Table 1.
Summary of articles based on structured abstracts
| Article | Year | Title | Aim/objective | Setting/place | Participants | Detail and period of intervention | Main and secondary outcomes | Main results | Conclusion |
|---|---|---|---|---|---|---|---|---|---|
| Willén et al15 | 2001 | Dynamic water exercise in individuals with late poliomyelitis | To evaluate the specific effects of general dynamic water exercise on individuals with late effects of poliomyelitis | A university hospital department | Twenty-eight individuals with late effects of polio, 15 (7 men, 8 women) assigned to the TG and 13 (9 men, 6 women) to the CG. The mean age was 51 years (range, 22–65 years) for the TG and 49 years (range, 28–59 years) for the CG | A 40-minute general fitness training session in warm (33°C) water twice a week. The average training period was 5 months | Peak load, peak work load, peak oxygen uptake, peak HR, muscle function in knee extensors and flexors, and pain dimension of the NHP | The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as significantly lower distress in the dimension pain of the NHP | A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals |
| Ebisu et al16 | 2001 | Effectiveness of serum lipids on spa-walking | To examine the effect of spa walking on serum lipids | A spa pool | Spa walking group consisted of five healthy female students who did not have an exercise regime (21.3 ± 0.7 years). Nonwalking group consisted of five females who did not have an exercise regime (22.1 ± 0.2 years) | Walking in a spa pool three times a week (30 minutes at a time) for 10 weeks | Serum lipids (TC, HDL-C, LDL-C, triglycerides) and energy intake | In the exercise group, a significant increase of HDL-C was seen. A group comparison was not conducted | Spa walking can improve HDL-C value, though the detailed mechanism for HDL-C increase is unclear |
| Aoba et al17 | 2001 | The effects of enforcement water exercise class on hypotensive elderly subjects | To examine the effect of 8 weeks of water exercise on blood pressure in 133 elderly subjects | A heated pool | One hundred elderly people (29 males and 71 females, aged 59.1 ± 10.0 years) who participated in the water exercise program and 30 elderly people (17 men and 13 women, aged 57.0 ± 12.5 years) who didn’t have fitness regimes | The exercise group trained for 8 weeks with two 90-minute programs per week. Each program consisted of stretches and cool down on land, and walking, stretching, resistance training, and aerobic exercise in water | Blood pressure | In elderly subjects, significant improvements of SBP or DBP and blood pressure were shown among the subjects in the elderly group. However, obese subjects showed no significant change | The present study suggested that blood pressure value would improve with water exercise and recognition of health for elderly subjects who participated in the water exercise program |
| Yamada et al18 | 2002 | Effects of water-based well-rounded exercise on vital age and physical fitness in older adults | To determine the effects of water-based exercise training on the VA of older adults | No description | Thirty-nine volunteers were randomly divided into an exercise group (8 males and 13 females aged 69 ± 4 years) and control group (5 males and 11 females aged 68 ± 4 years) | The exercise group participated in a 12-week water-based exercise program, 70 minutes/day, and 3 days/week; the control group continued their normal lives | VA based on age and various physical fitness tests | Significant lowering in VA was noted in the exercise group, and no significant changes were observed in the control group | Water-based exercise is an effective measure to lowering VA, thus improving the overall physical fitness in the elderly |
| Murai et al19 | 2002 | Exercise therapy for osteoarthritis of the knee – preliminarily study of water exercise | To compare the effects of aquatic exercise training and land exercise on patients with slight knee OA | No description | Aquatic exercise group consisted of 16 females aged 49.7 years on average. Land exercise group consisted of 6 females aged 53.5 years on average | Once per week for 10 weeks on average. Voluntary exercise was permitted. Aquatic exercise included walking in the water, balancing exercises and cool down. Land exercise included stretching, resistance training, balancing exercises, ergometer exercise and icing | Body fat, VAS, JOA knee score, and isometric knee extension force | There was no significant difference in weight and body fat. VAS, JOA score and COP sway were significantly decreased or improved by aquatic exercise. They improved by land exercise, although not significantly. Knee extension force was improved in both groups. Significance level was higher in aquatic exercise group | Knee pain, JOA, muscle force and COP were significantly improved in the aquatic exercise group. Only muscle force was improved in land exercise group. Aquatic exercise was more effective than land exercise in patients with slight OA |
