title: Aquatic exercise training and stable heart failure: A systematic review and meta-analysis.
abstract: OBJECTIVE
  A meta-analysis and review of the evidence was conducted to determine the efficacy of aquatic exercise training for individuals with heart failure compared to traditional land-based programmes.
  
  
  METHODS
  A systematic search was conducted for studies published prior to March 2014, using MEDLINE, PUBMED, Cochrane Library, CINAHL and PEDro databases. Key words and synonyms relating to aquatic exercise and heart failure comprised the search strategy. Interventions included aquatic exercise or a combination of aquatic plus land-based training, whilst comparator protocols included usual care, no exercise or land-based training alone. The primary outcome of interest was exercise performance. Studies reporting on muscle strength, quality of life and a range of haemodynamic and physiological parameters were also reviewed.
  
  
  RESULTS
  Eight studies met criteria, accounting for 156 participants. Meta-analysis identified studies including aquatic exercise to be superior to comparator protocols for 6 minute walk test (p < 0.004) and peak power (p < 0.044). Compared to land-based training programmes, aquatic exercise training provided similar benefits for VO(2peak), muscle strength and quality of life, though was not superior. Cardiac dimensions, left ventricular ejection fraction, cardiac output and BNP were not influenced by aquatic exercise training.
  
  
  CONCLUSIONS
  For those with stable heart failure, aquatic exercise training can improve exercise capacity, muscle strength and quality of life similar to land-based training programmes. This form of exercise may provide a safe and effective alternative for those unable to participate in traditional exercise programmes.
authors: Heart Failure Service, Royal Brisbane and Women's Hospital, Brisbane, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Australia. Electronic address: Julie.adsett@health.qld.gov.au.
authors: Julie A
authors: JA
authors: Adsett
authors: Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors: Alison M
authors: AM
authors: Mudge
authors: School of Allied Health Sciences, Griffith University, Gold Coast, Australia.
authors: Norman
authors: N
authors: Morris
authors: School of Physiotherapy, Australian Catholic University, Brisbane, Australia.
authors: Suzanne
authors: S
authors: Kuys
authors: Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Australia.
authors: Jennifer D
authors: JD
authors: Paratz
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D011788:Quality of Life
keywords: Aquatic exercise; Cardiomyopathy; Exercise training; Heart failure; Hydrotherapy