Hydrotherapy in the management of chronic obstructive pulmonary disease: a qualitative systematic review

Abstract

Background: Many people worldwide suffer from chronic obstructive pulmonary disease (COPD). Diverse medical conditions have been treated using hydrotherapy for many years but its use in the treatment of COPD is a recent development. Its use in the COPD population may lead to improvements in cardiopulmonary outcomes and quality of life (QoL) and the mastery of activities of daily living (ADL) in people with this disease. Objectives: To determine the effects of hydrotherapy on cardiopulmonary function, QoL, and ADL in people with COPD. Method: Studies relating to adults with non-acute, non-terminal COPD were located by searching electronic databases. Included studies were critically appraised by two independent reviewers using the Lewis, Olds, and Williams tool. Results: Nine studies met the inclusion criteria (n5207 subjects). Sample sizes of individual studies varied between 10 and 43 subjects. Three studies were of above average methodological quality, two were of average, and four were of a poor quality. Thirty-five outcome measures were identified. Cardiopulmonary parameters showed positive increases when the immersed COPD subjects exhaled into water. Aspects of QoL improved with physical training in water. Group hydrotherapy improved ADL performance. Conclusions: The few included studies, which address the use of hydrotherapy in the management of COPD, had small sample sizes and were mainly of low to moderate methodological quality. Hydrotherapy may improve cardiopulmonary, QoL, and ADL outcomes in the COPD population. Investigation into the effects of combined breathing and physical exercise during hydrotherapy, in the COPD population, is needed.

Effectiveness of Water-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

“…Due to the load of water exercise on the respiratory muscles, there may be a significantly positive effect on their strength [2,16]. Five studies assessed respiratory muscle strength using MIP and MEP [22,23,[25][26][27], and only the study by [27] found no improvement in either group; the remaining studies showed improvement in both the WE and the LE.…”

“…Aerobic WE, thanks to the loading effect on respiratory muscles, may also benefit lung function, dyspnea and respiratory muscle strength in COPD patients [2,4,16,17]. However, the meta-analysis by [3] suggests that there may be no significant differences between LE or WE in terms of exercise capacity or pulmonary function improvement [2,3].…”

Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease

“…However, in studies based on aerobic exercise in different water and land environments, exercise capacity showed different performance in the outcome index [8,19] . For example, the results of Shead and Aswegen [18] and McNamara et al [16] found that ESWT was significantly increased in both water and land groups, but the results of ISWT were particularly different. These studies show contradictory results, which may be due to the included study, the frequency, time and content of the intervention, and the severity of the disease.…”

“…Progressive dyspnea can lead to fatigue, [40] prevent physical exercise, and reduce the functional level of patients. [9] Studies found that after aerobic exercise intervention combined with respiratory muscle and auxiliary muscle stretching, [41,42] the dyspnea of COPD patients decreased, the respiratory efficiency needed for ventilation increased, [18] and upper limb fatigue was significantly improved. [42] We observed that the dyspnea level of patients in the aerobic training group decreased significantly by 0.70 (95% CI:-1.12, -0.27).…”

“…A meta-analysis found that there are additional advantages in water, [16] which may be due to the fact that the water environment has physical characteristics such as temperature, hydrostatic pressure, buoyancy, and resistance, which play a positive role in relieving pain and reducing joint load for the lower extremities. Due to the load effect of aerobic exercise in water on respiratory muscles, it may have a significant positive effect on improving lung function, [17] respiratory muscle strength, [18] and dyspnea [19] in COPD patients. However, the study found that there was no difference in changes to lung function or exercise capacity between land and water-based exercise, and there was still insufficient evidence to support the conclusion that either land or water-based exercise led to significant improvement in lung function and exercise capacity.…”