| Igarashi et al20 | 2002 | Health effect of aquatic exercise therapy using a hot spring | To examine the health effect of aquatic exercise therapy with a hot spring for people who are not athletes | A city hot spring pool | The aquatic exercise group consisted of an aquatic exercise class for 13 females for 2 years (56–70 years). The nonaquatic exercise group consisted of 7 females who did not have an exercise regime (60–75 years) | Stretching and balance training was included. 45 minutes a week for 4 months | Physical characteristics (height, weight, body fat, blood pressure), muscle volume, VO2 max, physical flexibility were examined at the beginning and end of the intervention. | In the exercise group, significant reduction of weight and minimum blood pressure were seen. A group comparison was not conducted | The intervention period (4 months) and frequency (once a week) might not be enough to improve health |
| Pechter et al21 | 2003 | Beneficial effects of water-based exercise in patients with chronic kidney disease | To ascertain whether water-based, 12-week, regular, low-intensity aerobic exercise conditioning provides beneficial effects for individuals with moderate CRF and to compare the outcome with data from a sedentary control group | No description | Twenty-six patients with moderate CRF: an exercise group (7 male and 10 females aged 31–72 years) and a control group (6 men and 3 women aged 35–65 years) | The exercise group did low-intensity aerobic exercise in the pool over a period of 12 weeks, twice a week, with sessions lasting for 30 minutes; the control group remained sedentary | Cardiorespiratory parameters (VO2 max and peak ventilation), renal functional parameters (serum creatinine, Cys-C, GFR, and U-prot), SBP and DBP, and oxidative stress indices (products of lipid peroxidation and reduced GSH | Only in the exercise group, all cardiorespiratory functional parameters, SBP, and DBP were lowered significantly. U-prot and U-prot were diminished significantly and GFR was enhanced. LPO was reduced significantly, and GSH showed significant improvement | Regular water-based exercise has beneficial effects on the cardiorespiratory, renal functional parameters, and oxidative stress status in patients with moderate renal failure, and can be used in the complex rehabilitation of chronic renal failure patients, together with blood pressure control, dietary consultation, encouragement and education to prevent physical worsening and to postpone cardiovascular and renal atherosclerotic complications. |
| Douris et al22 | 2003 | The effect of land and aquatic exercise on balance scores in older adults | To determine if aquatic exercise was more effective than land-based exercise when training balance | Aquatic: Inground Custom Therapy Pool (Longmont, CO, USA). Land; assisted living recreation area | Subjects were healthy elderly aged 65 years and older who were independent walkers with or without an assistive device and independent in activities of daily living. Land group: 83.2 ± 8.14 (73–91) years (5 subjects). Aquatic group: 75.0 ± 3.63 (68–78) years (6 subjects) | Exercise was comparable for both land and water and was administered twice a week for 6 weeks. Walking activities (3 times each): 1) walking forward 11 feet, 2) marching forward 11 feet, 3) sidestepping without crossing legs 11 feet, and 4) tandem walking 11 feet. Exercise activities (one set of 15 repetitions): 1) marching in place, 2) hip flexion/extension, 3) hip abduction/adduction, 4) toe raises/heel raises, 5) shallow knee bends, 6a) sit to stand from chair in land group, 6b) sit to stand from pool shelf in aquatic group | BBS score | There was a significant main effect of time (P < 0.001) but not group on BBS scores. There was no significant interaction between group and time | The utilization of lower body exercise, whether in water or on land, was accompanied by improved balance |
