Water-Based Exercises for Improving Activities of Daily Living After Stroke
Many people who have had a stroke have limited activities of daily living and reducing disability is 1 of the main goals of rehabilitation. There are many different rehabilitation approaches to improving activities after stroke. One example is water-based exercises. Water-based exercises might have the potential to improve activities of daily living and might also improve impaired cardiovascular fitness in people who have had a stroke. However, no systematic evaluation of the effectiveness of water-based exercises for people after stroke currently exists. Therefore, the rationale for this systematic review of randomized controlled trials was to evaluate the effects of water-based exercises to improve activities of daily living, ability to walk, muscle strength, postural balance, and fitness after stroke.
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 In an effort to identify further published, unpublished, and ongoing trials, we hand-searched relevant journals and conference proceedings, searched trials and research registers, checked reference lists, and contacted authors. We included studies using random assignment. Two review authors independently selected trials for inclusion, assessed trial quality, and extracted the data. The primary outcome was activities of daily living.
We included 4 trials involving 94 participants in this review. There was a significant improvement in activity of daily living (mean difference 13.20 points on the “Capacidad funcional” [functional capacity] subscale of the Brazilian-Portuguese version of the SF-36; 95% CI, 8.36 to 18.04; P<0.00001) and on muscle strength (mean difference 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 (mean difference 0.14 m/s; 95% CI, −0.32 to 0.606; P=0.55), postural balance (mean difference 3.05 points; 95% CI, −3.41 to 9.52; P=0.35), or fitness (mean difference 3.6 [maximal oxygen consumption]; 95% CI, −0.53 to 7.73; P=0.09) after water-based exercise treatment compared with controls. Adverse effects were not reported.
We conclude that the evidence from randomized controlled trials so far does not confirm or refute that water-based exercises after stroke might help to improve activities of daily living after stroke. There is a lack of hard evidence for water-based exercises after stroke. Better and larger studies are therefore required.
Note: The full text of this review is available in the Cochrane Library (for subscribers http://dx.doi.org/10.1002/14651858.CD008186). The full article should be cited as: Mehrholz J, Kugler J, Pohl M. Water-based exercises for improving activities of daily living after stroke. Cochrane Database Syst Rev. 2011. Issue 1.
- Received January 3, 2011.
- Accepted January 20, 2011.
- © 2011 American Heart Association, Inc.