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Meta-Analysis
. 2011 Jan 19;2011(1):CD008186.
doi: 10.1002/14651858.CD008186.pub2.

Water-based exercises for improving activities of daily living after stroke

Jan Mehrholz  1 , Joachim Kugler, Marcus Pohl
Affiliations
Meta-Analysis

Water-based exercises for improving activities of daily living after stroke

Jan Mehrholz et al. Cochrane Database Syst Rev. .

Abstract

Background: Water-based exercises are used in rehabilitation and might help to reduce disability after stroke.

Objectives: To investigate the effect of water-based exercises for reducing disability after stroke.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched August 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to April 2010), EMBASE (1980 to April 2010), CINAHL (1982 to April 2010), AMED (1985 to April 2010), SPORTDiscus (1949 to April 2010), the Physiotherapy Evidence Database (PEDro, April 2010) and OT Seeker (1969 to April 2010). In an effort to identify further published, unpublished and ongoing trials we handsearched relevant journals and conference proceedings, searched trials and research registers, checked reference lists and contacted authors.

Selection criteria: We included studies using random assignment.

Data collection and analysis: Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcome was activities of daily living.

Main results: We included four trials involving 94 participants in this review. There was a significant improvement in activity of daily living (mean difference (MD) 13.20 points on the 'Capacidad funcional' (functional capacity) subscale of the Brazilian-Portuguese version of the SF-36; 95% confidence interval (CI) 8.36 to 18.04; P < 0.00001) and on muscle strength (MD 1.01 Nm/kg; 95% CI 0.19 to 1.83; P = 0.02) but these results should be interpreted with caution because population numbers were small and the results are based on single studies. There was no significant improvement in ability to walk (MD 0.14 m/s; 95% CI -0.32 to 0.606; P = 0.55), postural balance (MD 3.05 points; 95% CI -3.41 to 9.52; P = 0.35) or fitness (MD 3.6 (VO(2max); 95% CI -0.53 to 7.73; P = 0.09) after water-based exercises treatment compared to control. Adverse effects were not reported.

Authors' conclusions: The evidence from randomised controlled trials so far does not confirm or refute that water-based exercises after stroke might help to reduce disability after stroke. There is a lack of hard evidence for water-based exercises after stroke. Better and larger studies are therefore required.

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Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Analysis 1.1
Analysis 1.1
Comparison 1 Water‐based exercises versus no water‐based exercises, Outcome 1 Activities of daily living.
Analysis 1.2
Analysis 1.2
Comparison 1 Water‐based exercises versus no water‐based exercises, Outcome 2 Ability to walk.
Analysis 1.3
Analysis 1.3
Comparison 1 Water‐based exercises versus no water‐based exercises, Outcome 3 Postural control.
Analysis 1.4
Analysis 1.4
Comparison 1 Water‐based exercises versus no water‐based exercises, Outcome 4 Muscle strength.
Analysis 1.5
Analysis 1.5
Comparison 1 Water‐based exercises versus no water‐based exercises, Outcome 5 Fitness.
Analysis 1.6
Analysis 1.6
Comparison 1 Water‐based exercises versus no water‐based exercises, Outcome 6 Drop out from study during the treatment phase.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. Aidar FJ, Silva AJ, Reis VM, Carneiro A, Carneiro‐Cotta S. A study on the quality of life in ischaemic vascular accidents and its relation to physical activity. Revista de Neurologia 2007;45(9):518‐22. - PubMed
    1. Chan K, Suter L, Heth D, Pauley T, Boulias C, Ismail F. A study examining the effect of hydrotherapy on balance in post stroke out‐patients. Stroke 2010;41:e492.
    1. Chu KS, Eng JJ, Dawson AS, Harris JEm Ozkaplan A, Gylfadottir S. Water‐based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2004;85:870‐4. - PMC - PubMed
    1. Noh DK, Lim JY, Shin HI, Paik NJ. The effect of aquatic therapy on postural balance and muscle strength in stroke survivors ‐ a randomized controlled pilot trial. Clinical Rehabilitation 2008;22:966‐76. - PubMed

References to studies excluded from this review

    1. Marronie A. Hyperbaric oxygen and in‐water rehabilitation in complete stroke. Journal of Hyperbaric Medicine 1988;3(1):15‐27.
    1. Revnic CRS, Teleki NG, Revnic FG. Rehabilitation therapy in hemiplegic patients post‐stroke. European Journal of Neurology 2004;11 Suppl 2:150 (Abst P1439).
    1. Wang Y‐H, Dai R, Dong M‐T, Lin L. Effects of seawater physical exercise on cerebral and cardiac hemodynamics in patients with cerebral infarction. Chinese Journal of Clinical Rehabilitation 2004;8(16):3006‐7.

References to studies awaiting assessment

    1. Lee SG, Lee SY, Im HL, Kim JH. Effect of hydrotherapy on the functional status in ischemic stroke patients. Neurorehabilitation and Neural Repair 2006;20(1):171 (Abst P2‐074).
    1. Xu W, Zhang L, Fan J. The comparison of gait rehabilitation in patients with hemiplegia by walking in water and the pneu‐weight walking therapies. Journal of Rehabilitation Medicine 2008;73 Suppl 46:Abst PP001‐055.

References to ongoing studies

    1. Gunn S. The effectiveness of higher intensity water‐ and gym‐based exercise programs on gait speed: a randomised controlled trial following stroke (pilot). Australian New Zealand Clinical Trials Registry (ANZCTR) http://www.anzctr.org.au/2007.

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