| Liquori et al23 | 2003 | Effects of a 6-week prenatal water exercise program on physiological parameters and wellbeing in women with pregnancies in the 2nd–3rd trimesters: a pilot study | To evaluate an established prenatal water aerobics program for its impact on the physiological function and wellbeing of females with low risk pregnancy in the 2nd and early 3rd trimesters | A pool in a rehabilitation center | Seven healthy females with uncomplicated singleton pregnancies participated in the exercise group (mean age 32.8 years). Six women having the same characteristics participated in the control group (mean age 30.5 years) | Participating in the 1-hour water aerobic exercise class using a pool in a rehabilitation center, 2 or 3 times a week for 6 weeks | Cooper 6-minute walk test, muscle force in the quadriceps, shoulder abductors, biceps, and triceps, and the health promoting lifestyle profile II questionnaire | Post-test measures of strength in the quadriceps and biceps, as well as the subscale of physical activity within the HPLP II questionnaire were greater in the exercise group | This study outcome supported the effect of prenatal water aerobic exercise but further research with greater number of subjects is necessary to establish the most effective protocols |
| Lin et al24 | 2004 | Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial | To examine the effectiveness of a 12-month community-based water exercise program on measures of self-reported health and physical function in people aged over 60 years with knee-hip OA | Public community swimming pool in Sheffield, UK | One hundred and six community-dwelling sedentary older people (aged >60 years), with conformed knee-hip OA, enrolled in an experimental controlled trial for 12 months. Sixty-six subjects in the exercise group were offered a water-exercise program. Forty age-matched, nonexercising, ‘control’ subjects received monthly education material and quarterly telephone calls | Participants in the exercise group were asked to attend two exercise sessions a week of 1 hour for 12 months led by specially trained swimming instructors | The disease-specific Western Ontario, McMaster University Osteoarthritis Index (WOMAC), a battery of performance-based physical function tests | After 1 year, participants in the exercise group experienced a significant improvement in physical function (4.0 ± 9.1 versus −0.4 ± 7.3 units; 95% CI 0.96–7.96, P < 0.05) and reduction in the perception of pain (1.3 ± 3.7 versus 0.2 ± 2.5 units; 95% CI −0.19–2.52, P < 0.05) compared with the control group, as measured by the WOMAC Osteoarthritis Index. In addition, the exercise group performed significantly better in the ascending and descending stairs tests (P < 0.05), had significantly greater improvements in knee range of movement (P < 0.01) and hip range of movement (P < 0.005). There were no significant differences in the two groups for quadriceps muscle strength and psychosocial wellbeing (Arthritis Impact Measurement Scales 2 questionnaire) | Older people with knee/hip OA gained modest improvements in measures of physical function, pain, general mobility, and flexibility after participating in 12 months of community-based water exercise |
| Akamine et al25 | 2005 | Effects of underwater exercise with hot spring bathing on middle aged people | To investigate the effects of underwater exercise with hot spring bathing on middle aged people | No description | Three males and 22 females (59.6 ± 8.9 years) without serious systemic complication | Group A: (1-day intervention): underwater exercise (70 minutes) and hot spring bathing (20 minutes). Group B: (1-day intervention): underwater exercise (70 minutes) and fresh water bathing (20 minutes) Group C: no exercise, no bathing | Blood pressure, total cholesterol, CD4, red blood cells, hematocrit, total protein, and POMS | Exercise with bathing significantly lowered values of DBP, TC, CD4, red blood cells, hematocrit, and total protein when compared with the before exercise with bathing group (P < 0.05). After exercise with bathing, significantly lower levels of depression-dejection, anger-hostility and confusion in POMS test were observed when compared with control group | Underwater exercise with hot spring bathing has good effects on the health of middle aged people |
