adapted swimming sports and rehabilitation

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356 ADAPTED SWIMMING SPORTS AND REHABILITATION height, 178.3cm, (SD= 8.4), weight, 78.5kg (± 11.4), body surface, 2.1m 2 (± 0.24). The test consisted of three 3 minute swims at the same mean swimming speed with added, subtracted or no extra load. One S-VHS video camera was placed outside the flume perpendicular to the swimming direction at 3.5-m from the swimmer. The actual camera view in the swimming plane was 4-m x 3-m. At the start of each video session a 1-m calibration ruler was placed in both the vertical and horizontal direction and recorded. Reference makers were set at eight points on the left side of the body: toe, ankle, knee, hip, shoulder, elbow, wrist and top middle finger. Recordings were made during each step, in order to analyse 10 movement cycles in the middle of each step. Sampling frequency was 50 Hz. Digitizing was done using the SIMI-Motion “ software package 6.1 and analysis was based on the breaststroke phase model of Wiegand et al. (12) (Figure 1). Figure 1. Breaststroke Phase-Model by Jähnig et al. (7). To describe the complex movement, time-discrete (paths, durations, velocities, angles) and time-continuous characteristics (v x-t-progress of the hip depend on arm and leg by Federle (4)), and timing of the swim-movement (Phase Structure Quotient-PSQ of Blaser et al. (1)) were examined. All in all 57 movement-parameters were determined in 3 swimming situations in each patient. Means and standard deviations were determined. Significant changes of parameters over 10 movement cycles between load steps were calculated using the nonparametric Wilcoxon-test. The level of significance was set at P < 0.05. A factor analysis (principle –component analysis) was performed as described by Hotelling (6) and Kelly (7). Phase structure quotient for both arm and leg movements were determined as follows: PSQ = (duration of main phase/ duration of initiation phase + duration of linking phase + duration of preparation phase) x 100%(1). RESULTS Based on the time-discrete findings 9 parameters were found to be relevant to describe the changes in swimming movement of the CAD-patients examined. These 9 parameters showed a frequency of change of more than 5 (Table 1). All in all only one patient demonstrated no significant changes over the increasing load steps. On average 31 (±14) parameters changed. Rev Port Cien Desp 6(Supl.2) 351-357 Table 1. Frequency and Characteristic of time-discrete kinematic parameters during swimming. Frequency Parameter ≥ 5 Characteristic Vertical path of hand in main phase of arm 8 1 x s; 1 x f ; 5 x d (^); 1 x d (v) Vertical path of foot in main phase of leg 7 2 x s; 1 x d (^); 4 x d (v) Resultant path of hand in main phase of arm 6 2 x s; 2 x d (^); 2 x d (v) Horizontal path of hand in main phase of arm 6 2 x s; 3 x d (^); 1 x d (v) Horizontal path of hand during arm stroke 5 1 x s; 3 x d (^); 1 x d (v) Horizontal path of hip during leg stroke 5 2 x f; 1 x d (^); 2 x d (v) Duration of propulsion-pause between main phase of arm and main phase of leg 8 2 x s; 2 x d (^); 4 x d (v) Duration of propulsion-pause between main phase of leg and main phase of arm 7 2 x f; 5 x d (^) Angle of attack of hip-shoulder-water surface 5 1 x f; 4 x d (^) Legend: s-increasing, f-decreasing, d-discontinuous (^)=direction From the time-continuous point of view individual time series patterns were observed in arm and leg movements. Figure 2 shows examples of an arm-swimmer (left) and leg-swimmer (right). It was also possible to distinguish so called “changeswimmers” (4) with differing propulsion of the arms and legs. Only one patient actually demonstrated an ideal velocity-timeregime of the hip according to Costill et al. (3) or Schramm (10). In total a marked divergent regime in horizontal hipvelocity was observed in this population: 12 arm-swimmers, 4 leg-swimmers and 10 change-swimmers. The calculated PSQ describes some problems of these patients to react to increased load conditions. Six patients showed significant changes of PSQ of the arms. The other 20 patients did not change time-continuous characteristics with increasing loads. The calculated PSQ-values of the legs changed significantly in 10 patients whereas 16 patients showed no adaptation during the step-test. As an example figure 3 shows the inter-individual adaptation of the development of PSQ of the arms and legs. Figure 2. Breaststroke arm-swimmer (left) and leg-swimmer (right). Figure 3. Two examples of the development of PSQ of the arm (PSQ A) and leg (PSQ B). Significant differences between load steps (*p ≤ .05, **p ≤ .01) are indicated.
