title: The effect of aquatic exercise on physical functioning in the older adult: a systematic review with meta-analysis.
abstract: ageing and sedentary behaviour cause negative changes in the neuromuscular systems of healthy older adults resulting in a decrease in physical functioning. Exercising in water (aquatic exercise, AE) has been shown to be effective at improving physical functioning in this population; however, no systematic review with meta-analysis has been published.
  
  
  
  to investigate the effect of AE on physical functioning in healthy older adults compared to control or land-based exercise (LE) through a systematic review with meta-analysis of randomised controlled trials.
  
  
  
  Medline, Embase, Cinahl, PEDro, SPORTDiscus, Web of Science, Cochrane Library, published before 31st December 2015.
  
  
  
  in total, 28 studies met the inclusion criteria and were included in the systematic review; 24 studies with 1,456 subjects (89% female) and with mean age 66.4 years were included in the meta-analysis.
  
  
  
  data were extracted and checked for accuracy by three independent reviewers.
  
  
  
  size of treatment effect was measured using the standardised mean difference with 95% confidence intervals (CIs).
  
  
  
  compared to control interventions, AE had a moderate positive effect on physical functioning 0.70 [95% CI 0.48 to 0.92]. Compared to LE, AE had a small positive effect on physical functioning 0.39 [0.12 to 0.66].
  
  
  
  there is a high risk of bias and low methodological quality in the studies particularly when comparing AE to LE with possible over estimation of the benefit of AE.
  
  
  
  AE may improve physical functioning in healthy older people and is at least as effective as LE.
authors: Department of Health Sciences, University of Jyväskylä, Jyväskylän yliopisto 40014, Finland.
authors: Benjamin
authors: B
authors: Waller
authors: Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland.
authors: Anna
authors: A
authors: Ogonowska-Słodownik
authors: Faculty of Sport, University of Porto, Porto, Portugal.
authors: Manuel
authors: M
authors: Vitor
authors: Department of Physiotherapy, Latvian Academy of Sport Education (LASE), Sport Medicine and Adapted Physical Activity, Riga, Latvia.
authors: Karina
authors: K
authors: Rodionova
authors: Faculty of Kinesiology and Rehabilitation Sciences, KULeuven, Leuven, Belgium.
authors: Johan
authors: J
authors: Lambeck
authors: Department of Health Sciences, University of Jyväskylä, Jyväskylän yliopisto 40014, Finland.
authors: Ari
authors: A
authors: Heinonen
authors: Faculty of Kinesiology and Rehabilitation Sciences, KULeuven, Leuven, Belgium.
authors: Daniel
authors: D
authors: Daly
mesh_terms: D000368:Aged; D015444:Exercise / Q000502:physiology; D006801:Humans; D010809:Physical Fitness; D014867:Water
chemical_list: D014867:Water
keywords: activity limitations; aquatic exercise; older adults; physical functioning; systematic review