| Takumi et al26 | 2005 | Participation in an aquatic exercise class twice a week for 12 weeks improved physical fitness for good walking, walking self-efficacy on winter roads, mental health and QOL in elderly women | This study investigated whether the level of good walking, walking SE on winter roads, mental health and QOL improved through participation in an aquatic exercise class (twice a week, for 12 weeks) in elderly women | A pool with water temperature 34°C | The subjects were 15 females who took part in the aquatic exercise class and 16 females in the control group (over 60 years) | The duration of each class was 60 minutes (twice a week, for 12 weeks) and was conducted under the guidance of a skilled instructor | Good walking tests (standing on one leg with eyes open, Bosu balance score), walking SE, MHP, and QOL | Good walking tests of the final class were improved compared with the first class (P < 0.05). Walking SE on winter roads did not change in either group, but the SE scores for general falling were significantly increased at the last class compared with the first class in the exercise group (P = 0.032). The stress scores of MHP did not increase in the exercise group, which indicates that participating in the aquatic exercise class was not stressful. In QOL measures, the scores of physical symptoms (P < 0.001) and the mean of QOL (P = 0.028) was significantly improved at the last class compared with the first class in the exercise group | Participation in an aquatic exercise class is suggested to be effective for promoting good walking, QOL, and an active lifestyle |
| Takumi and Moriya27 | 2005 | Participation in an aquatic exercise class for 12 weeks improved physical fitness for good walking, walking self-efficacy on winter roads, mental health and QOL in elderly women | This study investigated whether participation in an aquatic walking class (once a week, for 12 weeks) had an effect on middle-aged and elderly women, compared with no participation | A pool with water temperature 29°C | The subjects were 35 women (58.5 ± 8.3 years) who took part in the aquatic exercise class and 24 women (61.0 ± 7.4 years) in the control group | The duration of the exercise class was 50 minutes (once a week, for 12 weeks) under the guidance of a skilled instructor. Averages of % HRR during exercise were 24%–34%, so that the intensity of exercise was lower middle level | Mood Check List- Short Form 1, good walking tests (maximal one step distance, one leg squat, Bosu balance test, 10 m walk time), walking SE | Mood Check List-Short Form 1 for pleasantness and relaxation significantly increased post-exercise compared with pre-exercise every time (P < 0.001). Good walking tests in the 12th week improved compared with those from the first week. The scores of walking SE in strong wind and on an icy surface in the 12th week were increased compared with the scores from the first week. No changes were observed in the control women group | No changes were observed in the control group |
| Lee28 | 2006 | Comparison of effects among Tai Chi exercise, aquatic exercise, and a self- help program for patients with knee osteoarthritis | To compare the effects between Tai Chi exercise, aquatic exercise, and a self-help program for knee OA patients on symptoms of arthritis, muscle strength, balance, and difficulty of programming activities | Tai Chi exercise and self-help program: public health center. Aquatic exercise: a pool | Tai Chi exercise group (N = 18: 61.3 ± 9.5 years), aquatic exercise group (N = 16: 66.4 ± 6.7 years) and self-help program group (N = 16: 61.6 ± 7.6 years) were enrolled for this study. All subjects had knee OA and did not have an exercise regime during the past 6 months | Tai Chi exercise and aquatic exercise group exercised twice a week (1 hour) for 2 months. In the self-help program group, they exercised once a week (2 hours) for 2 months | Muscle strength, balance and difficulty of performing activities (K-WOMAC Index) | The Tai Chi group was significantly different from the self-help group for knee extensor peak torque, knee flexor, and stiffness. In addition, the Tai Chi group or aquatic group were significantly different from the self-help group for difficulty of performing activities | The Tai Chi group or aquatic group were significantly different from the self-help group. However, it seems that Tai Chi exercise may be more suitable than aquatic exercise in an OA exercise program |
| Lord et al29 | 2006 | The effects of water exercise on physical functioning in older people | To determine whether a 22-week water exercise program can improve physical functioning in older people | All participants in central and eastern Sydney. The exercises were undertaken in heated pools with water temperatures that ranged between 25°C and 29°C | Eighty-five persons (18 males and 67 females, mean age 71.8 years) participated in a water-exercise program, and 44 control subjects (7 males and 37 females, mean age 76.5 years) participated in the study | The exercisers participated in approximately 1-hour exercise sessions once a week for two 10-week periods (with 2-week inter-term break). The intervention comprised the ‘WAVES’ water exercise program specifically designed for older people | Leaning balance, quadriceps strength, reaction time and shoulder range of motion | The 48 