Table 3 Studies and interventions (including assessments, results and limitations found in each study for clinicians and researchers)

Silva et al., 2018 [31]

To investigate the effects of two water programs on functional capacity and quality of life of elderly women.

Forty-one elderly female (65 ± 4 years) were divided into aerobic training group (n = 13), combined training (n = 11) and CG (n = 9).

Depth: Between the xiphoid process and shoulders.

Tª: 33 °C

Strength: 30-s chair-stand.

The 30-s chair-stand test resulted in an increase of 32 ± 11%, 24 ± 14% and 20 ± 9% for AG1 (I), AG (II) and CG, respectively.

The absence of a water-based resistance training group to compare the adaptation with water-based groups. The lack of control of the exercise program intensity and the frequency of elderly women in CG.

Specific intensity control

W

F

D

Maximum effort

1–6 sets of 30″-5′/30″-2′ rest; AT: 85–110%

12

2

N/A

Reichert et al., 2018 [16]

To compare the effects of 1 × 30″, 3 × 10″, and 1 × 10″ water resistance training on muscle strength and functional capacity in older women.

Thirty-six healthy women (60–75 years) AG (I): n = 12, AG (II): n = 13 and AG (III): n = 11 were divided into three different aquatic training.

Depth: Between the xiphoid process and shoulders.

Tª: 31 °C

Strength: Maximal dynamic strength (1-RM)

Muscular endurance with a load of 60%RM.

The main finding was that the three groups strategies performed twice a week induced similar relevant improvements in maximal strength, muscular endurance, and functional capacity. However, only the AG (I) 1 × 30s and the AG (II) 1 × 10s showed increased maximal strength in the bench press exercise.

The absence of an evaluation of the explosive strength, which is also important for the elderly population, as it is related to the capacity to perform daily life activities and risk of falls.

Specific intensity control

W

F

D

RPE: 19

12

2

N/A

Maximum velocity

1–3 sets of 30″/ 2′ rest.

Seyedjafari et al., 2017 [32]

To investigate the effect of deep aquatic exercises on lower body strength and balance

Thirty elderly men over 65 were divided into AG (n = 15) and CG (n = 15).

Depth: Over 2 m.

Tª:

Does not appear.

Balance: Biodex Balance System.

Strength:

Hand-Held Dynamometer

All variables including lower body strength, static balance was significantly improved (p < 0.001) in experimental group after aquatic exercises program.

The method of participant selection was by volunteer and therefore subjects were not randomly selected. This could affect the generalizability of the outcomes.

Specific intensity control

W

F

D

Not included

8

3

60’

Bento et al., 2015 [34]

To evaluate the effects of a water-based exercise program on static and dynamic balance.

Sixty-five independent participants (over 60 years old) were divided in AG (n = 20) and CG (n = 16).

Depth: Xiphoid process.

Tª:

28–30 °C.

Balance: Displacement of the center of pressure in a quiet standing position and 8-Foot Up-and Go.

No differences were found in the center of pressure variables; however, the AG group showed better performance in the 8 Foot Up-and-Go Test after training (5.61–0.76 vs. 5.18–0.42; p < 0.01).

The physical conditioning of the participants at baseline revealed a good status, which may have reduced the magnitude of the training effects.

Specific intensity control

W

F

D

RPE: 12–16

12

3

N/A

HRR: 40 to 60%

3 sets × 40″ / 20″ rest

Kim y O’Sullivan, 2013 [28]

To examine the effects of aquatic exercise on biomechanical and physiological elements influencing gait.

Healthy women (70–78 years) bone mineral density score up −1.

AG: n = 8

CG: n = 7

Depth: Between waist and chest.

Tª:

28 ± 1 °C.

Balance: Gait observations, kinematics at 60 Hz were recorded by 8 cameras, and kinetics on by 2 force platforms.

Strength:

30″ chair stand, arm curl.

