In people with Parkinson disease, aquatic exercise improved some outcomes more than land-based exercise

Cugusi L, Manca A, Bergamin M, et al. Aquatic exercise improves motor impairments in people with Parkinson's disease, with similar or greater benefits than land-based exercise: a systematic review. J Physiother. 2019;65:65-74.

Review question

In people with Parkinson disease, how does aquatic exercise compare with land-based exercise for improving symptoms and quality of life?

Background

Parkinson disease causes movement symptoms (including tremors and rigidity), impairs posture and balance, and reduces quality of life. Exercise has been shown to help reduce some symptoms of Parkinson disease.

Aquatic exercise has been shown to reduce pain and stiffness in some people, but it is not known whether aquatic exercise can help people with Parkinson disease.

How the review was done

The researchers did a systematic review of studies available up to December 2017. They found 6 randomized controlled trials that included 166 people.

The key features of the studies were

• the average age was 61 to 70 years, and 64% were men;
• people had Parkinson disease for an average of 6 to 9 years and had mild to moderate disability;
• aquatic exercise was done in group classes supervised by physiotherapists for 45 or 60 minutes, 2 to 5 times per week, for 4 to 10 weeks;
• aquatic exercise was compared with land-based group exercise classes of the same duration and frequency supervised by physiotherapists;
• the effects were measured immediately after the exercise intervention or between 17 days and 8 weeks later.

What the researchers found

Immediately after the classes finished

Compared with land-based exercise, aquatic exercise:

• improved balance by a small amount (2.7 points on a 57-point scale);
• reduced fear of falling by a small amount (2.1 points on a 49-point scale); and
• did not reduce disease severity or motor impairment or improve mobility, activities of daily living, or quality of life.

17 days to 8 weeks after the classes finished

Aquatic exercise did not differ from land-based exercise for any of the outcomes.

Conclusion

In people with Parkinson disease, aquatic exercise improved balance and fear of falling by a small amount compared with land-based exercise immediately after exercise, but these differences did not last when exercise was stopped.

Aquatic vs land-based exercise in people with Parkinson disease