exercise subjects who were available for retest showed significantly improved leaning balance (as measured by tests of maximal balance range and coordinated stability) and shoulder range of motion compared with the controls. The groups did not differ in tests of quadriceps strength and reaction time. However, 37 people dropped out from the program because of dislike of the pool environment (N = 7), move/vacation (N = 6), hospitalization (N = 5), illness (N = 11), caring for sick spouse (N = 2), requested no second interview (N = 2), deceased (N = 1), changed to another program (N = 1), and no reason (N = 2) | These findings show that water exercise can produce benefits with regard to improving balance and flexibility in older people |
| Smith and Michel30 | 2006 | A pilot study on the effects of aquatic exercises on discomforts of pregnancy | To estimate the impact of an aquatic exercise program on the perception of body image, participation in health-promoting behaviors, barriers to health-promoting participation, level of physical discomfort, and mobility | No description | Forty nonexercising pregnant women with more than 19 weeks gestation. Based on self-selection, participants were assigned to either aquatic exercise group (N = 20: 25.1 ± 4.9 years) or control group (N = 20: 24.8 ± 5.6 years) | The aquatic exercise group participated in a 60-minute, 6-week aquatic exercise program (three sessions per week). The control group was instructed to continue their normal activities of daily living | The Pregnancy Body Shape Questionnaire, the Health Promotion Lifestyle Profile, the Timed Get Up and Go Test, and the Discomfort Intensity Index | Women in the aquatic exercise group reported significantly less physical discomfort, improved mobility, and improved body image and health-promoting behaviors as compared with control subjects | Aquatic exercise during pregnancy may enhance physical functioning, decreasing maternal discomfort, improving maternal body image, and improving health-promoting behaviors |
| Chishaki et al31 | 2006 | Comparison of usefulness between water exercise and gymnastic exercise, Jikyojutsu, in maintaining physical ability for the elderly | To compare physical ability and physical characteristics of elderly women between water exercise and gymnastic exercise | No description | The aquatic group consisted of 21 healthy females (60 ± 5.2 years). The land group consisted of 10 healthy females (60 ± 3.2 years) | Aquatic group: aquatic walking, swimming (twice or more [60 minutes at a time] a week for 1 year). Land group: gymnastic (shoulder raise/lower, arm raise/lower, push-up, lower back twist, straddle stretching, head shake, tumble, etc) (every day [20 minutes in the morning and the afternoon] of the week for 1 year) | Physical characteristics (body mass index, waist size, hip size, % fat), and physical fitness (10 m walking, 10 m maximal walking, 10 m obstacle walking, single-leg standing with eyes open, grip strength, sit up, side steps, sitting-toe-touch test, VO2 max) | The mean percentage of fat mass was reduced in the gymnastic exercise group without change of weight. The average estimated maximal oxygen uptake increased in the gymnastic exercise more than in the water exercise. Sitting trunk flexion was decreased in both groups after 1 year | The results of this study suggested that water exercise could be more beneficial by adding flexibility exercise in the gymnastic exercise, and could maintain and promote physical fitness in elderly people |
| Kawasaki et al32 | 2007 | The effect of aquatic exercise on preventing falls and lifestyle related disease among middle-aged and elderly people | To evaluate the effects of water exercise on blood pressure, carbohydrate and lipid metabolism, arterial sclerosis, and stability of center of mass in middle- and old-age | A swimming club in Kyushu Sangyou University | Eleven healthy males and 24 healthy females were assigned to the training group (N = 35, 61.5 ± 0.8 years) and control group (N = 22, 62.6 ± 0.9 years) | A 2-hour program consisted of stretching, bicycling, walking in warm (30.5°C) water stream, and swimming twice weekly. The training period was 6 months | Anthropometric variables, blood pressure, HR, work load, blood biochemical values, urine testing, blood pressure pulse wave, and stability of center of mass | Weight, body mass index, amount of body fat, blood pressure, and pulse wave velocity decreased and lipid and carbohydrate metabolism and index of arterial sclerosis significantly improved in the training group | Water exercise may be useful for controlling metabolic syndrome and preventing falls in the middle-aged and elderly |
