Musculoskeletal conditions such as osteoarthritis, lower back pain and fibromyalgia are the most common causes for utilizing healthcare resources, and are amongst the world’s leading causes of chronic pain, disability and reduced health-related quality of life (Escorpizo et al, 2009). These conditions also account for approximately 7% of total disability adjusted for life years (Vos et al, 2012). As a major cause of motor impairment in the adult and elderly population, rehabilitation specialists have long been interested in the potential benefits of exercise therapy for musculoskeletal conditions.
There are many benifits to exercise performed in water. The buoyancy it provides decreases compressive weight-bearing stresses on joints and, important for very weak individuals, allows exercises to be performed with a reduced gravitational load. Being in a pool where the water is close to body temperature can decrease sympathetic nervous system activity. When this effect is combined with the compressive effects of hydrostatic pressure, aquatic therapy can help reduce swelling and the perception of pain. Given these benefits and advantages of aquatic exercise, numerous studies have investigated the effectiveness of water-based therapy improve the overall well being of those living with a musculoskeletal condition. Although the results are generally promising, there is considerable variability in the study designs, musculoskeletal conditions, aquatic exercises, outcome measures and sample sizes used in these studies. In order to see the forest from the trees, Barker and colleagues used a methodological approach called a meta-analysis to quantify the effectiveness of aquatic exercise for musculoskeletal conditions. Meta-analyses overcome the limitation of small sample sizes or rare outcomes by pooling results from a number of individual studies to generate a single best estimate. They can be instrumental in reliably demonstrating benefit or harm of an intervention when results of individual randomised controlled trials are conflicting or inconclusive.
WHAT DID THEY FIND?
The studies included in the meta-analysis were either randomized-control trials or quasi-randomized controlled trials on the effect of aquatic exercise on a range of musculoskeletal conditions. The outcomes of interest were pain, physical function and quality of life, and the methodological quality of all included studies were assessed with the PEDro scale (Maher et al, 2003). A total of 26 studies were retained and were found to have high methodological quality. The main conclusion from this study was that aquatic therapy provides moderate benefits to people with musculoskeletal conditions by reducing pain and improving physical function, and quality of life. Also, these improvements were comparable to those observed with land-based exercise.
SIGNIFICANCE AND IMPLICATIONS
This study confirms that aquatic exercise is beneficial to people living with a musculoskeletal condition. The fact that aquatic exercise was as effective as land-based exercise is also important because choice of treatment interventions improves outcomes (Guadagnoli & Ward, 1998). To put it another way, a ‘fish’ may not improve by doing exercises in a clinic or gym setting, but put that fish in a pool and factors such as motivation and participation will increase the likelihood that they will benefit from exercise.
PUBLICATION
Barker AL, Talevski J, Morello RT, Brand CA, Rahmann AE, Urquhart DM (2014). Effectiveness of aquatic exercise for musculoskeletal conditions: A meta-analysis. Arch Phys Med Rehabil 95, 1776-1786.
KEY REFERENCES
Escorpizo R, Cieza A, Beaton D, Boonen A (2009). Content comparison of worker productivity questionnaires in arthritis and musculoskeletal conditions using the International Classification of Functioning, Disability, and Health framework. Journal of Occupational Rehabilitation 19, 382-97.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2163-96.
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003). Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical Therapy 83, 713-21.
Guadagnoli E, Ward P. Patient participation in decision-making (1998). Social Science & Medicine 47, 329-39.