Objective: To examine the effectiveness of therapeutic aquatic exercise in the treatment of low back pain. Design: A systematic review. Methods: A search was performed of PEDro, CINAHL (ovid), PUBMED, Cochrane Controlled Trials Register and SPORTDiscus databases to identify relevant studies published between 1990 and 2007. Population: Adults suffering from low back pain. Intervention: All types of therapeutic aquatic exercise. Comparison: All clinical trials using a control group. Outcomes: Oswestry Disability Index, McGill Pain Questionnaire, subjective assessment scale for pain (e.g. visual analogue scale) and number of work days lost as a direct result of low back pain. Methodological quality was assessed using the PEDro scale and the SIGN 50 assessment forms. Results: Thirty-seven trials were found and seven were accepted into the review. Therapeutic aquatic exercise appeared to have a beneficial effect, however, no better than other interventions. Methodological quality was considered low in all included studies. The heterogeneity among studies, in numbers of subjects, symptoms durations, interventions and reporting of outcomes, precluded any extensive meta-analysis of the results. Conclusion: There was sufficient evidence to suggest that therapeutic aquatic exercise is potentially beneficial to patients suffering from chronic low back pain and pregnancy-related low back pain. There is further need for high-quality trials to substantiate the use of therapeutic aquatic exercise in a clinical setting.

Background: Current management of osteoarthritis (OA) focuses on pain control and maintaining physical function through pharmacological, nonpharmacological, and surgical treatments. Exercise, including therapeutic aquatic exercise (TAE), is considered one of the most important management options. Nevertheless, there is no up-to-date systematic review describing the effect of TAE on symptoms and function associated with lower limb OA.Purpose: The purpose of this study was to conduct a systematic review with meta-analysis to determine the effect of TAE on symptoms and function associated with lower limb OA.Data Sources: The data sources used in this study were: MEDLINE, PubMed, EMBASE, CINAHL, PEDro, and SPORTDiscus.Study Selection: All studies selected for review were randomized controlled trials with an aquatic exercise group and a nontreatment control group. In total, 11 studies fulfilled the inclusion criteria and were included in the synthesis and meta-analysis.Data Extraction: Data were extracted and checked for accuracy by 3 independent reviewers.Data Synthesis: Standardized mean difference (SMD) with 95% confidence interval (95% CI) was calculated for all outcomes. The meta-analysis showed a significant TAE effect on pain (SMD=0.26 [95% CI=0.11, 0.41]), self-reported function (SMD=0.30 [95% CI=0.18, 0.43]), and physical functioning (SMD=0.22 [95% CI=0.07, 0.38]). Additionally, a significant effect was seen on stiffness (SMD=0.20 [95% CI=0.03, 0.36]) and quality of life (SMD=0.24 [95% CI=0.04, 0.45]).Limitations: Heterogeneity of outcome measures and small sample sizes for many of the included trials imply that conclusions based on these results should be made with caution.Conclusions: The results indicate that TAE is effective in managing symptoms associated with lower limb OA.

Background 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. Purpose 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. Data sources Medline, Embase, Cinahl, PEDro, SPORTDiscus, Web of Science, Cochrane Library, published before 31st December 2015. Study selection 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 extraction data were extracted and checked for accuracy by three independent reviewers. Data synthesis size of treatment effect was measured using the standardised mean difference with 95% confidence intervals (CIs). Results 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]. Limitations 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. Conclusions AE may improve physical functioning in healthy older people and is at least as effective as LE.