Advertisement

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

  • Anna Lucia Barker
    Correspondence
    Corresponding author Anna Lucia Barker, PhD, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne VIC 3004, Australia.
    Affiliations
    Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
    Search for articles by this author
  • Jason Talevski
    Affiliations
    Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
    Search for articles by this author
  • Renata Teresa Morello
    Affiliations
    Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
    Search for articles by this author
  • Caroline Anne Brand
    Affiliations
    Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Melbourne EpiCentre, University of Melbourne, Melbourne, VIC, Australia
    Search for articles by this author
  • Ann Elizabeth Rahmann
    Affiliations
    Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia

    Brighton Health Campus, Metro North Hospital and Health Service, Brisbane, QLD, Australia
    Search for articles by this author
  • Donna Michelle Urquhart
    Affiliations
    Musculoskeletal Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
    Search for articles by this author
Published:April 22, 2014DOI:https://doi.org/10.1016/j.apmr.2014.04.005

      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.

      Keywords

      List of abbreviations:

      CI (confidence interval), PEDro (Physiotherapy Evidence Database), RCT (randomized controlled trial), SMD (standardized mean difference)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Escorpizo R.
        • Cieza A.
        • Beaton D.
        • Boonen A.
        Content comparison of worker productivity questionnaires in arthritis and musculoskeletal conditions using the International Classification of Functioning, Disability, and Health framework.
        J Occup Rehabil. 2009; 19: 382-397
        • Vos T.
        • Flaxman A.D.
        • Naghavi M.
        • et al.
        Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2163-2196
        • Walker J.G.
        • Littlejohn G.O.
        Measuring quality of life in rheumatic conditions.
        Clin Rheumatol. 2007; 26: 671-673
        • MacKay C.
        • Canizares M.
        • Davis A.M.
        • Badley E.M.
        Health care utilization for musculoskeletal disorders.
        Arthritis Care Res. 2010; 62: 161-169
        • Brooks P.M.
        The burden of musculoskeletal disease–a global perspective.
        Clin Rheumatol. 2006; 25: 778-781
        • McVeigh J.G.
        • McGaughey H.
        • Hall M.
        • Kane P.
        The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review.
        Rheumatol Int. 2008; 29: 119-130
        • Waller B.
        • Lambeck J.
        • Daly D.
        Therapeutic aquatic exercise in the treatment of low back pain: a systematic review.
        Clin Rehabil. 2009; 23: 3-14
        • Batterham S.I.
        • Heywood S.
        • Keating J.L.
        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. 2011; 12: 123
        • Zhang W.
        • Moskowitz R.W.
        • Nuki G.
        • et al.
        OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines.
        Osteoarthritis Cartilage. 2008; 16: 137-162
        • Becker B.E.
        Aquatic therapy: scientific foundations and clinical rehabilitation applications.
        PM R. 2009; 1: 859-872
        • Poyhonen T.
        • Sipila S.
        • Keskinen K.L.
        • Hautala A.
        • Savolainen J.
        • Malkia E.
        Effects of aquatic resistance training on neuromuscular performance in healthy women.
        Med Sci Sports Exerc. 2002; 34: 2103-2109
        • Hall J.
        • Grant J.
        • Blake D.
        • Taylor G.
        • Garbutt G.
        Cardiorespiratory responses to aquatic treadmill walking in patients with rheumatoid arthritis.
        Physiother Res Int. 2004; 9: 59-73
        • Bartels E.M.
        • Lund H.
        • Hagen K.B.
        • Dagfinrud H.
        • Christensen R.
        • Danneskiold-Samsoe B.
        Aquatic exercise for the treatment of knee and hip osteoarthritis.
        Cochrane Database Syst Rev. 2007; 4: CD005523
        • Langhorst J.
        • Musial F.
        • Klose P.
        • Hauser W.
        Efficacy of hydrotherapy in fibromyalgia syndrome–a meta-analysis of randomized controlled clinical trials.
        Rheumatology (Oxford). 2009; 48: 1155-1159
        • de Morton N.A.
        The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study.
        Aust J Physiother. 2009; 55: 129-133
        • Maher C.G.
        • Sherrington C.
        • Herbert R.D.
        • Moseley A.M.
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Higgins J.P.
        • Green S.
        • Cochrane Collaboration
        Cochrane handbook for systematic reviews of interventions.
        Wiley-Blackwell, Chichester2008
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Cohen J.
        Statistical power analysis in the behavioral sciences.
        2nd ed. Erlbaum, Hillsdale1988
        • Arnold C.M.
        • Busch A.J.
        • Schachter C.L.
        • Harrison E.L.
        • Olszynski W.P.
        A randomized clinical trial of aquatic versus land exercise to improve balance, function, and quality of life in older women with osteoporosis.
        Physiother Can. 2008; 60: 296-306
        • Belza B.
        • Topolski T.
        • Kinne S.
        • Patrick D.L.
        • Ramsey S.D.
