title: Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review.
abstract: OBJECTIVE
  Previous systematic reviews have found hydrotherapy to be an effective management strategy for fibromyalgia syndrome (FMS). The aim of this systematic review was to summarize the components of hydrotherapy programs used in randomized controlled trials.
  
  
  METHODS
  A systematic review of randomized controlled trials was conducted. Only trials that have reported significant FMS-related outcomes were included. Data relating to the components of hydrotherapy programs (exercise type, duration, frequency and intensity, environmental factors, and service delivery) were analyzed.
  
  
  RESULTS
  Eleven randomized controlled trials were included in this review. Overall, the quality of trials was good. Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component. Great variability was noted in both the environmental components of hydrotherapy programs and service delivery.
  
  
  CONCLUSIONS
  Aerobic exercise, warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes. Treatment duration of 60 minutes, frequency of three sessions per week and an intensity equivalent to 60%-80% maximum heart rate were the most commonly reported exercise components. Exercise appears to be the most important component of an effective hydrotherapy program for FMS, particularly when considering mental health-related outcomes.
authors.affiliation: International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Perraton
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Machotka
authors.forename: Saravana
authors.initials: S
authors.lastname: Kumar