Exercise as it relates to Disease/The effects of water-based exercises on depressive symptoms and nonspecific low back pain in retired professional athletes

This is a critique of the article: The Effects of Water-based Exercises on Depressive Symptoms and Non-specific Low Back Pain in Retired Professional Athletes: A Randomized Controlled Trial

What is the background to this research?
Aquatic Exercise can also be referred to as hydrotherapy. It is usually characterised by movements that are slow and controlled, helping with reducing the pain often associated with exercise on dry land. \ Non-specific low back pain has been defined as pain within the lumbar region which is not linked to any known pathologies. It is often common in people of all walks, with roughly 60-80% of people experiencing it throughout life. Depression is a mental health disorder highlighted by the most common symptom of lingering sadness. Both depression and non-specific low back pain have been widely researched throughly by the medical community, however the effects, within more specific communities has been skimmed over. Taheri and Irandoust's research has filled the gap in the athletic population. Their research highlighted the importance for this population to continue to move and be active after retiring from their careers. It has paved the way for future research into the area with even more specific populations.

Where is the research from?
The article was written by Morteza Taheri and Khadijeh Irandoust who are both associate professors in the discipline of physical education and sports science at Imam Khomeini International University in Qazvin, Iran. Irandoust has focused her research over the years on athletes of all abilities and has many papers discussing performance improvement and the effect of physical activity on disease. Taheri has examined a wider range of groups and the effect of physical activity on disease. However, he has recently shifted his focus towards the effects of COVID-19. It is unclear if there are any organisational links due to the lack of information available about the Dr Irandoost Sport Medicine Counseling Center. This could be due to the largely Persian dominance of language in Iran.

What kind of research was this?
The study conducted was a randomised controlled trial (RCT). An RCT is considered the gold-standard for determining the causal relationship between factors. The population consisted of all retired professional male athletes within the Qazvin Province and the sample was narrowed down to 60 participants through the use of accessible sampling.

What did the research involve?
The 60 participants were randomly split and assigned to the control group or the experimental group. Consent was gained and two tests were performed. These were the Keele STarT Back Screening Tool (SBT) to assess non-specific low back pain, and the Beck Depression Inventory (BDI) to assess depressive symptoms. The intervention group then performed roughly 40-60 minutes of water-based exercise three times per week for eight weeks. The control group did not perform any additional exercise bouts in these eight weeks. Following the completion of the intervention both the SBT and the BDI were completed again and compared to the baseline data. The methodology could have been improved in many areas. Whilst the article mentions that all participants attended four counselling sessions in the duration of the study, it does not mention what else the control group did. The results showed improvements in all facets, however how this was achieved is not explained. Testing could also have been implemented in the duration of the study to better reflect upon the improvements in certain areas. A number of limitations from the study were encountered. Research only looked at water-based exercises in an all-male sample, from a particular province. In addition, all subjects were obese and had low levels of exercise which does not always reflect the population.

What were the basic results?
It was found that the intervention group's results made significant improvements in the SBT and BDI compared to the control group who made very slight improvements. Tables 1 and 2 show the differences in the scores pre and post interventions for both the intervention group and control group respectively. Taheri and Irandoust came to the conclusion that the difference between both groups was a significant finding. It was also found that there was a reduction in body fat and weight of the participants, this was utilised to draw wider conclusions and the generalisation of the study.

It was highlighted in the discussion that the findings were not specific enough to ensure that these results were directly influenced by the aquatic exercise. Instead, the conclusion was that general exercise helps with decreasing abdominal fat, which in turn can reduce non-specific low back pain and depression symptoms. This conclusion, highlights that Taheri and Irandoust were aware that although the results between the control and intervention groups were significant, this could be due to other lifestyle factors that may not have been accounted for.

What conclusions can we take from this research?
The study presented with questions surrounding the validity of the research. Thus, it can be concluded that other lifestyle factors most likely took precedence over the aquatic exercise itself. Participants may have completed extra exercise outside of the supervision of the test, as well as potential dietary changes may have been implemented. These factors lead to the conclusion, that general exercise will often decrease fat and weight. A study by F.H Abadi in 2019 found that aquatic based exercises had significant improvement in low back pain levels in a group of obese women. This aligns quite well with the results found in the 2014 paper.

Practical advice
Aspects of this research can be translated into more generalised populations. It can be concluded that exercise of any kind can be helpful in reducing the impact of non-specific low back pain as well as depression symptoms, especially in non-active patients. However, aquatic exercise can be utilised to ease pressure on the joints, which can be better for ageing populations. A larger population is needed better understand the significance of this training modality and its impact. However, appropriate medical advice from a GP surrounding ones ability to participate safely should be gained before participation.

Further information/resources
For further information surrounding depression and where to get help see the below links:

Mental Health Helplines

Beyond Blue

For further information and where to get help for non-specific low back pain see the below links:

Find a Physio