Flexibility: Chair sit-and-reach

Back scratch

AG obtain reductions (p < 0.05) in body weight, and body fat mass, and stride time. Significant increases (p > 0.05) in leg strength corresponded to the maximum joint moment of the landing leg, getting better the ability for recovery of balance after any perturbation.

High dropout rate. The evaluation of the balance is not clear and the study does not indicate clearly the load magnitude of training in AG.

Large sample difference between intervention group and control group.

Specific intensity control

W

F

D

RPE: 7–11

12

3

60’

Sanders, Takeshima, Rogers, Colado y Borreani, 2013 [36]

To evaluate the aquatic environment in the improvement of the ADL in women over 60 years.

Women (60–89 years), sedentary, independent and confirmed by a physician their healthy situation.

AG: n = 48

CG: n = 18

Depth: Xiphoid process.

Tª:

28–29 °C.

Balance: One leg with eyes open and maintain balance while they walk in a circle.

Strength: Sit-to- stand and arm curl.

Flexibility: Sit-and-reach

AG obtained improvements with respect to CG in balance, flexibility, strength and agility (p < 0.05).

Long difference in sample size between intervention group and control group. Short duration of intervention and important difference of age between participants. Absence of specificity of training load. The type of exercise in the AG is not specified.

Specific intensity control

W

F

D

Progressive to Moderate;

16

3

25–45’

2 sets × 10 rep. /15″ rest.

Bergamin et al., 2013 [30]

To evaluate the effects of aquatic exercise on the strength and functionality of the elderly.

Healthy elderly (70–76 years) were divided into aquatic group (n = 17), land group (n = 17) and control group (n = 19)

Depth: 1.30–1.80 m.

Tª: 36 °C.

Balance: 8-ft up-and go

Strength: Dynamometry for hand-grip and isometric knee flexion-extension

Flexibility: Back-scratch test and sit-and-reach.

It has found significant improvement (p < 0.05) in flexibility, mobility and balance, obtaining AG a greater improvement dynamic balance a loss weight (P < 0.05)

Low sample size. Lack of specificity of the height of the water during the development of exercises.

Specific intensity control

W

F

D

RPE: 13–16

6

2

60’

HRmáx: 55–65%

3 sets × 1′ / 30″ rest

Elbar et al., 2013 [33]

To evaluate a perturbation programme of balance targeted compensatory and voluntary stepping to improve speed of stepping.

34 healthy volunteers (64–88 years) was divided in two groups n = 17, respectively.

Depth: Xiphoid process.

Tª: Does not appear.

Balance: Fall Efficacy Scale.

Folstein Mini-Mental State Examination.

Voluntary Step Execution Test Stabilogram-Diffusion Alysis.

Berg Balance Scale.

Get-up-and-go.

A significant interaction effect between group and time was found for the step execution, due to improvement in initiation phase and swing phase durations in the AG. Also, significant improvement in postural stability in eyes open and closed conditions is noted.

No benefits for performance aspects of balance control. Although this lack of improvement could be due to ceiling effects, it may reflect the specificity of training principle and the need for therapists to tailor balance training programs to target specific aspects.

Specific intensity control

W

F

D

Progressive levels of balance intensity

12

2

40’

Javaheri, Rahimi, Rashidlamir y Alikhajeh, 2012 [24]

To compare aquatic and terrestrial environment in the improvement of the static and dynamic balance for elderly.

Thirty older adults (63–70 years); independents in the daily activities was divided in two groups (n = 15)

Depth: Between waist and chest.

Tª: 33 °C.

Balance: Sharpened Romberg (open eyes and closed eyes) and Timed up & Go.

After the intervention, improvements were found in AG and LG in balance (p < 0.05). It was not found differences between groups AG and LG (p > 0.05).

Low sample size and only male.

Absence of specificity in both groups.

Specific intensity control

W

F

D

Progressive levels of balance intensity

1 set × 15 rep.

