Effectiveness Of Aquatic Exercise On Dynamic Balance In Older Adults: A Systematic Review And Meta-analysis

Abstract

Balance and mobility impairments are the leading causes of falls in older adults. Aquatic-based exercises have been broadly practiced as an alternative to land-based exercises due to several beneficial effects. However, there has been no systematic review with meta-analysis regarding the effects of aquatic exercises on dynamic balance in older adults. PURPOSE: To compare the effectiveness of aquatic exercises (AE) to land exercises (LE) on dynamic balance in older adults. METHODS: Electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, psycINFO), from inception to March 2019, were searched. Studies met the following eligibility criteria: Randomized controlled trials, English language, older adults aged 65 years or older, a minimum of one AE group and one LE group, at least one assessment for dynamic balance. For the meta-analysis, the effect sizes of dynamic balance outcomes were calculated using a weighted mean difference (WMD) or a standardized mean difference (SMD) and a 95% confidence interval (CI). RESULTS: A total of 9 trials met the inclusion criteria, and 7 studies including 328 participants (age = 69.6 ± 6.4yr) were eligible for the meta-analysis. Exercise intervention duration and frequency varied from 4 to 20 weeks, from 2 to 5 sessions per week, from 45 to 60 min per session. The tests most used in the studies were Berg Balance Scale (BBS), Tinetti scale, gait assessment, Functional Reach Test (FRT), Timed Up and Go test (TUG), and Five Times Sit-to-Stand test (FTSTS). The meta-analysis showed that older adults in AE groups demonstrated comparably enhanced dynamic balance compared with those in LE groups (SMD = 0.38; 95% CI, 0.16-0.60). Subgroup analysis showed that there were no differences in BBS (WMD = 1.66; 95% CI, -0.27-3.59; P = .09), FRT (WMD = 2.40; 95% CI, -3.38-8.18; P = .42), TUG (WMD = 0.98; 95% CI, -0.08-2.04; P = .07), and FTSTS (WMD = 2.05; 95% CI, -0.59-4.70; P = .13) between AE and LE groups. CONCLUSION: AE may have comparable effects on dynamic balance abilities in older adults aged 65 years or older when compared to LE, which implies that AE may serve as a safe low-impact alternative to LE. Older adults may participate in various physical activities in the safer aquatic environment to improve dynamic balance and possibly reduce the risk of falls.