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Scoping review: how do the properties of heated water influence the prescription of aquatic physical exercises to develop motor skills in people with Parkinson’s disease?
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Federal University of Paraná, Curitiba, Brazil
Submission date: 2020-10-26
Acceptance date: 2021-10-09
Publication date: 2022-04-25
Hum Mov. 2023;24(1):56-66
Aquatic intervention seems to influence the motor skills of people with Parkinson’s disease (PD). However, little is known about the transference of these motor skills to the land environment, as well as the use of the therapeutic properties of water. The study aim was to identify the aquatic intervention strategies considering the properties of water for the development of motor skills in PD.

With the PRISMA and Cochrane checklist, a systematic review was conducted involving 7 databases with randomized and nonrandomized studies from 2010 to July 2020. The prescription and description of aquatic physical exercise data were extracted and summarized, and the use of physical and thermal properties of heated water was analysed.

Overall, 13 studies involving 307 participants (Hoehn and Yahr scale 1–4) met the inclusion criteria. In accordance with the Jadad scale, 7 studies were classified as low-quality (score 0–2), whereas 6 were categorized as high-quality (score 3). All the selected studies concentrated on aquatic physical exercise programs developed by the researchers who focused on transferring motor skills – such as mobility and functional reach, balance, motor aspects, activities of daily living, quality of life, and gait – to the land environment.

Aquatic intervention strategies can be adequately prescribed as beneficial to motor skill training in PD. The analysis of the physical and thermal properties of heated water is useful to systematize prescription parameters depending on the characteristics of the PD patient and the heated aquatic environment.