As a result of factor analysis 4 factor-components of relevance provide indications for organizing swim rehabilitation programs with a special view to movement co-ordination. Table 2 gives on overview of the specific movement parameters of each relevant factor-component. The variance of the factor-components are: 30% for time-structure, 18% for velocity-regime, 10% posture of upper part of the body, 8% for angle of attack of thigh. The verification of reliability of the factors showned good internal consistencies (Cronbachs Alpha from .62 to .89). All main items may be evaluated as strong to very strong regarding selectivity and being greater than the limiting value of .4 (.55-.99). Table 2. Loading of main items of each factor-component . Factor: time-structure Factor-load duration of leg movement .93 duration of arm movement .92 movement frequency of the legs .92 movement frequency of the arms .92 duration of propulsion-pause between main phase of the arms and main phase of the legs .87 duration of propulsion-pause between main phase of the legs and main phase of the arms .78 Factor: velocity parameters Factor-load mean velocity of the hip in main phase of the arms .92 maximum velocity of the hip during arm stroke .91 maximum velocity of the hip during leg stroke .90 maximum velocity of the foot during leg stroke .74 Factor: posture of upper part of the body Factor-load angle of attack of hip-shoulder-water surface during to start main phase of the legs .96 angle of attack of hip-shoulder-water surface at the end of main phase of the arms .94 angle of attack of hip-shoulder-water surface at the end of main phase of the legs .89 angle of attack of hip-shoulder-water surface during to start main phase of the arms .88 Factor: angle of attack of thigh Factor-load angle of attack of thigh at the end of main phase of the legs .84 angle of attack of thigh during start of main phase of the legs .81 angle of attack of thigh-water surface during start of main phase of the legs .69 angle of attack of thigh-water surface at the end of main phase of the legs .65 DISCUSSION Based on kinematic analysis of time-discrete parameters during breaststroke in patients with CAD the movement path of the arms and legs and of the hip, the duration of pause between the movements of the extremities and the angle of attack of hip-shoulder-water surface are of crucial importance to forward speed. These findings are supported by the findings of factor analysis where comparable parameters were found to be of relevance. Results indicated large individual variations in timecontinuous characteristics. The PSQ as a good predictor for load specific adaptations related to movement co-ordination. When compared to the findings on healthy volunteer’s from Blaser (1) or for elite swimmer by Witte (13) different values were observed. The values in CAD-patients are usually larger ADAPTED SWIMMING SPORTS AND REHABILITATION with no differences between arms and legs. Therefore the majority of CAD-patients are not able to react to increasing loads adequately. Patients who were not able to change the PSQ-values under increasing external loads might be increasing their cardiac stress. The movement patterns of CAD-patients react in diverse ways to increased loads. Based on these findings the importance of movement analysis in swimming of CAD-patients was underlined in order to guarantee an adapted sport-specific rehabilitation program as an additional way to control the load-stress situation and to develop movement skills. REFERENCES 1. Blaser P (1993). Charakteristik der Koordinationsstruktur zyklischer Bewegungen bei unterschiedlicher psycho-physischer Beanspruchung im Schwimmen (Co-ordination of cyclic movements with different velocity under psycho-motor loads in swimming). Deutsche Sporthochschule Köln: Forschungsbericht 2. Bücking J, Wiskirchen G, Puls G (1991). The increase of cardiac output by immersion in water measured by transesophageal echocardiography. European Journal of Physiology, 419: 109-113 3. Costill DL, Maglischo EW, Richardson AB (1992). Swimming. Oxford: Mayfield Publishing Company 4. Federle S (1991). Schwimmtechnik (Swim-Technique). In Pfeifer H (ed.). Schwimmen. Berlin: Sportverlag, 65-94 5. Hanna RD, Sheldahl LM, Tristani FE (1993). Effect of enhanced preload with head-out water immersion on exercise response in men with healed myocardial infarction. American Journal of Cardiology, 71: 1041-1044 6. Hotteling H (1933). Analysis of a complex of statistical variables into principal components. Journal of Educational Psychology, 24: 498-520 7. Kelly TL (1935). Essential traits of mental life. Harvard Stud. in Educ. 26. Cambridge, Mass.: Harvard Univ. Press 8. McMurry RG, Fieselmann CC, Avery KE, Sheps DS (1988). Exercise hemodynamics in water and on land in patients with coronary artery disease. Journal of Cardiopulmonary Rehabilitation, 8: 69-74 9. Meyer K, Bücking J (2004). Exercise in Heart Failure: Should Aqua Therapy and Swimming be allowed? Med Sci Sports Exerc, 36: 2017-2023 10. Schramm E. (1987). Hochschullehrbuch Sportschwimmen (University textbook of Sport Swimming. Berlin: Sportverlag 11. Weston CF, O´Hare JP, Evans JM, Corrall RJ. (1987). Haemodynamic changes in man during immersion in water at different temperatures. Clin Sci, 73: 613-616 12. Wiegand, K, Wuensch, D, Jaehnig, W (1975). The division of swimming strokes into phases, based upon kinematic parameters. In Lewillie, L, Clarys, JP (eds.), Swimming II (pp. 161-166). Baltimore: University Park Press 13. Witte K, Bock H, Strob U, Blaser P (2003). A synergetic approach to describe the stability and variability of motor behavior. In: Tscharner W, Dauwalder JP (eds.). The dynamical systems approach to cognition. New Jersey, London, Singapore: World Scientific, 133-144. Rev Port Cien Desp 6(Supl.2) 351-357 357
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