        Does adherence make a difference? Results from a community-based aquatic exercise program.
        Nurs Res. 2002; 51: 285-291
        • Cochrane T.
        • Davey R.C.
        • Matthes Edwards S.M.
        Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis.
        Health Technol Assess. 2005; 9 (iii-iv, ix-xi, 1-114)
        • Dundar U.
        • Solak O.
        • Yigit I.
        • Evcik D.
        • Kavuncu V.
        Clinical effectiveness of aquatic exercise to treat chronic low back pain: a randomized controlled trial.
        Spine (Phila Pa 1976). 2009; 34: 1436-1440
        • Evcik D.
        • Yigit I.
        • Pusak H.
        • Kavuncu V.
        Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome: a randomized controlled open study.
        Rheumatol Int. 2008; 28: 885-890
        • Eversden L.
        • Maggs F.
        • Nightingale P.
        • Jobanputra P.
        A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis.
        BMC Musculoskelet Disord. 2007; 8: 23
        • Foley A.
        • Halbert J.
        • Hewitt T.
        • Crotty M.
        Does hydrotherapy improve strength and physical function in patients with osteoarthritis–a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme.
        Ann Rheum Dis. 2003; 62: 1162-1167
        • Fransen M.
        • Nairn L.
        • Winstanley J.
        • Lam P.
        • Edmonds J.
        Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes.
        Arthritis and Rheum. 2007; 57: 407-414
        • Gill S.D.
        • McBurney H.
        • Schulz D.L.
        Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial.
        Arch Phys Med Rehabil. 2009; 90: 388-394
        • Hale L.A.
        • Waters D.
        • Herbison P.
        A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis.
        Arch Phys Med Rehabil. 2012; 93: 27-34
        • Hall J.
        • Skevington S.M.
        • Maddison P.J.
        • Chapman K.
        A randomized and controlled trial of hydrotherapy in rheumatoid arthritis.
        Arthritis Care Res. 1996; 9: 206-215
        • Han G.
        • Cho M.
        • Nam G.
        • et al.
        The effects on muscle strength and visual analog scale pain of aquatic therapy for individuals with low back pain.
        J Phys Ther Sci. 2011; 23: 57-60
        • Hinman R.S.
        • Heywood S.E.
        • Day A.R.
        Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial.
        Phys Ther. 2007; 87: 32-43
        • Lim J.Y.
        • Tchai E.
        • Jang S.N.
        Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial.
        PM R. 2010; 2 (quiz 793): 723-731
        • Lund H.
        • Weile U.
        • Christensen R.
        • et al.
        A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis.
        J Rehabil Med. 2008; 40: 137-144
        • Munguia-Izquierdo D.
        • Legaz-Arrese A.
        Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial.
        Arch Phys Med Rehabil. 2008; 89: 2250-2257
        • Patrick D.L.
        • Ramsey S.D.
        • Spencer A.C.
        • Kinne S.
        • Belza B.
        • Topolski T.D.
        Economic evaluation of aquatic exercise for persons with osteoarthritis.
        Med Care. 2001; 39: 413-424
        • Silva L.E.
        • Valim V.
        • Pessanha A.P.
        • et al.
        Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial.
        Phys Ther. 2008; 88: 12-21
        • Stener-Victorin E.
        • Kruse-Smidje C.
        • Jung K.
        Comparison between electro-acupuncture and hydrotherapy, both in combination with patient education and patient education alone, on the symptomatic treatment of osteoarthritis of the hip.
        Clin J Pain. 2004; 20: 179-185
        • Suomi R.
        • Collier D.
        Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis.
        Arch Phys Med Rehabil. 2003; 84: 1589-1594
        • Tomas-Carus P.
        • Hakkinen A.
        • Gusi N.
        • Leal A.
        • Hakkinen K.
        • Ortega-Alonso A.
        Aquatic training and detraining on fitness and quality of life in fibromyalgia.
        Med Sci Sports Exerc. 2007; 39: 1044-1050
        • Tomas-Carus P.
        • Gusi N.
        • Hakkinen A.
        • Hakkinen K.
        • Leal A.
        • Ortega-Alonso A.
        Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial.
        J Rehabil Med. 2008; 40: 248-252
        • Vitorino D.F.
        • Carvalho L.B.
        • Prado G.F.
        Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial.
        Sleep Med. 2006; 7: 293-296
        • Wang T.J.
        • Belza B.
        • Elaine Thompson F.
        • Whitney J.D.
        • Bennett K.
        Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee.
        J Adv Nurs. 2007; 57: 141-152
        • Wang T.J.
        • Lee S.C.
        • Liang S.Y.
        • Tung H.H.
        • Wu S.F.
        • Lin Y.P.
        Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis.
        J Clin Nurs. 2011; 20: 2609-2622
        • Wyatt F.B.
        • Milam S.
        • Manske R.C.
        • Deere R.
        The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis.
        J Strength Cond Res. 2001; 15: 337-340
        • Guadagnoli E.
        • Ward P.
        Patient participation in decision-making.
        Soc Sci Med. 1998; 47: 329-339
        • Marks R.
        • Allegrante J.P.
        Chronic osteoarthritis and adherence to exercise: a review of the literature.
        J Aging Phys Act. 2005; 13: 434-460