The Effectiveness of Aquatic Exercise on Improving Fatigue and Quality of Life in Individuals with Multiple Sclerosis: A Meta-Analysis

Abstract

Background/Purpose: Individuals with multiple sclerosis (MS) require long-term treatment and health care management, dealing with fatigue and decreased quality of life. Aquatic exercise could be a long-term intervention for this population. The aim of this meta-analysis is to evaluate the effectiveness of aquatic exercises on fatigue and quality of life in individuals with MS who present with mild to moderate symptoms. Methods: Articles were accessed by searching across PubMed Central, CINHAL, Cochrane Library, and PEDro, using the terms “multiple sclerosis” and one of the following: “aquatic therapy,” “hydrotherapy,” “aquatic exercises,” or “water exercises.” The meta-analysis was performed comparing mean differences in fatigue (physical, cognitive, and psychosocial) and quality of life (physical and mental) using within-group differences at pre- and post-intervention and between-group differences of the aquatic exercise and control groups. Results: Five studies with a total of 115 patients with MS were included in the analysis. Aquatic exercise resulted in decreased physical (−8.98, I 2 = 62.59%, P = .0001), cognitive (−2.23, I 2 = 0, P < .0001), and psychosocial (−7.00, I 2 = 0, P < .0001) fatigue compared with the control groups. Studies on physical fatigue reported a high heterogeneity, while studies on cognitive and psychosocial fatigue had no heterogeneity. Aquatic exercise improved both physical (10.63, I 2 = 69.74%, P = .048) and mental (12.53, I 2 = 64.25%, P = .052) quality of life; however, both reported high heterogeneity. Discussion/Conclusions: The findings suggest that aquatic exercise programs are effective in reducing fatigue and improving quality of life among individuals with mild to moderate MS. Therefore, aquatic exercises can be another method in the continuum of care for individuals with MS in a home or community environment.