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Table 1 Summary description of the 12 studies included in the review

From: Effectiveness of water-based exercise in people living with Parkinson’s disease: a systematic review

Reference

Aim

Measurement tools (variable)

Evaluation on/off

Participants (n)

Mean age (years)

Disease severity (H&Y)

Duration of PD (years)

Type of intervention

Dropouts during intervention (n)

Adherence

Findings

Reuter et al. [29]

To investigate the influence of an intensive exercise training on motor disability, mood and subjective well-being

BMT (strength, flexibility and coordination), UPDRS (PD Disability Scale), CURS (PD specific motor disability), MMSE (dementia), AMQZ (quality of life), SIP (well-being)

On

E = 16

65.4 ± 5.9

2.84 ± 0.4

6.7 ± 3.7

E = WBE (water program) + LBE (gymnasium program)

E = 0

92.8 %

Significant improvements in UPDRS (p < 0.0001), CURS (p < 0.0001), and BMT (p < 0.0001)

Pellecchia et al. [25]

To evaluate the effects of a rehabilitation program on disability in patients with PD

UPDRS-II (activities of daily living), UPDRS-III (motor symptoms), Ten-Meter Walk (mobility), SaPDDS (PD Disability Scale), Self-rating depression Scale (depression)

On

E = 20

59 ± 11.8

1.5–3

4.8 ± 3.4

E = LBE + WBE (rehabilitation program)

E = 0

NR

Significant improvements in UPDRS-II (p < 0.002), UPDRS-III (p < 0.0001), Ten-Meter Walk p < 0.012), SaPDDS (p < 0.001) and Self-Rating Depression Scale (p < 0.0001)

Pospíšil et al. [27]

To study elucidation of the reaction of basic haemodynamic parameters to water immersion of the lower part of the body

SBP and DBP (blood pressure), HR and RPP (HR × SBP).

On

E = 9

71 ± 7

2.2 ± 0.7

7 ± 3

E = WBE (balneotherapy)

E = 0

NR

Significant reduction of HR (p ≤ 0.05) and DBP values (p ≤ 0.05)

Crizzle and Newhouse [6]

To study the effect of WBE on PD symptoms

ABCS (balance), VPS (health-related quality of life), Ten physical tests (fitness)

On

E = 6

71–89

2

NR

E = WBE (water exercise)

E = 2

89.5 ± 10.2 %

Improvements were found in all analyzed variables, except in flexibility tests, ABCS and VPS

Therrien et al. [34]

To study the effect of WBE on postural control and quality of life

BCS (balance and posture), PDQ-8 (quality of life), UPDRS-III (motor symptoms)

NR

NR

NR

NR

NR

E = WBE (aquatic exercise)

NR

NR

Significant improvements in the psychological factor (p = 0.015), UPDRS-III (p = 0.025) and postural stability (BCS) (p < 0.024)

Sage et al. [31]

To evaluate the effectiveness of four exercise interventions on motor symptoms of PD

UPDRS-III (motor symptoms)

On

E 1 = 12(M)

E 1 = 63.1 ± 9.2

NR

E 1 = 7.7 ± 6.4

E 1 = WBE (aquatic exercise)

E 1 = 0

90 %

E 1 = UPDRS-III did not improve significantly (p > 0.05)

E 2 = 17

E 2 = 65.8 ± 9.9

E 2 = 3.8 ± 3.9

E 2 = LBE (aerobic intervention)

E 2 = 0

E 2 = UPDRS-III did not improve significantly (p > 0.05)

E 3 = 18

E 3 = 68.7 ± 8.3

E 3 = 5.7 ± 4.0

E 3 = LBE (strength training)

E 3 = 0

E 3 = UPDRS-III improved significantly (p < 0.004)

E 4 = 24

E 4 = 68.0 ± 11.0

E 4 = 5.1 ± 4.5

E 4 = LBE (sensory attention-focused exercise)

E 4 = 0

E 4 = UPDRS-III improved significantly (p<0.001)

C = 18

C = 68.6 ± 8.1

C = 3.2 ± 2.8

C = nonexercise

C = 0

 

Ayán and Cancela [2]

To evaluate the feasibility and efficacy of WBE on PD

SFT (fitness), PDQ-39 (quality of life), UPDRS-III (motor symptoms), UPDRS-I (mental status), UPDRS-II (activities of daily living), and BI (autonomy)

On

E = 13

65.3 ± 9.6

1–3

5.8 ± 3.9

E = WBE (aquatic exercise)

E = 3

≥80 %

Significant improvements in PDQ-39 (parts I and II) (p ≤ 0.05), UPDRS-II (p ≤ 0.05), BI (p ≤ 0.01), SFT flexibility (p ≤ 0.05), and SFT aerobic (p ≤ 0.01).

