Purpose/Hypothesis: Aquatic therapy provides an alternate therapeutic environment that allows for the use of traditional therapeutic approaches as well as new intervention strategies. A growing body of evidence supports the beneficial effects of aquatic exercise for individuals with neurological disorders including patients with Parkinson's disease. The purpose of this systematic review was to examine the evidence regarding the effectiveness of aquatic exercise for individuals with Parkinson's disease.
Number of Subjects: A total of 19 studies with 437 participants were analyzed.
Materials and Methods: A database of articles published up to April 2019 was compiled using electronic databases PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PEDro. Two individuals independently searched for relevant literature and compiled a list of articles that were then sorted based on the predefined inclusion and exclusion criteria. Studies were included if they met the criteria of adult patients with the diagnosis of Parkinson's disease and included aquatic exercise as the main intervention. Articles were excluded if they were not available in English. Study characteristics, such as the amount and duration of interventions, and specific methodological criteria, were related to reported effects. The PEDro scale was used to detect risk of bias in individual studies.
Results: Of the 19 articles, eleven were randomized controlled trials, one was a quasi-experimental, one was a case control study, five were cohort studies, and one was a case study. Participant age ranged from 60 to 76 as the overall inclusion criteria across studies was 19-95 or older. The sample sizes ranged from 1 to 46 participants. Duration of treatment was from 3-4 up to 16 weeks with frequency of sessions being 1-2 sessions up to 5 per week and length of sessions ranged from 35 to 60 minutes. A range of aquatic exercises and techniques were used to address multiple impairment areas, including: functional activities (such as gait and dual task activities), upper and lower extremity strengthening and flexibility, coordination, aerobic endurance, and tone. Various outcome measures were used to assess effectiveness of aquatic exercises including those that assessed gait, Parkinson's severity, functional activities, mental health, balance, endurance, risk of falls, and pain.
Conclusions: The evidence suggests that aquatic exercise is effective in addressing deficits in quality of life, functional mobility, walking, balance, posture, pain, and mood. Studies reported that aquatic exercises are safe, enjoyable, & feasible interventions without adverse events or exacerbation of symptoms for patients with Parkinson's disease. Variability between studies was found with regard to intervention activities, dosing (frequency, duration, intensity), population (disease severity and subjects' age), and outcome measures used to document changes.
Clinical Relevance: Currently available literature on Parkinson's specific aquatic exercise programs suggests it may be beneficial for improving physical function and well-being. The lack of adverse outcomes & potential for facilitating development of social support systems further supports its utility. Additional research should include higher quality study design and larger sample sizes.