Does Aquatic Exercise Relieve Pain in Adults With Neurologic or Musculoskeletal Disease? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Hall, Jane; Swinkels, Annette; Briddon, Jason; McCabe, Candy

doi:10.1016/j.apmr.2007.09.054

Cited by 103 publications

(70 citation statements)

References 45 publications

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“…[57][58][59] They also found a 3% absolute reduction and a 6.6% relative reduction in pain, measured on a visual analogue scale (n = 638, standardised mean difference 0.19, 95% CI 0.04 to 0.35). The meta-analyses identified no differences for walking ability or stiffness.…”

Section: Evidence For Effectivenessmentioning

confidence: 88%

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation

Hind

Parkin

Whitworth

et al. 2017

Health Technol Assess

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BackgroundDuchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent.ObjectivesTo assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work.DesignParallel-group, single-blind, randomised pilot trial with nested qualitative research.SettingSix paediatric neuromuscular units.ParticipantsChildren with DMD aged 7–16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8–34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications.InterventionsParticipants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise.Main outcome measuresFeasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs.ResultsOver 6 months, 348 children were screened – most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was –5.5 [standard deviation (SD) 7.8] for LBT and –2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient.LimitationsThe focus on delivery in hospitals limits generalisability.ConclusionsNeither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended.Trial registrationCurrent Controlled Trials ISRCTN41002956.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information.

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Section: Evidence For Effectivenessmentioning

confidence: 88%

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation

Hind

Parkin

Whitworth

et al. 2017

Health Technol Assess

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“…Hall et al (22) highlight the uncertainty concerning the ideal duration of analgesia induced by physical exercise, but they suggest that the interaction between intensity and duration affect analgesia. The authors report that water training programs of shorter duration (2x/week) are less efficient to pain relief.…”

Section: Discussionmentioning

confidence: 99%

Avaliação do exercício físico como fator de analgesia em um modelo experimental de ciatalgia

Gaffuri

Meireles

Rocha

et al. 2011

Rev Bras Med Esporte

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Objective: To evaluate the efficacy of physical exercise (swimming and jumping), with and without overload, working in reducing the pain of rats undergone to an experimental model of sciatica. Methods: 24 rats were divided into four groups: Placebo (PG), Swimming Group (SG) Swimming 10% Group (SG10) and Jump Group (JG). All groups were submitted to the experimental sciatica model and assessed for pain post-exercise for the Functional Disability Test and the Von Frey filament. Results: In comparison within groups there were significant differences in the moments after injury with the pre-injury, for both assessment instruments. With Von Frey filament was observed a significant difference in group GN10 and GS in the final moments of evaluation. In comparisons between groups were not statistically significant differences obtained with any assessment instrument. Conclusion: Treatment with physical exercise was not effective in reducing pain in rats subjected to experimental sciatica model.

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“…Dentre as modalidades de exercícios aquáticos, a caminhada tem sido utilizada em atividades de reabilitação, terapêuticas e também em programas de condicionamento específicos, sendo particularmente útil para indivíduos com lesões nos membros inferiores. Tal modalidade de exercício destaca-se ainda pelo fato de não envolver habilidades especiais, além de poder ser realizada nas mais variadas condições de saúde do indivíduo (1,2) . Na reabilitação em ambiente aquático é necessário conhecer, além das sutilezas do meio, as alterações fisiológicas produzidas nas diversas modalidades de atividades, durante e após a imersão em diferentes condições de temperatura da água.…”

Section: Introductionunclassified

Efeito da temperatura da água nas respostas cardiovasculares durante a caminhada aquática

Ovando

Eickhoff

Dias

et al. 2009

Rev Bras Med Esporte

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O objetivo deste estudo foi verificar o efeito da temperatura da água nas respostas cardiovasculares: frequência cardíaca (FC), pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD), durante a caminhada aquática em três temperaturas (29°C, 33°C e 37°C). Participaram do estudo 10 homens, com média de idade de 23,2 ± 2,25 anos, massa corporal de 78,4 ± 4,01kg e estatura de 1,774 ± 0,017m. Os participantes realizaram caminhadas aquáticas durante 30 min, a uma cadência controlada de 55 passos/minuto, na altura do processo xifoide, em dias diferentes para cada temperatura, sendo as respostas cardiovasculares monitoradas nos minutos 5, 10, 20 e 30. Apesar do efeito principal de 75,4% (p < 0,001) da temperatura da água sobre a variação da FC, também foi identificado um efeito do tempo de exercício de 91,8% (p = 0,001). A FC aumentou gradativamente no decorrer da caminhada, especialmente na temperatura de 37°C (71,3 ± 8,4 para 114,6 ± 4,4); ao final da caminhada foi maior que os 29°C (p < 0,01) e 33°C (p < 0,05); estas últimas não apresentaram diferença entre si. A temperatura parece ter tido pouco efeito sobre a PAS, visto que apenas nos minutos 20 e 30 foi maior aos 33°C comparada com a de 29°C (p < 0,05). A PAD sofreu efeito da temperatura, diminuindo gradativamente no decorrer da caminhada, especialmente na temperatura de 37°C (70,0 ± 5,0 para 40,0 ± 2,5); apresentou diferença significativa em relação às temperaturas de 29°C e 33°C (p < 0,05), as quais não mostraram diferença entre si. Considerando o efeito da temperatura da água sobre a FC e a PAD durante a caminhada aquática, sugere-se que, quando piscinas terapêuticas forem utilizadas para realização de caminhada na água, a escolha da temperatura da água seja considerada, recomendando-se valores entre 29°C e 33°C para menor estresse cardiovascular.

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Does Aquatic Exercise Relieve Pain in Adults With Neurologic or Musculoskeletal Disease? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 103 publications

References 45 publications

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation

Avaliação do exercício físico como fator de analgesia em um modelo experimental de ciatalgia

Efeito da temperatura da água nas respostas cardiovasculares durante a caminhada aquática

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