DALLAS – Aquatic exercise can be beneficial for individuals with multiple sclerosis, and it can be considered as an adjunct to other therapies, according to a systematic review and a small randomized, controlled trial presented by the same group at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.
In the systematic review, all 11 studies had positive outcomes in patients with multiple sclerosis (MS), and none identified any exacerbation or adverse changes in neurologic status, reported Yasser Salem, Ph.D., of the University of North Texas Health Science Center’s Physical Therapy Program, Fort Worth.
Dr. Yasser Salem
Dr. Salem and his colleagues also conducted a single-blind randomized, controlled trial of 20 patients and found better overall scores in all outcome measures in individuals with MS who received aquatic therapy, compared with those who didn’t.
Aquatic therapy has started receiving attention in recent years and is "now recommended by many physicians, therapists, and the National Multiple Sclerosis Society [NMSS] as an adjunct treatment for individuals with multiple sclerosis," Dr. Salem said in an interview.
The therapy uses the unique aspects and natural properties of water and is generally a well-tolerated form of exercise, Dr. Salem said. "There is no specific contraindication to aquatic therapy other than general contraindications associated with exercise and immersion in water such as fever and severe cardiac diseases," he said.
For their systematic review, Dr. Salem and his colleagues analyzed 11 studies that totaled 141 participants with MS. They said this is the first time such a systematic review has been done.
Of the 11 studies, 3 were randomized, controlled trials; 5 had a single-subject design; and 3 were case studies. The length of treatment ranged from 5 to 12 weeks, and the frequency ranged from 1 to 3 times per week. Most studies didn’t report the duration of the workout sessions, but the longest duration was 1 hour. The exercises included stretching, strength training, aerobics, endurance, balance, and general exercises.
All studies indicated that individuals with MS benefited from aquatic therapy, including increases in mobility and muscle strength, improved quality of life, cardiovascular fitness, and grip strength.
"There is a need for more studies with longer-term follow-up to determine if any gains are retained" on a long-term basis, Dr. Salem and his associates wrote in their unpublished study, which was presented as a poster.
Their single-blind randomized, controlled trial included 20 people with chronic MS, and examined the effects of a 10-week aquatic training program on mobility function, strength, fatigue, and quality of life.
Ten participants were in the exercise group and 10 in the control group. The training included strength, balance, walking, and aerobic training, originally designed by the NMSS and implemented at several local community settings sponsored by the local chapter of NMSS, according to the authors.
Participants were assessed 1 week before and after the training by a blinded investigator. Primary outcomes included a self-paced 10-m walk test, timed Up & Go (TUG) test, Berg Balance Scale, grip strength measured by a hand-held dynamometer, Modified Fatigue Impact Scale, Quality of Life using the MS Quality of Life 54 test (MSQOL-54), and a survey and interview.
The average attendance at the training sessions was 78%. No MS-related exacerbations were reported. "Participants reported better overall scores in all outcome measures, compared with participants in the control group," the authors wrote in the poster. The majority were also extremely satisfied with the program.
Currently, there’s not enough evidence to show whether aquatic therapy is superior to land therapy or whether it can substitute for land therapy. But Dr. Salem said that based on the current literature, it can be an adjunct to other forms of therapy. "When properly performed, aquatic therapy is a gentle and invigorating exercise with little or no adverse effects," he said.
Dr. Salem highly recommends the American Physical Therapy Association’s (APTA’s) Aquatic Physical Therapy Section website, aquaticpt.org, and its "Find an Aquatic PT Clinic" feature to search for places that offer aquatic therapy in your state.
In addition, some local support groups offer free aquatic classes for people with MS. For example, some local offices of the NMSS sponsor aquatic exercise programs designed for individuals with MS. An MS Navigator, available at 1-800-344-4867, can be used to find out if other resources are available in your area.
Dr. Salem reported having no financial disclosures.
On Twitter @naseemmiller