Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review

Abstract

Background According to the World Health Organization, the elderly are at the highest risk of injury or death from a fall. Age-related changes in strength, balance and flexibility are degenerative factors that may increase the risk of falling, and an aquatic training may offer a favourable environment to improve these modifiable risk factors. Methods A systematic review was conducted to assess the potential preventative role of aquatic exercise for reducing the risk of falls in the elderly by improving predisposing risk factors. Electronic databases and reference lists of pertinent articles published between 2005 and 2018 were searched. Randomized controlled trials (RCTs) that directly or indirectly addressed the effect of aquatic exercise for the prevention of falls in healthy participants were included within the synthesis. Studies were included if they were reported between January 2005 and May 2018 within a population aged between 60 and 90 years old that were without exercise-effecting comorbidities. Data related to participant demographics, study design, methodology, interventions and outcomes was extracted by one reviewer. Methodological quality assessment was independently performed by two reviewers using the PEDro (Physiotherapy Evidence Database) scale. Results Fourteen trials met the inclusion criteria. Exercise intervention duration and frequency varied from 2 to 24 weeks, from 2 to 3 times per week, from 40 to 90 min per session. Fall rate was not reported in any of the studies analysed. However, aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling. Conclusions There is limited, low-quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling. Although the evidence is limited, and many interventions are not well described, these results should be considered by health and exercise professionals when making evidence-based, clinical decisions regarding training programmes to reduce the risk of falling.

The Effects of Physical Exercise on Balance and Prevention of Falls in Older People: A Systematic Review and Meta-Analysis

“…In particular, only two studies analyzed aquatic therapy [34,35], which seems to be an interesting alternative to land-based exercise for the geriatric population, permitting low-impact and low-weight-bearing exercise. In fact, Guillamon et al [52] presented some evidence that aquatic exercise can improve modifiable risk factors of falls, although the quality of this evidence was low, and there was a lack of consistency between studies. A limitation of this systematic review was the high variability of the training protocols of the included studies.…”

A systematic review and meta-analysis comparing the effect of aquatic and land exercise on dynamic balance in older adults

“…Previous systematic reviews have summarized empirical evidence for aquatic exercises on strength, mobility, flexibility, balance, and various health outcomes in older adults [12,13,17]. Observations from these reviews have indicated that aquatic exercises may improve the aforementioned outcome measures.…”

“…Aquatic exercises have been utilized as an alternative to land-based exercises for older adults that display lower physical activity levels, neuromuscular degeneration, or orthopedic disabilities that affect balance, mobility, and pain [ 12 – 14 ]. For this systematic review and meta-analysis, we defined the aquatic exercise as any type of exercise performed in water.…”

Systematic review of aquatic physical exercise programs on functional fitness in older adults

“…These aquatic activities have to do with the development of varied types of motor practices, which have to do with educational, competitive, utilitarian, recreational, preventive, therapeutic, training and maintenance objectives. 24. In general, these aquatic activities developed in aging populations provide a low-impact and lightweight environment where people can exercise safely, 12 where buoyancy, pressure, resistance and water temperature maximize the effectiveness of aquatic exercise, allowing light and safe body movements. 25 Regarding the protocols used, the 9 systematized studies have reported varied intensities, frequencies and durations of the intervention programs.…”

“…[5][6][7] Currently, several studies have shown that physical activity programs based on aquatic exercise have produced significant positive changes in the functional fitness of older adults. [8][9][10][11] Therefore, it is necessary for aging populations to participate in these intervention programs to improve their levels of agility, balance, coordination, strength, flexibility and speed, 12 as well as, muscle power, respiratory muscle function, postural stability, and aerobic capacity. 13 Aquatic programs are defined as a set of exercises performed in water, mainly in upright position, with or without music, and in shallow or deep water, 14 or even involves any type of physical exercise that is practiced immersed in water.…”