Effects of the combined swimming, corrective and aqua gymnastics programme on body posture of preschool age children

© 2013 Aldvin Torlakoviæ et al.; licensee University of Sarajevo Faculty of Health Studies. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. UNIVERSITY OF SARAJEVO FACULTY OF HEALTH STUDIES ABSTRACT


INTRODUCTION
Movement and various sport activities of largely comprehensive aff ect anthropological status of man and the quality of his life (1).Th e complex functional transformation of a developing child does not occur regularly and equally in all of the diff erent body parts, but it does according to a specifi c rhythmic fl ow, which is marked by the so-called development crisis (2).Th e regular growth and development in children plays an important role as a foundation for maintaining their psycho-physical health.Due to the plasticity and sensitivity of the child's organ-ism, the process of forming a correct posture is of particular importance in both the preschool period of development and the fi rst years of schooling (3).Th e fact is that the correct postural position takes an ever decreasing presence in the children's daily activities.Improper sitting postures, diff erent kinds of motion activities and certain endogenous factors all have a systematic impact on the spinal cord, thus causing such levels of strain and pressure that often exceed the zone of tolerance in the soft spinal tissues.Even though in such situations there are no major resulting defects, the cumulative eff ect as a result of a series of repeating and long-lasting positions and motions is that the tissues go through certain visible changes.Th e fi ndings of some research eff orts undertaken thus far lead to the conclusion that the bad posture in the preschool and early school age children is actually an indicator of specifi c health problems, and these problems can become extremely serious if the bad posture is not corrected in due time (4).In the age between 5 and 10, when the growth becomes slower, the postural problems show somewhat lower rate of incidence, whereas with the onset of puberty, an increased emergence of abruptly deteriorating postural conditions and a detection of new cases can be widely anticipated.Th erefore, it is highly important to detect the postural problems at an early stage and keep them under the strict kinesiological control (5).As it is widely known, body posture consists of a set automatically regulated mechanisms activated by a neuromuscular system so that the body could resist (defy) the force of gravity.Th e best posture is the one that provides for maximum energy savings, maximum comfort, maximum performance while guaranteeing ideal relationships between the various parts of the body (6).To put it in simple terms, the posture of the body involves proper alignment of the body segments and their balance, which is achieved by providing a minimal input of power with maximum mechanical efficiency (7).One should bear in mind that among a number of diverse physical activities, it is undoubtedly the child play that has an extremely important place in every child's life.Such types of motion activities greatly contribute to the mental and physical development of the child, the improvement of his or her psychomotor skills, and consequently to the improvement of their muscle tone, which in turn plays an important role in enabling the child to adopt and maintain the proper posture.Th is research paper is aimed at identifying the possible eff ects that the implementation of the combined kinesiological programs of swimming and hydro-kinesiological therapy may have on the body posture in preschool children.

Respondents Sample
Th e survey was conducted on a sample of 50 boys (medical assessment -boys with poor muscle tone) from a number of Sarajevo kindergartens, in the age group of 5.2±0.6 yrs.; mean height=114±7 cm; mean weight= 21.8±4.7 kg.Th e fi nal data processing of the research results captured the children who participated in the initial and fi nal measurements and regularly attended the planned programme of combined kinesiological activities (all respondents have undergone complete treatment).

Sample of Variables
In order to evaluate the postural status (Table 1), we used a reduced Napoleon Wolanski method (8).As part of that evaluation, we used 9 variables for the observed body parts: head posture assessment (HPA), shoulder posture assessment (SPA), shoulder blade posture assessment (SBPA), chest posture assessment (CPA), spinal cord posture assessment (SCPA), abdominal posture assessment (APA), leg posture assessment (LPA), feet posture assessment (FPA) and the overall body posture basement according to Wolanski (OBPAW).Th e diagnosing of the body posture status has been carried out by scoring the deviations that occurred in the particular body parts compared with the normal (proper) posture.Th e scoring has been made by the method of Wolanski -expert evaluation (Table 2).On the basis of the total scores, we have determined the assessment values (grades) for the particular observed body parts, and also an overall grade for the overall body posture (Table 3).

Exercise Program
A combined program of exercises was undertaken in the Olympic Swimming Pool Centre Sarajevo in the afternoon hours.Th e activities were carried out within the period of 16 weeks, twice a week for 60 minutes (Table 4).Th e program of corrective gymnastics, workouts and exercises with Pilates balance balls was carried out in a sports hall covered with adequate fl oor-padding.Hydro-gymnastics exercises and basic swimming games and exercises were performed in a pool with the multifaceted gradually sloping fl oor, whose depth was 40-90 cm.During the implementation of the swimming and hydrogymnastics programmes, the water temperature was 29.4°C on average.Th e exercises were performed in groups of 15 respondents under the expert guidance of a Graduate Physiotherapist and a Professor of Sports and Physical Education.Each class of workouts and exercises consisted of four stages.Warm-up exercises for 5-10 minutes, aerobic dryland exercises for 20-25 minutes, then 20-25 minutes of aerobic water exercises (swimming games and exercises with hydro-gimnastics) and 5-10 minutes of relaxation and body-calming.During each class, the Introductory-Preparatory and the Main "A" stages were performed on dryland outside the pool, whereas the Main "B" Stage and the Final Stage were performed in water.

