Aquatic Therapy

'''Geriatrics Wiki: Aquatic Therapy'''

Purpose: 

Aquatic therapy (AT) has been shown to be a viable exercise option for all patients, and it can have additional benefit from specific population such as older adults.1,2 The purpose of this page is to highlight the benefits of AT in the older adult, demonstrate

Objectives:

1.    Introduce some specific indications for AT in the older adult

2.    Introduce some interventions to address strength and endurance

3.    Follow up with some suggested outcome measures to assess the effectiveness of AT for some of the common conditions

4.    Introduction to balneotherapy

Indications:

·      Fibromyalgia: AT decreases pain in this population allowing for increased endurance, improved compliance, and improved sleep quality.3

·      Osteoarthritis: Unweighting the joints that are having pain caused by osteoarthritis allows from more pain-free movement.4

·      Frequent falls: AT may provide a safer medium for balance training for older adults that struggle with land-based balance exercises. AT is equal to land-based programs for improving balance score on the Berg Balance Scale.5

o This can also be applied to a large variety of neurological conditions that have balance and gait deficits.

·      Back pain: Unloading the spine in the pool often can alleviate some of the low pain patients have making it less painful to exercise.

·      Obesity: Performing exercises on land may be too challenging for this population due to their higher body weight, however the buoyancy in the pool can make it much easier to exercise.

These are just a few of the more common applications of AT, however there are countless other conditions AT can benefit. The water temperature is also important to monitor for some conditions.

Contraindications:6

·      Incontinence

·      Open wounds

·      Excessive fear of water

·      Infectious diseases

·      Severe weakness, decreased range of motion, or lack of endurance that could be a safety hazard

'''Example Exercises:'''

·      Forward/backward walking and jogging

·      Side steps

·      Leaps

·      Kicks

·      Arm curls, pushes, and pulls

·      Single leg balance

·      Marching and deep-water bicycle

All of these exercises can be made easier (by moving slower) or harder (by moving quicker or by adding webbing/water weights)

'''Outcome Measures:'''

Fibromyalgia Impact Questionnaire

Berg Balance

Oswestry Disability Index

Balneotherapy:7,8,9

Balneotherapy is the use of natural mineral waters, natural peloids and mud, and natural sources of certain gases for medicinal purposes. The evidence is somewhat conflicting on the effectiveness of this treatment for musculoskeletal conditions. While it is suggested to improve lower back pain, osteoarthritis pain, and chronic inflammatory pelvic diseases, balneotherapy should only be used as an alternative therapy used in addition to other interventions.

'''Additional Resources:'''

Aquatic Therapy Guide

Aquatic Therapy Book

Top 10 Pool Exercises

Aquatic Physical Therapy

Balneotherapy

1.    Chase NL, Sui X, Blair SN. Comparison of the health aspects of swimming with other types of physical activity and sedentary lifestyle. Int J Aquatic Res Educ 2008;2:151-161.

2.    Batterham SI, Heywood S, Keating JL. Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskelet Disord. 2011;12(1):123. doi:10.1186/1471-2474-12-123

3.    Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the Effects of Aquatic Therapy on Global Symptomatology in Patients With Fibromyalgia Syndrome: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2008;89(12):2250-2257. doi:10.1016/j.apmr.2008.03.026.

4.    Wyatt, Frank & Milam, Stacie & Manske, Robert & Deere, Randall. The Effects of Aquatic and Traditional Exercise Programs on Persons With Knee Osteoarthritis. ''Journal of strength and conditioning research / National Strength & Conditioning Association''. 2001;15:337-40.

5.    Douris P, Southard V. The Effect of Land and Aquatic Exercise on Balance Scores in Older Adults. ''Journal of Geriatric Physical Therapy'' Vol. 26;1:03.

6.    Cole AJ, Becker BE. Comprehensive Aquatic Therapy. Butterworth Heinemann; 2004. https://books.google.com/books?hl=en&lr=&id=vovrDRkuthcC&oi=fnd&pg=PR7&dq=contraindications+of+aquatic+therapy&ots=3GmtIi9b5o&sig=dnzPAqEjKLP4smDajtT-7T1YKPs#v=onepage&q=contraindications of aquatic therapy&f=false. Accessed July 12, 2018.

7.    Bender T, Bálint G, Prohászka Z, Géher P, Tefner IK. Evidence-based hydro- and balneotherapy in Hungary—a systematic review and meta-analysis. Int J Biometeorol. 2014;58(3):311-323. doi:10.1007/s00484-013-0667-6.

8.    Kamioka H, Tsutani K, Okuizumi H, et al. Effectiveness of Aquatic Exercise and Balneotherapy: A Summary of Systematic Reviews Based on Randomized Controlled Trials of Water Immersion Therapies. J Epidemiol. 2010;20(1):2-12. doi:10.2188/jea.JE20090030.

9.    Verhagen AP, Cardoso JR, Bierma-Zeinstra SMA. Aquatic exercise &amp;amp; balneotherapy in musculoskeletal conditions. Best Pract Res Clin Rheumatol. 2012;26(3):335-343. doi:10.1016/J.BERH.2012.05.008.