Go test in which the walking time is timed. Ten seconds or less indicates independence in gait and balance, between 10 and 20 independence and medium risk of falls, above 20 seconds gait dependence with high risk for falls Expected outcome: Expected outcome: improvement of upper limb and lower limb muscle strength after aquatic physiotherapy, increased muscle strength in the elderly who were treated by aquatic physiotherapy. The ability is measured by the test of Rikli and Jones in number of elbow pushups and lift and sit the chair in 30 seconds. The higher the number of repetitions the better the capacity. Expected outcome: Improved muscle flexibility after aquatic physical therapy. Greater flexibility in the elderly who did aquatic physiotherapy. The flexibility of the musculature was evaluated with the sit and reach test with Wells bench, measured in centimeters, the greater the measure in centimeters the better the flexibility. Expected outcome: Improvement in signs of depression in the elderly after aquatic physical therapy. Less signs of depression in the elderly who were attended by aquatic physiotherapy compared to those who were not attended. Depression was assessed by the Yesavage Geriatric Depression Scale where 5 or more points diagnosed depression and 11 or more points characterized severe depression. Expected outcome: Improvement of dynamic balance after aquatic physiotherapy. Equilibrium evaluated by the Tinetti Scale with nine items to be observed. It has a score of zero to 28 points. Values ??above 24 points indicate a low risk of falls, between 19 and 24 moderate risk, and below 19 high risk points. Expected outcome: Improvement of functional capacity after aquatic physical therapy. It is determined by the six‐minute walk test in which the distance walked by the elderly person for a six‐minute walk is measured. Expected outcome: improvement of inspiratory and expiratory respiratory muscle strength after aquatic physiotherapy and better respiratory muscle strength in the elderly attended by aquatic physiotherapy compared to those not attended. Measured by maximal expiratory pressure and maximal inspiratory pressure. The higher the pressures the greater the strength of the muscles. Expected outcome: improvement of the lateral‐lateral, antero‐posterior static balance and reduction of the oscillation area after the intervention. The balance was evaluated by the baropodometer which measures the oscillations of the body in the latero‐lateral and antero‐posterior plane and the area of ??oscillation of the body in the standing posture. The greater the number of oscillations and the smaller area is the individual's balance. Outcome found: After aquatic physical therapy, there was improvement of the dynamic balance with a score of 20.73 and a score after the intervention of 26.73 (p <0.001). Outcome found: Improvement in anteroposterior balance with closed eyes. There was no improvement in lateral‐lateral balance open and closed eyes and antero‐posterior open eyes. The area of ??oscillation did not diminish characterizing the non‐improvement of the balance. Outcome found: improvement of expiratory muscle strength after aquatic physiotherapy. The elderly who were attended had better inspiratory muscle strength compared to the group that was not attended.; Outcome found: No group scored for depression. There was no significant improvement after the intervention, nor was there any difference between those who did aquatic physical therapy and those who did not. Outcome found: There was a decrease in the risk of falls and an improvement in the mobility of the intervention group after aquatic physiotherapy with a mean before aquatic physiotherapy 9.95 and post 8.93 (p = 0.002). As for classification, there was a decrease in the risk of falls and improvement in mobility in the group attended by aquatic physiotherapy in relation to that not attended (p = 0.012). Outcome found: There was a significant improvement in the muscular strength capacity in the lower and upper limbs after the aquatic physiotherapy, with the average number of lower limb repetitions being 11,18 before and 13,82 after (p = 0,013) and upper limbs 10,36 before and 16,82 after (p = 0.001) aquatic physiotherapy. The muscular strength capacity of upper limb and lower limb were greater in the elderly who underwent aquatic physiotherapy.; Outcome found: There was a significant improvement regarding the vulnerability of the intervention group after aquatic physiotherapy. The mean value before intervention was 11.45 points and after 5.0 (p = 0.008). As for classification, there was a decrease in vulnerability in the intervention group in relation to the control (p = 0.015). Outcome found: There was improvement of flexibility after the aquatic physiotherapy in the group that received the intervention as well as in the one that did not receive. There was a difference in the classification of flexibility among the elderly who did aquatic physiotherapy and the elderly who did not. Outcome found: There was no significant improvement in functional capacity after aquatic physical therapy. The mean initial distance of the test was 430.08 meters and the final after the aquatic physiotherapy was 438.18 meters. Outcomes found: there was improvement in quality of life in the areas "pain", "general condition", "social aspects" and "physical aspects" after aquatic physiotherapy; The elderly who received the intervention presented better quality of life compared to those who did not receive the "pain" and "emotional aspects" domains. SECONDARY OUTCOME: Expected outcome: Satisfaction with care. Expected outcome:Social and economic profile. Outcome found: all participants in the intervention group rated between good and excellent care. Outcome found: The mean age was 68.59 ± 6.31 years, the majority were women (75%), with incomplete first degree (75%), family income of 1 to 3 minimum wages (91.7%), The majority have diabetes and hypertension (66.7%). INCLUSION CRITERIA: Elderly people aged 60 to 80 years; Of both genders; Who frequent the HIPERDIA group; That present independent gait and independence in activities of daily living (ADLs). Individuals should be aware of the research and that they accept the conditions established in the work and specified in the Informed Consent Term (ICT).