Statistical analisys
For the analysis of the outcomes of the initial and fi nal series of testing we used a T-test for dependent samples, i.e.Paired Samples Test (where diff erences are regarded as signifi cant at p < .05).A somewhat lower level of statistical signifi cance with regard to the variable of abdominal posture assessment (APA) and the variable of chest posture assessment (CPA) is most likely an outcome of a weaker impact of the program on the abdominal and chest muscle system, which indicates that the program was implemented for a too short period of time to be capable of triggering any signifi cant transformation of these posture segments, which is perhaps also suggestive of a need to include additional exercises and workouts in the program that would deal specifi cally with these body parts alone.Generally speaking, there has been a decrease of the standard deviation in almost all variables in both the partial and the integral defi ning of the posture status, which had a direct impact on the overall body posture assessment (Figure 1).Th e low level of statistical signifi cance with regard to the variable of head posture assessment (HPA) is a result of a very small deviation from the standard value in this test observed at the initial testing in most of the respondents.Th us the implemented program was not capable of making any signifi cant corrections in this regard either.Th e rates of statistical signifi cance point to the fact that there are signifi cant diff erences in almost all variables when it comes to the initial and fi nal series of testing.Accordingly, the program of combined kinesiological activities conducted on the treated sample of respondents proved to be an effi cient transformational process for most of the variables included in the survey.

DISCUSSSION
Th e body posture is the main precondition for good health, normal growth and development in general.It is quite important that the elimination and prevention activities are initiated as early as possible and with the youngest age categories possible.Th e combined physical training programmes that include strength and muscle stretching exercises, particularly with regard to the postural antigravity muscles, should help in the prevention of health problems that could occur later in life, since incorrect or improper posture constitutes the basis for further deterioration of health.As is widely known from practice, in the kinesics-therapy of children with defective body posture, as well as in the therapeutic treatments and procedures in general, there is a very important role of the actions designed in order to achieve a full degree of control over the applied motion treatments.It is also important to stress the crucial role of a timely detection of deviations from proper body posture, which is defi nitely the starting point for the success in correcting the resulting postural changes.An early diagnosis is regarded as the most important element of a successful treatment.In order to identify the moment of occurrence of a postural disorder, regardless of the cause of its occurrence, this problem has to be examined from the very moment of inclusion of children into a new environment or kindergarten.Th ereafter, selection of the adequate kinesics-therapeutic programs -in this case through the application of the hydro-kinesis therapy and swimming, through hard and concerted work of physical education teachers, medical doctors, parents and children -can result in the desired levels of success in correcting a bad posture.Th e most important role in forming and maintaining a proper posture is played by muscles as an active part of the movement apparatus.Th e weakness of certain muscle groups and their excessive and unilateral strain can cause the occurrence of a number of various disorders in the spinal cord, chest, upper and lower extremities, and particularly in the foot.Th e therapy that focuses on correcting the postural disorders and deformities in children is often diffi cult, strenuous, painful, discouraging and uninteresting for children.On the other hand, the physical training programs that include strength exercises and muscle stretching, specifically of the group of postural antigravity muscles, should help in the prevention of health problems that may occur later in life.Th e outcomes of this research clearly show that all respondents have absolutely improved in terms of the grades awarded from their body posture assessment.Similar conclusions were also reached by other authors who believe that it is possible to improve the body posture to a considerable extent by implementing adequate motion/movement programs (9-13).In order to make higher quality changes of a muscle-ligament apparatus in the preschool and early school age children in whom certain deviations from the correct posture have been identifi ed (e.g.kyphotic, scoliotic or lordotic posture), it would be necessary to organize specialised additional programs of corrective gymnastics that would be performed under the control of physical education teachers and physiotherapists, in a specially designated and specialized facilities covered with adequate fl oor-padding, and equipped with appropriate devices and equipment.

CONCLUSION
It can be concluded that a combined program of corrective gymnastics with games and exercises in water had signifi cant eff ects on improving the muscle tone in the respondents, which in turn had a direct impact on improving their body posture, both in terms of all of the individually surveyed body parts and in overall terms.Th e results of this research also provide an opportunity of their comparing with the eff ects of other research projects and programs that set the same or similar objectives.Also, this research needs to initiate further activities associated with undertaking closer studies examining the treated subject matters, all aimed at enabling a timely diagnosis and control of the said disorders and their curbing through the focused exposure to a number of effi ciently programmed corrective exercises and workouts.

TABLE 1 .
Sample of Variables

Table 5
p=.004) and chest posture assessment (CPA p=.013).A relatively low level of statistical signifi cance is observed only in the variable of head posture assessment (HPA p=.083).

TABLE 2 .
Posture Assessment according to the Negative Score Model -Wolanski

TABLE 3 .
Defi ning the posture status according to Wolanski

TABLE 5 .
Results of T-test for dependent samples (Paired Samples Test) in assessing postures and awarding body posture grades FIGURE 1.Comparison between the overall initial and fi nal assessments of body posture (Wolonski method).OBPAW, Overall Body Posture Assessment by Wolanski method.