| Nishikawa et al33 | 2008 | Effect of aquatic walking on the cardiovascular patients in our hospital and health-related QOL – in comparison with indoor exercise therapy | To compare the effectiveness of a program of aquatic exercise therapy and land exercise therapy in patients with heart disease | Rehabilitation pool | The aquatic group consisted of 11 males and 3 females 66 ± 7 years. The land group consisted of 8 males and 2 females 63 ± 9 years. Patient characteristic (aquatic/land); angina pectoris (7/5), myocardial infarction (4/5), valve replacement (2/0), dilatative cardiomyopathy (1/0) | Aquatic exercise therapy: stretching, aquatic walking, resistance training. Land exercise therapy: stretching, resistance training, aerobic exercise (ergometer). Each therapy was conducted two times (60 minutes at a time) a week for 3 months | ATVO2, VO2 max, and health-related QOL | ATVO2, VO2 max, and health-related QOL were significantly improved in both groups | The improvement of aerobic fitness was similar in both groups. The difference of improved effect in QOL was due to the fact that the content and the environment of each exercise were different |
| Rotstein et al34 | 2008 | The effect of a water exercise program on the bone density of postmenopausal women | To examine the effect of a 7-month program of water exercise on BMD in postmenopausal females | A heated pool | Thirty-five postmenopausal females aged 50–65 (20 in the experimental group and 10 in the control) | The exercise group trained for 7 months with three 1-hour sessions per week. Each session was divided into four different segments: warm-up, aerobic set, strengthening muscles, and loading the bones, and cool down and stretches | Bone density by DEXA (lunar) for vertebrae L2–L4 and femoral neck of the legs | DEXA test findings for femoral neck density indicated no significant differences between the groups pre- and post-treatment. However a significant interaction was found for BMC in the right leg indicating an increased trend in BMC in the experimental group and a trend towards decrease for the control group | It is possible to plan and execute a water exercise program that has a positive effect on bone status of postmenopausal women |
| Brady et al35 | 2008 | The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study | To determine the feasibility of implementing and investigating the effect of a combined aquatic and land-based rehabilitation program in the post-operative rehabilitation of rotator cuff tears | University of Sydney and Delmer Private Hospital | Eighteen subjects undergoing rotator cuff repair. Aquatic and land group (N = 12, 56.3 ± 9.1 years) and land group (N = 53.5 ± 16.0 years) | Twice per week for 12 weeks. Combined aquatic- and land-based program: standard protocol (passive ROM, active-assisted ROM, resistive phase). Standard land-based program: standard protocol, adding 10 days postoperatively three primary stages: buoyancy assisted ROM, buoyancy supported ROM, and resistive phase | Passive ROM (forward flexion, external rotation), WORC index, health-related QOL, and 11-point VAS | Both subjects improved passive ROM and WORC. Participation in aquatic therapy significantly improved passive flexion range of motion measured at 3 and 6 weeks. No significant differences in the attendance rate and patients perceptions of the programs | The implementation of a combined aquatic- and land-based physiotherapy program following surgical repair of the rotator cuff is feasible and presents a potentially viable alternative to conventional land-based exercise with comparable outcomes |
Note:
*Description of study design was omitted.
Abbreviations: ATVO2, anaerobic threshold oxygen consumption; BBS, Berg Balance Scale; BMC, bone mineral content; BMD, bone mineral density; CG, control group; CI, confidence interval; COP, center of pressure; CRF, chronic kidney disease; Cys-C, cystatin-c; DBP, diastolic blood pressure; GFR, glomerular filtration rate; GSH, glutathione; HDL-C, high density lipoprotein cholesterol; HR, heart rate; HRR, heart rate reserve; HPLP II, Health Promotion Lifestyle Profile II; JOA, Japanese Orthopedic Association; LDL-C, low density lipoprotein cholesterol; LPO, lactoperoxidase; MHP, mental health pattern; NHP, Nottingham Health Profile; OA, osteoarthritis; POMS, Profile of Mood States; QOL, quality of life; ROM, range of motion; SBP, systolic blood pressure; SE, self-efficacy; TC, total cholesterol; TG, training group; U-prot, protein/creatinine ratio; VA, vital age; VAS, visual analog scale; VO2 max, maximal oxygen consumption; WORC, Western Ontario Rotator Cuff.