Author(s): TENNANT, J., BALTHAZAAR, S., NIGHTINGALE, T., LUCAS, S., Institution: UNIVERSITY OF BIRMINGHAM, Country: UNITED KINGDOM, Abstract-ID: 1615

INTRODUCTION:
Exercise and water immersion activities independently modulate vascular function markers, however their combined effect remains less clearly categorised (1,2). An aquatic exercise intervention induces synergistic responses due to the additive effect of hydrostatic pressure on an exercise stimulus, which can additionally address some accessibility issues surrounding more traditional exercise, including increased convenience for individuals with mobility limitations (2,3). Hence, aquatic exercise has been explored in numerous modalities, including underwater cycling, deep water running and ambulatory-type shallow water exercise; the latter offering an accessible ambulation alternative with potentially greater clinical applicability. The aim of this scoping review was to summarise the vascular markers explored in ambulatory-type shallow water exercise and review the populations investigated within these interventions.
METHODS:
On August 07, 2024 an initial systematic literature search was performed in PubMed, CINAHL, Web of Science, Embase and MEDLINE, using the PICO framework to inform eligibility criteria. Publications were included if interventions contained shallow water ambulatory exercise, were performed in adult humans and examined vascular outcomes – with full eligibility details registered on the Open Science Framework. Two individual reviewers sequentially screened non-duplicate articles for relevancy, and all data from approved studies were extracted independently and methodically in Covidence.
RESULTS:
The database searches yielded a total of 8,120 unique citations, of which 140 studies were included within final extraction. Out of these 140 articles, 113 assessed heart rate, 65 explored blood pressure, 20 examined cardiac function (e.g. HRV), and 20 assessed markers of peripheral vascular function (e.g. FMD); while only 4 studies assessed cerebrovascular variables and 8 examined potential biomarkers of vascular function (e.g. NO). 96 articles studied adults with clinical conditions including hypertension (n=15), coronary artery disease (n=8) and type 2 diabetes (n=10); the remaining assessing healthy individuals. 38 studies explored individuals categorised as active, whilst 22 examined untrained or inactive adults.
CONCLUSION:
Ambulatory-type shallow water exercise has been assessed across numerous vascular outcomes and adult populations, primarily focusing on heart rate and blood pressure responses, with less emphasis on peripheral and cerebral vascular function markers. These findings highlight the vascular outcomes needing further exploration within this modality, and enable rationalisation for continued investigation in numerous populations, including vascular-related clinical conditions.

1) Green D J et al., Cold Spring Harb Perspect Med, 2018
2) Roxburgh B H et al., Temperature, 2025
3) Faíl L B et al., Scand J Med Sci Sports, 2022