Clinician Article

The effect of aquatic exercise on physical functioning in the older adult: a systematic review with meta-analysis.

  • Waller B
  • Ogonowska-Slodownik A
  • Vitor M
  • Rodionova K
  • Lambeck J
  • Heinonen A, et al.
Age Ageing. 2016 Sep;45(5):593-601. doi: 10.1093/ageing/afw102. Epub 2016 Jul 4. (Review)
PMID: 27496935
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  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 4/7
  • Geriatrics
    Relevance - 6/7
    Newsworthiness - 4/7
  • Public Health
    Relevance - 4/7
    Newsworthiness - 4/7


BACKGROUND: ageing and sedentary behaviour cause negative changes in the neuromuscular systems of healthy older adults resulting in a decrease in physical functioning. Exercising in water (aquatic exercise, AE) has been shown to be effective at improving physical functioning in this population; however, no systematic review with meta-analysis has been published.

PURPOSE: to investigate the effect of AE on physical functioning in healthy older adults compared to control or land-based exercise (LE) through a systematic review with meta-analysis of randomised controlled trials.

DATA SOURCES: Medline, Embase, Cinahl, PEDro, SPORTDiscus, Web of Science, Cochrane Library, published before 31st December 2015.

STUDY SELECTION: in total, 28 studies met the inclusion criteria and were included in the systematic review; 24 studies with 1,456 subjects (89% female) and with mean age 66.4 years were included in the meta-analysis.

DATA EXTRACTION: data were extracted and checked for accuracy by three independent reviewers.

DATA SYNTHESIS: size of treatment effect was measured using the standardised mean difference with 95% confidence intervals (CIs).

RESULTS: compared to control interventions, AE had a moderate positive effect on physical functioning 0.70 [95% CI 0.48 to 0.92]. Compared to LE, AE had a small positive effect on physical functioning 0.39 [0.12 to 0.66].

LIMITATIONS: there is a high risk of bias and low methodological quality in the studies particularly when comparing AE to LE with possible over estimation of the benefit of AE.

CONCLUSIONS: AE may improve physical functioning in healthy older people and is at least as effective as LE.

Clinical Comments

Family Medicine (FM)/General Practice (GP)

This is a simple, low tech intervention which would be easy to implement.


This is another Standard Review with MA and good Quality. It does find though that not enough high quality studies exist for AE. Yet, the effect as compared to medium quality land-based exercises still seems higher which would qualify for at least comparable efficacy. It's good to know; although, most might already know this...


There is a lot of emphasis on weight-bearing exercise due to it's supposedly beneficial effect on bones. Swimming is favored by some elderly over land-based exercise and to know that it offers benefits in and of itself will enable more enthusiastic endorsement from practitioners. The best exercise is still the one you do and being able to swim and derive benefit will broaden the appeal of exercise in the elderly.

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