6

2

N/A

Alikhajeh, Moghaddam & Moghaddam, 2012 [35]

To evaluate the effect of hydrotherapy on the static and dynamic balance.

Twenty-eight healthy sedentary elderly men (64–79 years; 14 in the experimental group and 14 in the CG).

Depth: Xiphoid process.

Tª:

28–29 ° C.

Balance: Sharpened Romberg test and Timed Up & Go.

AG obtained improvements with respect to CG in balance, flexibility, strength and agility (p < 0.05).

Low sample size, short duration of intervention and important difference of age between participants. Absence of specificity of training load. The type of exercise in the AG is not specified.

Specific intensity control

W

F

D

Progressive to Moderate;

2 set × 10 rep. / 1′ rest

8

2

60’

Bento, Gleber Pereira y Rodacki, 2012 [29]

To analyze the effects of aquatic exercise on improving LL strength and older functionality.

Elderly (60–75 years) able to walk and perform their daily tasks independently.

AG: n = 24

CG: n = 14

Depth: Xiphoid process.

Tª: 28–30 °C.

Balance: 8-ft up-and go

Strength: 30″ chair-stand test.

MVIC: peak torque and rate of torque development tests

Flexibility: Sit-and-reach

AG obtained improvement in strength of UL (p < 0.05) and functionality (p < 0.05).

Importance difference between intervention group and control group. Absence of specificity of training load.

Specific intensity control

W

F

D

HRmáx: 40–60%

RPE: 12–16

40″ moderate speed / rest 20”

12

3

60

Walia y Shefali, 2012 [28]

Comparing aquatic and land exercise in the improvement of balance in elderly.

Healthy asymptomatic elderly (65–71 years) who were divided in a land group (n = 30) and an aquatic group (n = 30).

Depth: Between waist and chest.

Tª: 35° ± 2 ° C.

Balance: Sharpened Romberg (open eyes and closed eyes) and Timed up & Go.

After the intervention, improvements were found in AG and LG in balance (p < 0.05). It was not found differences between groups AG and LG (p > 0.05).

Small sample size and shorter duration are the major limitations of the study. Lack of information about the periodization of the intervention in AG. Absence of specificity of training load.

Specific intensity control

W

F

D

Not included

2

5

60’

Katsura et al., 2010 [27]

To assess the efficacy of aquatic exercise in older adults using resistance material.

Twenty healthy elderly individuals (68–75 years) who did not exercise regularly. A resistance equipment group (n = 12) and a non-resistance equipment group (n = 8).

Depth: Does not appear.

Tª: 30–32 °C

Balance: Timed Up & Go

Strength: Hand held dynamometer

Flexibility: Sit and reach

AG (I) and AG (II): improvements (p < 0.05) in flexibility, strength (plantar flexion) and in static equilibrium. AG (I) obtained greater improvements (p < 0.05) than GA (II).

Low sample size.

Under sample size and long duration of the training programme. Too much gender difference in the sample (women 16, men 4). Absence of control group. Absence of load magnitude for the intervention group.

Specific intensity control

W

F

D

RPE: Moderately strong

8

3

90’

Tsourlou, Benik, Konstantina, Dipla y Kellis, 2006 [25]

To determine the effectiveness of an aquatic training programme in healthy women over age 60.

Twenty two healthy elderly (60–75 years; AG: n = 12; CG: n = 10) without any medical contradiction.

Depth: From the xiphoid process to the axillary region.

Tª: 30 °C.

Balance: Timed Up & Go

Strength: Isometric test of knee’s flexo-extension; Isometric wrist grip. 3 RM in machine for UL and DL.

Flexibility: Sit and reach.

AG obtained improvement in pre/post-test in balance, strength and flexibility (p < 0.0125). AG obtained improvement (p < 0.0125) with respect to CG in strength and balance.

Low sample size.

Specific intensity control

W

F

D

EV, MA, Rhythm of movement. ± 60 b / min

2–3 set × 12–15 rep./20–30″ rest

24

3

60