Why was this study necessary?

Various forms of land-based exercise have been shown to be beneficial for people with Parkinson’s disease (PD). Water-based exercise has also become very popular in the management of disease severity and motor impairments in people with PD, but the evidence for it has not been adequately summarised.

How did you collect the data?

We systematically reviewed the literature following the preferred reporting items for systematic reviews and meta-analysis guidelines to identify any relevant randomised controlled trials focused on specific supervised aquatic exercise programs (> 2 weeks) for people with idiopathic PD. The systematic review protocol was registered in the international prospective register of systematic reviews.

What were the outcome?

Our primary outcomes were disease severity, motor impairments, activity performance, and fear of falling, while the secondary outcomes were non-motor impairments and quality of life.

What were the results?

Of the 129 identified records, we found seven trials in which the intervention was aquatic exercise. One trial assessed its effects compared with a control group (no exercise) and found a significant improvement in the Unified Parkinson’s Disease Rating Scale Part III in favour of aquatic exercise, while six studies (159 participants), which compared aquatic exercise with land-based exercise after intervention (7.2 weeks of training) entered the meta-analysis.

Our data showed that the effect of aquatic exercise was superior to land-based exercise on the Berg Balance Scale (BBS), the Falls Efficacy Scale and the 39-item Parkinson’s Disease Questionnaire (PDQ-39), with no other significant effects identified. Moreover, the significant benefit on the Berg Balance Scale was maintained at the follow-up assessment (54 participants). According to the GRADE assessment, all the analysed outcomes were scored as very low to low quality of evidence, except for PDQ-39, which was scored as high, and BBS at the end of the treatment period, which was scored as moderate.

What can clinicians take from this study?

Ultimately, clinicians or patients who have the chance to choose among different rehabilitation protocols may opt for aquatic exercise rather than land-based exercise, especially in the presence of relevant motor impairments (shuffling gait, start hesitation, freezing of gait, festination, impaired gait propulsion and difficulty in turning), which increase the risk of falling during exercise. However, the potential extra costs and complexity of aquatic context need to be considered case by case in this clinical decision.

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Dr Lucia Cugusi is a physical therapist and a research fellow in cardiovascular sciences at the University of Cagliari, Italy. Her research is related to the exercise- based rehabilitation programs adapted to individuals with chronic-degenerative diseases, with particular attention to the area of cardiovascular and neurological sciences.