Exploring the Effects of Aquatic Exercise on Cardiovascular Function in Older Adults

Study Overview
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Brief Summary
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Cardiovascular ageing is implicated in the development of cardiovascular disease (CVD). Aquatic exercise is being considered as a co-adjuvant form of rehabilitation, but there is limited evidence for its cardiovascular risk-reduction properties for older people. Our study aims to address this by exploring the cardiovascular effects of long-term aquatic exercise in older adults in comparison to those who are either inactive or engaged in land-based/mixed training by measurement of micro- and macro-circulation.

Official Title
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Exploring the Effects of Aquatic Exercise on Cardiovascular Function in Older Adults

Conditions
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Cardiovascular Diseases

Intervention / Treatment
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* Procedure: Aquatic exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: being over 55 years of age and normotensive (e.g., <140/90 mm Hg). Exclusion Criteria: any overt chronic disease which would affect microvascular functioning, anaemia (irrespective of whether an iron supplementation course is followed or not) a recent (3 months' ago) major surgery None of the participants were undertaking high intensity interval training of any form.

Ages Eligible for Study
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Minimum Age: 55 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Aquatic Exercise<br>General inclusion criteria included being over 55 years of age and normotensive (e.g., <140/90 mm Hg). Specifically for this group, we include participants engaging in swimming or other aquatic, primarily aerobic-based, training regimes for more than 2 times a week, for more than 6 months, at the time of the assessments. | |
| Land-based exercise<br>General inclusion criteria included being over 55 years of age and normotensive (e.g., <140/90 mm Hg). Specifically for this group, we include participants engaging in land-based, primarily aerobic training regimes (e.g. aerobic exercise) for more than 2 times a week, for a period longer than 6 months, at the time of the assessments. | |
| Mixed exercise<br>General inclusion criteria included being over 55 years of age and normotensive (e.g., <140/90 mm Hg). Specifically for this group, we include participants engaging in both land-based and aquatic, primarily aerobic, exercise regimes on an equal basis, for more than 6 months. | |
| Sedentary.<br>General inclusion criteria included being over 55 years of age and normotensive (e.g., <140/90 mm Hg). Specifically for this group, we include participants who are sedentary (e.g., defined as undertaking less than 60 min of structured/planned physical activity per week), for a period longer than 6 months. | Procedure: Aquatic exercise<br>* Participants belonging to Group D (sedentary group) will be randomised 1-to-1 between remaining sedentary (n=20) and following a self-managed, 8-week, aquatic-based exercise programme (n=20). The latter group will be offered an 8-week access to pool facilities. For Group D participants, all baseline assessments will be repeated at 8 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nitric oxide-mediated, macro (arterial)- circulatory function. | We will use FMD as a measure of endothelium-dependent, nitric oxide (NO)-mediated, macro (arterial)- circulatory function. Baseline scanning to assess resting vessel diameter will be recorded over 3 minutes, following a 10-minute resting period. A rapid inflation-deflation pneumatic cuff placed immediately distal to the elbow joint will be used to as an FMD stimulus. | Baseline. | 
| Nitric oxide-mediated, macro (arterial)- circulatory function. | We will use FMD as a measure of endothelium-dependent, nitric oxide (NO)-mediated, macro (arterial)- circulatory function. Baseline scanning to assess resting vessel diameter will be recorded over 3 minutes, following a 10-minute resting period. A rapid inflation-deflation pneumatic cuff placed immediately distal to the elbow joint will be used to as an FMD stimulus. | 8 weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Microcirculatory function | Skin blood flow will be measured as cutaneous red blood cell flux using a Laser Doppler Flowmeter (LDF). Local thermal hyperaemia will be induced using a heating disc surrounding the probe. The probe will be attached to the skin using a double-sided adhesion sticker. Participants will be rested in a supine position in a temperature-controlled room with a constant ambient temperature of 24° C for 35 minutes. Heart rate and diastolic and systolic blood pressure was recorded from the left arm at 5-minute intervals throughout the protocol (Dinamap Dash 2500, GE Healthcare, USA). Baseline skin blood flow data will be recorded for 5 minutes with the local heating disc temperature set at 30° C. Following this, rapid local heating will be initiated to obtain maximal vasodilation and the temperature will be increased by 1° C every 10 seconds until 42° C was reached. This will then be maintained for 30 minutes following, which the test will be completed. | Baseline. | 
| Microcirculatory function | Skin blood flow will be measured as cutaneous red blood cell flux using a Laser Doppler Flowmeter (LDF). Local thermal hyperaemia will be induced using a heating disc surrounding the probe. The probe will be attached to the skin using a double-sided adhesion sticker. Participants will be rested in a supine position in a temperature-controlled room with a constant ambient temperature of 24° C for 35 minutes. Heart rate and diastolic and systolic blood pressure was recorded from the left arm at 5-minute intervals throughout the protocol (Dinamap Dash 2500, GE Healthcare, USA). Baseline skin blood flow data will be recorded for 5 minutes with the local heating disc temperature set at 30° C. Following this, rapid local heating will be initiated to obtain maximal vasodilation and the temperature will be increased by 1° C every 10 seconds until 42° C was reached. This will then be maintained for 30 minutes following, which the test will be completed. | 8 weeks. | 
| Anthropometry - 1 | Stature, waist and hip circumferences will be measured (all in cms). | Baseline. | 
| Anthropometry - 2 | Body mass will be measured. | Baseline. | 
| Anthropometry - 1 | Stature, waist and hip circumferences will be measured (all in cms). | 8 weeks. | 
| Anthropometry - 2 | Body mass will be measured. | 8 weeks. | 
| EQ-5D-5L | The EQ5D-5L questionnaire will be completed, to support assessment of quality of life. | Baseline. | 
| EQ-5D-5L | The EQ5D-5L questionnaire will be completed, to support assessment of quality of life. | 8 weeks. | 
| SF-IPAQ | The SF-IPAQ questionnaire will be completed, to assess physical activity levels. | Baseline. | 
| SF-IPAQ | The SF-IPAQ questionnaire will be completed, to assess physical activity levels. | 8 weeks. | 
| Q-Risk | The online Q-Risk questionnaire will be competed, which assesses the risk of cardiovascular disease risk | Baseline. | 
| Q-Risk | The online Q-Risk questionnaire will be competed, which assesses the risk of cardiovascular disease risk | 8 weeks. | 
| Feasibility outcome - 1 | Recruitment rate (% of those expressing an interest, being actually recruited). | Baseline | 
| Feasibility outcome - 2 | Adherence rate (% of those recruited completing at least 75% of the prescribed number of exercise sessions). | 8 weeks | 
| Feasibility outcome - 3 | Retention rate (% of those recruited completing the post-intervention assessments). | 8 weeks |