Schaefer SY, Louder TJ, Foster S, Bressel E. Effect of water immersion on dual-task performance: implications for aquatic therapy. Physiother Res Int. 2016;21(3):147–154; doi: 10.1002/pri.1628.
Iucksch DD, Araujo LB, Novakoski KRM, Yamaguchi B, Carneiro CF, Mélo TR, et al. Decoding the aquatic motor behavior: description and reflection on the functional movement. Acta Sci. 2020;42:e47129; doi: 10.4025/actascihealthsci.v42i1.47129.
Da Silva AZ, Israel VL. Effects of dual-task aquatic exercises on functional mobility, balance and gait of individuals with Parkinson’s disease: a randomized clinical trial with a 3-month follow-up. Complement Ther Med. 2019;42:119–124; doi: 10.1016/j.ctim.2018.10.023.
De Assis GG, da Silva TA, Dantas PMS. Dual-task exercise as a therapy for executive motor function in Parkinson’s disease. Hum Mov. 2018;19(1):57–63; doi: 10.5114/hm.2018.73613.
Israel VL, Pardo MBL. Hydrotherapy: application of an Aquatic Functional Assessment Scale (AFAS) in aquatic motor skills learning. Am Int J Contemp Res. 2014;4(2):42–52.
Marinelli L, Quartarone A, Hallett M, Frazzitta G, Ghilardi MF. The many facets of motor learning and their relevance for Parkinson’s disease. Clin Neurophysiol. 2017;128(7):1127–1141; doi: 10.1016/j.clinph.2017.03.042.
Pereira D, Garrett C. Risk factors for Parkinson disease: an epidemiologic study [in Portuguese]. Acta Med Port. 2010;23(1):15–24.
Andrade AO, Machado ARP, de Morais CR, Campos M, Naves KFP, Pessôa BL, et al. Motor signs and symptoms of Parkinson’s disease: characterization, treatment and quantification [in Portuguese]. In: Leite CRM; Rosa SSR F (eds.), New technologies applied to health: integrating areas to transform society [in Portuguese]. Mossoró: EDUERN; 2017; 195–227.
Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol. 2013;12(7):716–726; doi: 10.1016/S1474-4422(13)70123-6.
Araujo LB, Moreira NB, Villegas ILP, Loureiro APC, Israel VL, Gato SA, et al. Investigating information regarding functional capacity and quality of life in institutionalized elderly according to the ICF. Acta Fisiatr. 2015;22(3):111–117; doi: 10.5935/0104-7795.20150022.
Vojciechowski AS, Zotz TGG, Loureiro APC, Israel VL. The International Classification of Functioning, Disability and Health as applied to Parkinson’s disease: a literature review. Adv Parkinson Dis. 2016;5:29–40; doi: 10.4236/apd.2016.52005.
Yamaguchi B, Ferreira M, Israel VL. Aquatic physiotherapy and Parkinson’s disease: effects on functional motor skills. Adv Parkinson Dis. 2020;9:1–12; doi: 10.4236/apd.2020.91001.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097; doi: 10.1371/journal.pmed.1000097.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. (eds.). Cochrane handbook for systematic reviews of interventions, 2nd ed. Chichester: John Wiley & Sons; 2019.
Bento T. Guidelines for planning, conducting, reporting and evaluating systematic reviews in sport and health [in Portuguese]. Motricidade. 2014;10(2):107–123; doi: 10.6063/motricidade.10(2).3699.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12; doi: 10.1016/0197-2456(95)00134-4.
Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, et al. The Delphi list: a criteria list for quality assessment of randomized clinical for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51(12):1235–1241; doi: 10.1016/s0895-4356(98)00131-0.
Ayán C, Cancela JM. Effects of aquatic exercise on persons with Parkinson’s disease: a preliminary study. Sci Sports. 2012;27(5):300–304; doi: 10.1016/j.scispo.2011.12.006.
Ayán C, Cancela JM. Feasibility of 2 different waterbased exercise training programs in patients with Parkinson’s disease: a pilot study. Arch Phys Med Rehabil. 2012;93(10):1709–1714; doi: 10.1016/j.apmr.2012.03.029.
Clerici I, Maestri R, Bonetti F, Ortelli P, Volpe D, Ferrazzoli D, et al. Land plus aquatic therapy versus landbased rehabilitation alone for the treatment of freezing of gait in Parkinson disease: a randomized controlled trial. Phys Ther. 2019;99(5):591–600; doi: 10.1093/ptj/pzz003.
Crizzle AM, Newhouse IJ. Themes associated with exercise adherence in persons with Parkinson’s disease: a qualitative study. Occup Ther Health Care. 2012;26(2–3):174–186; doi: 10.3109/07380577.2012.692174.
Da Silva DM, Nunes MCO, Oliveira PJAL, Coriolano MGWS, Berenguer FA, Lins OG, et al. Effects of aquatic physiotherapy on life quality on subjects with Parkinson disease. Fisioter Pesq. 2013;20(1):17–23; doi: 10.1590/S1809-29502013000100004.
Tonial LP, Mocelin TK, Silva AZ, Yamaguchi B, Israel VL. Effects of aquatic physical exercises on the flexibility and functional reach of individuals with Parkinson’s disease [in Portuguese]. Rev Bras Cienc Mov. 2019;27(4):13–19; doi: 10.31501/rbcm.v27i4.10092.
Vivas J, Arias P, Cudeiro J. Aquatic therapy versus conventional land-based therapy for Parkinson’s disease: an open-label pilot study. Arch Phys Med Rehabil. 2011;92(8):1202–1210; doi: 10.1016/j.apmr.2011.03.017.
Carroll LM, Volpe D, Morris ME, Saunders J, Clifford AM. Aquatic exercise therapy for people with Parkinson disease: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(4):631–638; doi: 10.1016/j.apmr.2016.12.006.
Kurt EE, Büyükturan B, Büyükturan Ö, Erdem HR, Tuncay F. Effects of Ai Chi on balance, quality of life, functional mobility, and motor impairment in patients with Parkinson’s disease. Disabil Rehabil. 2018;40(7):791–797; doi: 10.1080/09638288.2016.1276972.
Palamara G, Gotti F, Maestri R, Bera R, Gargantini R, Bossio F, et al. Land plus aquatic therapy versus landbased rehabilitation alone for the treatment of balance dysfunction in Parkinson disease: a randomized controlled study with 6-month follow-up. Arch Phys Med. Rehabil. 2017;98(6):1077–1085; doi: 10.1016/j.apmr.2017.01.025.
Pérez-de la Cruz S. A bicentric controlled study on the effects of aquatic Ai Chi in Parkinson disease. Complement Ther Med. 2018;36:147–153; doi: 10.1016/j.ctim.2017.12.001.
Zhu Z, Yin M, Cui L, Zhang Y, Hou W, Li Y, et al. Aquatic obstacle training improves freezing of gait in Parkinson’s disease patients: a randomized controlled trial. Clin Rehabil. 2018;32(1):29–36; doi: 10.1177/0269215517715763.
Cunha MCB, Alonso AC, e Silva TM, de Raphael ACB, Mota CF. Ai Chi: aquatic relaxing effects on functional performance and quality of life in elderly [in Portuguese]. Fisioter Mov. 2010;23(3):409–417; doi: 10.1590/S0103-51502010000300008.
Pérez-de la Cruz S, Luengo AVG, Lambeck J. Effects of an Ai Chi fall prevention programme for patients with Parkinson’s disease. Neurologia. 2016;31(3):176–182; doi: 10.1016/j.nrleng.2015.05.006.
Kruel LFM, Peyré-Tartaruga LA, Coertjens M, Dias ABC, Da Silva RC, Rangel ACB. Using heart rate to prescribe physical exercise during head-out water immersion. J Strength Cond Res. 2014;28(1):281–289; doi: 10.1519/jsc.0b013e318295d534.
Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R. 2009;1(9):859–872; doi: 10.1016/j.pmrj.2009.05.017.
Van Uem JMT, Marinus J, Canning C, van Lummel R, Dodel R, Liepelt-Scarfone I, et al. Health-related quality of life in patients with Parkinson’s disease – a systematic review based on the ICF model. Neurosci Biobehav Rev. 2016;61:26–34; doi: 10.1016/j.neubiorev.2015.11.014.
Siega J, Iucksch DD, Alves MAR, Heeren CES, Israel VL. Elderly practitioners of water exercises: a biopsychosocial view with international classification of functionality (ICF) [in Portuguese]. R Bras Qual Vida. 2020;12(2):e10989; doi: 10.3895/rbqv.v12n2.10989.
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