Ayán and Cancela [1]

To compare the effects of 2 different WBE on PD symptoms

FTSTS (functional mobility), UPDRS-III (motor symptoms) and PDQ-39 (quality of life)

On

E 1 = 11

E 1 = 68.9 ± 9.6

E 1= 2.4 ± 0.7

E 1= 6.1 ± 3.1

E 1 = WBE (low-intensity water exercise)

E 1 = 1

80–85 %

Significant improvements in UPDRS-III (p = 0.006), PDQ-39 (p = 0.001) and FTSTS (p = 0.001)

E 2 = 10

E 2 = 71.9 ± 5.1

E 2= 2.0 ± 0.7

E 2= 7.5 ± 5.5

E 2 = WBE (muscular resistance water exercise)

E 2 = 0

Kargarfard et al. [20]

To survey the effects of WBE on balance

BBS (balance)

On

E = 10(W)

E = 87.6 ± 1.4

NR

NR

E = WBE (aquatic exercise)

E = 0

NR

Significant improvements in BBS (p ≤ 0.05)

C = 10(W)

Ca = 60.8 ± 5.5

C = Maintain their current lifestyle

C = 0

Kawasaki [21]

To explain the effects of WBE on balance improvement and to discuss the differences with home-based land exercise

BBS (balance), BBT (balance), STS (balance) and ABCS (balance)

NR

E = 15

NR

NR

NR

E = WBE (therapeutic exercise)

E = 0

NR

Significant improvements in STS (p < 0.05) and BBT (p < 0.05)

Ca = 15

Ca = LBE (similar exercises at home)

Ca = 0

Vivas et al. [38]

To compare 2 different protocols of physiotherapy (WBE, LBE) on postural stability and self-movement

FRT (flexibility), BBS (balance), gait (balance) TUG (postural stability) and UPDRS (PD Disability Scale)

Off

E = 6

E = 65.6 ± 3.6

E = 2.67 ± 0.5

E = 4.17 ± 1.6

E = WBE (water-based therapy)

E = 1

NR

Significant improvements in BBS (p = 0.010) and UPDRS (p = 0.036)

Ca = 6

Ca = 68.3 ± 6.9

Ca = 2.40 ± 0.5

Ca = 7.83 ± 3.9

Ca = LBE (land-based therapy)

Ca = 0

Jung et al. [18]

To investigate the effects of WBE on various balance outcomes

ABCS (balance), BBS (balance), postural sway (balance) and STS (balance)

NR

E = 12

NR

NR

NR

E = WBE (therapeutic exercise program)

E = 3

NR

Significant improvements in STS (p < 0.039)

Ca = 12

Ca = LBE (similar exercises at home)

Ca = 6

  1. ABCS Activities Specific Balance Confidence Scale, ADL activities of daily living, AMQZ Adjective Mood Questionnaire of Zeersen, BI Barthel index, BBS Berg Balance Score, BBT Biodex Balance Test, BCS Balance Control System, BMT Basic Motor Test, C control group, Ca active control group, CURS Columbia University Rating Scale, DBP diastolic blood pressure, E experimental group, FRT Functional Reach Test, FTSTS Five Times Sit-to-Stand, HBE home-based exercise, HR heart rate, H&Y Hoehn and Yahr scale, LBE land-based exercise, M men, MMSE Mini-Mental State Examination, NR not reported, On presence of the effect of medication, Off no presence of the effect of medication, PD Parkinson’s disease, RPP rate × pressure product, SaPDDS Self-Assessment Parkinson’s Disease Disability Scale, SBP systolic blood pressure, SIP Sickness Impact Profile, SFT Senior Fitness Test, STS Sit to Stand, TUG Timed Up and Go, UPDRS Unified Parkinson’s Disease Rating Scale, UPDRS-I mental status of Unified Parkinson’s Disease Rating Scale, UPDRS-II activities of daily living of Unified Parkinson’s Disease Rating Scale, UPDRS-III motor symptoms of Unified Parkinson’s Disease Rating Scale, VPS Vitality Plus Scale, W women, WBE Water-Based Exercise training, PDQ-39 39-item Parkinson’s Disease Questionnaire, PDQ-8 eight-item Parkinson’s Disease Questionnaire