Systematic review of published studies on aquatic exercise for balance in patients with multiple sclerosis, Parkinson's disease, and hemiplegia.

The review included only English-language publications, which may have missed relevant studies and may overestimate benefits. Only eight studies and 221 participants were available, and most samples were small, so the review cannot provide a precise overall effect. The studies used different populations, aquatic programmes, and balance tests, so results could not be combined into one overall effect. Methodological quality was variable and generally fair; none of the studies used concealed randomization, and blinding was limited. Only one study reported a power calculation, so many studies were likely underpowered. No study had long-term follow-up, so durability of balance gains is unknown. Stroke participants were at least 6 months after stroke and could walk at least 15 m, so findings may not apply to acute or non-ambulatory stroke patients. Adverse events were not reported in most studies, so safety is not well described. The included patients were selected and not representative of the broader neurological population.

No funding was received, and all authors declared no conflicts of interest.

Do not conclude that aquatic exercise is clearly better than land-based exercise for every neurological patient. The review found short-term balance benefits mainly in multiple sclerosis and stroke, could not draw conclusions for Parkinson's disease, and the included studies were small, heterogeneous, and methodologically weak.