Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis.
OBJECTIVE
To investigate the effectiveness of aquatic exercise in the management of musculoskeletal conditions.


METHODS
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.


METHODS
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.


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


RESULTS
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.
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. Electronic address: anna.barker@monash.edu.
Anna Lucia
AL
Barker
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.
Jason
J
Talevski
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.
Renata Teresa
RT
Morello
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.
Caroline Anne
CA
Brand
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.
Ann Elizabeth
AE
Rahmann
Musculoskeletal Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Donna Michelle
DM
Urquhart
D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D009140:Musculoskeletal Diseases / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D010003:Osteoarthritis / Q000534:rehabilitation; D010146:Pain / Q000145:classification / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011788:Quality of Life; D013550:Swimming / Q000502:physiology
Arthritis; Exercise; Hydrotherapy; Musculoskeletal diseases; Osteoarthritis; Rehabilitation