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Effectiveness of Aquatic Exercise in Improving Lower Limb Strength in Musculoskeletal Conditions: A Systematic Review and Meta-Analysis
Abstract
Objective To investigate the effectiveness of aquatic exercise in improving lower limb strength in people with musculoskeletal conditions. Data sources A systematic search used 5 databases, including MEDLINE, CINAHL, Embase, SPORTDiscus, and The Cochrane Library. Study selection Randomized controlled trials evaluating aquatic exercise with a resistance training component for adults with musculoskeletal conditions compared with no intervention or land-based exercise were identified. Fifteen studies from the initial yield of 1214 met these criteria. Data extraction Data related to participant demographics, study design, and methods, interventions, and outcomes, including numerical means and SDs, were extracted independently by 2 reviewers. Data synthesis Nine of the 15 studies were of high quality, scoring at least 6 on the Physiotherapy Evidence Database Scale. Limited consideration of the prescription of resistance in the aquatic exercise and application of resistance training principles existed. Low- or very low-quality evidence indicates there was no difference in average effect between aquatic exercise and no exercise in improving hip abductor strength (standardized mean difference [SMD], .28; 95% confidence interval [CI], -.04 to .59), knee extensor strength (SMD, .18; 95% CI, -.03 to .40), knee flexor strength (SMD, .13; 95% CI, -.20 to .45), or lower limb endurance (SMD, .35; 95% CI, -.06 to .77). Low-quality evidence indicates no difference in average effect between aquatic and land exercise for knee extensor (SMD, -.24; 95% CI, -.49 to .02) or flexor strength (SMD, -.15; 95% CI, -.53 to .22). Conclusions It is likely that the inadequate application of resistance in water is a significant contributor to the limited effectiveness of aquatic exercise interventions in improving hip and knee muscle strength in people with musculoskeletal conditions. Future research is needed to quantify resistance with aquatic exercises and to determine if using opportunities for greater resistance in aquatic rehabilitation and appropriate resistance training principles can be more effective in improving muscle strength.
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Metadata
- Authors
- Heywood, S., McClelland, J., Mentiplay, B., Geigle, P., Rahmann, A., & Clark, R.
- Affiliations
- Australian Catholic University (AU)
- La Trobe University (AU)
- University of Maryland, Baltimore (US)
- University of the Sunshine Coast (AU)
- Corresponding author
- Heywood, Sophie
- Venue
- Archives of Physical Medicine and Rehabilitation
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 98
- Issue
- 1
- Pages
- 173-186
- ISSN
- 0003-9993 (ISSN-L)
- OpenAlex
- W2521795822
- Semantic Scholar
- 1f47d68369860fdea61b97064a9f7f7ffd42bb2c
- Cited by
- 87
- References
- 75
- Citations by year
- 2026: 2 · 2025: 14 · 2024: 7 · 2023: 8 · 2022: 11 · 2021: 15 · 2020: 5 · 2019: 15 · 2018: 8 · 2017: 2
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Physical Medicine and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Keywords
- aquatic exercise, lower limb muscle strength, hip abductor strength, quadriceps strength, hamstring strength, musculoskeletal disorders
- MeSH terms
- Hamstring Muscles, Humans, Musculoskeletal Diseases, Water, Exercise, Randomized Controlled Trials as Topic, Lower Extremity, Quadriceps Muscle, Muscle Strength, Resistance Training
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