Effectiveness of Aquatic Exercise for Musculoskeletal Conditions: A Meta-Analysis

doi:10.1016/j.apmr.2014.04.005

Archives of Physical Medicine and Rehabilitation

Volume 95, Issue 9, September 2014, Pages 1776-1786

https://doi.org/10.1016/j.apmr.2014.04.005 Get rights and content

Abstract

Objective

To investigate the effectiveness of aquatic exercise in the management of musculoskeletal conditions.

Data Sources

A systematic review was conducted using Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and The Cochrane Central Register of Controlled Trials from earliest record to May 2013.

Study Selection

We searched for randomized controlled trials (RCTs) and quasi-RCTs evaluating aquatic exercise for adults with musculoskeletal conditions compared with no exercise or land-based exercise. Outcomes of interest were pain, physical function, and quality of life. The electronic search identified 1199 potential studies. Of these, 1136 studies were excluded based on title and abstract. A further 36 studies were excluded after full text review, and the remaining 26 studies were included in this review.

Data Extraction

Two reviewers independently extracted demographic data and intervention characteristics from included trials. Outcome data, including mean scores and SDs, were also extracted.

Data Synthesis

The Physiotherapy Evidence Database (PEDro) Scale identified 20 studies with high methodologic quality (PEDro score ≥6). Compared with no exercise, aquatic exercise achieved moderate improvements in pain (standardized mean difference [SMD]=−.37; 95% confidence interval [CI], −.56 to −.18), physical function (SMD=.32; 95% CI, .13–.51), and quality of life (SMD=.39; 95% CI, .06–.73). No significant differences were observed between the effects of aquatic and land-based exercise on pain (SMD=−.11; 95% CI, −.27 to .04), physical function (SMD=−.03; 95% CI, −.19 to .12), or quality of life (SMD=−.10; 95% CI, −.29 to .09).

Conclusions

The evidence suggests that aquatic exercise has moderate beneficial effects on pain, physical function, and quality of life in adults with musculoskeletal conditions. These benefits appear comparable across conditions and with those achieved with land-based exercise. Further research is needed to understand the characteristics of aquatic exercise programs that provide the most benefit.

Section snippets

Literature search

A systematic search of literature was conducted until May 2013. Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and The Cochrane Central Register of Controlled Trials were searched to identify published research. A sensitive search strategy was developed using medical subject heading search terms and keywords (appendix 1) and translated for each database as appropriate. The references of included studies were also reviewed for further relevant literature.

Study selection

Two

Search yield

The electronic search identified 1199 potential studies for screening of eligibility after duplicate studies were removed. Of these, 1136 studies were excluded based on title and abstract. The full text was obtained for the remaining 63 studies. Based on the reviewer's decisions, 36 studies were excluded after full text review because they did not meet inclusion criteria (appendix 3). A total of 26 studies were included in the review (fig 1).20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33

Discussion

This review provides new evidence that aquatic exercise provides moderate benefits to people with musculoskeletal conditions reflected in reduced pain and improved physical function and quality of life. These results are consistent with prior reviews that focused on individual musculoskeletal conditions in isolation. Improvements in pain and physical function were observed to be mostly consistent across different musculoskeletal conditions. Importantly, these results persisted when low-quality

Conclusions

Overall, the studies included in this review were of high quality and demonstrate that aquatic exercise can have positive effects on pain, physical function, and quality of life for adults with musculoskeletal conditions. However, there is further need for large-scale trials of sufficient duration and adequate follow-up period to validate the long-term effects of aquatic exercise. In addition, future trials need to examine different modes, frequency, intensity, and participation in aquatic

Supplier

a.
Review Manager (RevMan 5.2); The Cochrane Collaboration, Finance & Core Services Dept, Cochrane Central Executive, Summertown Pavillion, 18-24 Middle Way, Oxford OX2 7LG, UK.

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: Supported by Arthritis and Osteoporosis Victoria.

: Disclosures: none.

View full text

Review article (meta-analysis)Effectiveness of Aquatic Exercise for Musculoskeletal Conditions: A Meta-Analysis

Abstract

Objective

Data Sources

Study Selection

Data Extraction

Data Synthesis

Conclusions

Section snippets

Literature search

Study selection

Search yield

Discussion

Conclusions

Supplier

Lancet

Osteoarthritis Cartilage

PM R

Aust J Physiother

Arch Phys Med Rehabil

Arch Phys Med Rehabil

PM R

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Sleep Med

Soc Sci Med

Content comparison of worker productivity questionnaires in arthritis and musculoskeletal conditions using the International Classification of Functioning, Disability, and Health framework

J Occup Rehabil

Measuring quality of life in rheumatic conditions

Clin Rheumatol

Health care utilization for musculoskeletal disorders

Arthritis Care Res

The burden of musculoskeletal disease–a global perspective

Clin Rheumatol

The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review

Rheumatol Int

Therapeutic aquatic exercise in the treatment of low back pain: a systematic review

Clin Rehabil

Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes

BMC Musculoskelet Disord

Effects of aquatic resistance training on neuromuscular performance in healthy women

Med Sci Sports Exerc

Cardiorespiratory responses to aquatic treadmill walking in patients with rheumatoid arthritis

Physiother Res Int

Aquatic exercise for the treatment of knee and hip osteoarthritis

Cochrane Database Syst Rev

Efficacy of hydrotherapy in fibromyalgia syndrome–a meta-analysis of randomized controlled clinical trials

Rheumatology (Oxford)

Reliability of the PEDro scale for rating quality of randomized controlled trials

Phys Ther

Review article (meta-analysis)
Effectiveness of Aquatic Exercise for Musculoskeletal Conditions: A Meta-Analysis